Consultancy Corner: Preeclampsia can be slow, sudden or severe, or entirely preventable

"Concerned for her health, her husband rushed her to the hospital. A battery of tests followed and the Doctor, who confirmed a suspicion of preeclampsia ordered her to bed rest for the rest of her pregnancy and prescribed antihypertensives, along with weekly check-ups to monitor her health and the health of her babies. Two weeks before her due date, the doctor made the decision to deliver the twins via C-section, for her safety and that of her babies. The twins were born healthy and only remained under observation in the hospital for a week and a half. However, the mother’s condition continued to deteriorate. Her urine output decreased, the levels of protein in her urine increased, and while her BP returned to a close-to-normal range, her left kidney began to fail. Her doctor decided to remove her kidney and continued her regimen of drugs to ensure further damage did not occur. After a few weeks, she had made almost a full recovery, and went home with her twins.” 

This case summarizes the effect that Eclampsia can have on a young family. Pregnancy though considered as a normal physiological occurrence in women, required to preserve and perpetuate humans is associated with health risks for both the mother and the unborn child. Eclampsia is one such serious medical condition that affects women during pregnancy, it occurs late in pregnancy and can cause seizures, convulsions and fatality of both mother and child. 

The clinical diagnosis of preeclampsia till recently was driven by the development of symptoms and association of risk factors. Now, however, extensive research and development in medicine has yielded several significant biomarkers to support doctors in preventing and managing pregnancy better. 

Two landmark studies have revolutionized the we diagnose and manage PE. The first is the “ASPRE” (Aspirin for Evidence-Based Preeclampsia Prevention) trial which has proved both early screening and prevention of PE is possible with advanced prenatal screening and simple intervention. 

 The early detection is done using a combination of laboratory investigations on the mother’s blood namely – PAPP A (Pregnancy associated plasma protein A) and PlGF (Placental Growth factor) with ultrasound findings of UAPI (Uterine artery Pulsatility Index) and blood pressure readings at 11-13.6 weeks of pregnancy. This can help with detection almost 85-90 % cases at a population level. 

 Clinical intervention with low-dose Aspirin (75- 150mg/day) prescribed at bedtime can prevent complications of preeclampsia in majority of the women (statistically significant reduction of 82% (PE <34 weeks) and 62% (PE <37 weeks) screened as high risk.  

The second is “PROGNOSIS” ((Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia Study) which provided evidence that simple blood tests namely SFlt1 and PlGF ratio can: