Complications of preeclampsia : A perspective from developing country

Hypertensive disorders represent most common medical complication of pregnancy affecting 7-15% of all pregnancies and quarter of antenatal admissions. According to WHO they remain the leading cause of maternal mortality. They are also associated with substantial morbidity and risk for the baby. Pre eclampsia is disease of unknown aetiology with blood pressure of 140/90mmhg, along with proteinuria after 20 weeks of pregnancy. Risk factors are Primigravida, extremes of ages, smoking, obesity, multifetal pregnancies, family history, family history of preeclampsia, etc. It is associated with problems in itself and has many life threatening complications. These complications have to be recognised well in advance and treated so that the morbidity and mortality decreases.

HELLP syndrome

It is one of the most serious haematologic complication of preeclampsia which presents with haemolytic anemia, thrombocytic anemia and elevated liver enzymes. Prevalence is 0.5-0.9% and 70% cases occur in the third trimester of pregnancy and remain till 48 hrs of delivery, some common associated factors are multiparity , increased maternal age, genetic predisposition, increase BMI, metabolic disorder, APLA syndrome. Recently seen that patients with SARS-COV2 infection have more risk of preeclampsia and HELLP. There is microangiopathic Haemolysis due to endothelial disruption with platelet adhesion and fibrin deposition and not form of DIC.

Patients are multiparous with age more than 35 years with mid gastric pain, with right upper quadrant pain, nausea, vomiting, fatigue, jaundice, headache and visual symptoms.

Lab investigation: increased LFT( Increased AST and ALT >70 IU /ml) , Increased LDH, RFT, peripheral smear: burr cells, schitiocytes, fragmented RBC. Mississipe and Tennesse classification are used to grade and know the severity of HELLP.

Differential diagnosis : Pre eclampsia with DIC, acute fatty liver of pregnancy , hepatitis, SLE, HUS, TTP. The most important thing to be noted is that we have to have suspicion in mind always, as once diagnosed, termination is the best treatment. There is always hitch in diagnosis as AFL of pregnancy and hepatitis have overlapping laboratory levels. Hepatitis needs conservative treatment while HELLP needs immediate termination, so reaching to correct diagnosis is important.

Treatment Immediate termination, corticosteroids and magnesium sulphate are the mainstay of treatment along with managing preeclampsia. It is life threatening as mortality is 0-24% and perinatal death 37%.

Eclampsia

It is another life threatening condition where preeclampsia is associated with convulsions. It affects 1:2000 to 1:3448 pregnancies in western world but higher in developing countries.

Maternal complications are abruption, DIC, HELLP syndrome, peripartum cardiomyopathy, renal failure, aspiration pneumonia, pulmonaryoedema.

There are same warning signs like headache, blurring of vision, vomiting, epigastric pain, decreased urine output which is called eminent eclampsia. If we treat at this point patient will not land is eclampsia.