1) What is pregnancy poisoning?
The medical name for the disease, commonly known as pregnancy poisoning, is preeclampsia. Preeclampsia has nothing to do with actual poisoning. It mainly occurs during pregnancy due to increased blood pressure. Pregnancy poisoning develops in relation to high blood pressure, swelling in the hands, feet and face (edema), and excessive protein excretion in the urine.
2) Are there different types of preeclampsia?
Preeclampsia is examined in 2 groups as mild and severe. In mild preeclampsia, the expectant mother visits with blood pressure of 140/90 mmHg or above. While protein excretion in the urine is very little in mild preeclampsia (more than 300 mg per day), in severe preeclampsia more than 2 grams of protein is excreted from the body through urine during the day.
In severe preeclampsia, blood pressure is above 160/110 mmHg. Symptoms such as excess protein in the urine (albuminuria), increased liver function tests, decreased platelet count, persistent headache, vision problems, and pain around the liver may also be added. Pregnancy poisoning (preeclampsia) causes seizures that resemble epileptic seizures during pregnancy. This condition is called eclampsia.
3) What is the probability of encountering pregnancy poisoning?
Preeclampsia is a common pregnancy disease that affects approximately 5% to 10% of expectant mothers. Approximately three-quarters of preeclampsia cases are mild, and one-quarter are severe.
4) Which candidates are more likely to experience preeclampsia?
If the following conditions occur, expectant mothers are at increased risk of preeclampsia.
First pregnancy (nulliparity)
Advanced maternal age (over 35)
People with a history of preeclampsia in previous pregnancies
Chronic hypertension in people who had hypertension before pregnancy
In people with a family history of preeclampsia
Poor obstetric history (intrauterine death, growth retardation, abruption, etc. in previous pregnancies)
5) What are the problems caused by pregnancy poisoning?
Symptoms that indicate the development of severe pregnancy poisoning:
More protein loss in urine
Blood pressure is 160/100 mmHg
Decrease in daily urine output
Occurrence of vision problems
Stomach ache,
Decrease in the amount of platelets in the blood,
When epileptic seizures are added to these symptoms, it is called eclampsia. At this point, brain edema has developed and these seizures have begun to occur.
Health problems such as brain hemorrhage, heart failure, coagulation disorder, pulmonary edema, and kidney failure continue to develop in the expectant mother.
The baby begins to have developmental delays, which can lead to premature birth or even death in the womb.
6) What are the points to be considered in the diagnosis and follow-up of preeclampsia?
The most important point in diagnosing and monitoring pregnancy poisoning is that the expectant mother regularly measures her blood pressure. In mild preeclampsia (mild pregnancy poisoning), blood pressure is above 140/90 mmHg. In severe preeclampsia, this is above 160/110 mmHg. In addition to blood pressure measurement, urine protein (albumin) level, blood tests (usually kidney function tests), and eye fundus examination are used in diagnosis and control.
7) What are the risk factors for preeclampsia?
Multiple pregnancy (twins, triplets) pregnancy
Type 1 Diabetes
Kidney disease
Obesity
Immune system disorders
Thrombophilia (clotting disorders),
Leiden mutation
Antiphospholipid antibody syndrome
Hydatiform mole
Kidney disease in the mother
8) What are the changes that occur in the mother in pregnancies that develop preeclampsia?
The classic pathological lesion in the kidney is gelomerulocapillary endotheliosis.
The earliest deteriorating laboratory finding is an increase in plasma uric acid level, but it is not used as a diagnostic criterion.
Plasma creatinine level increases.
Proteinuria occurs.
The glomerular filtration rate (GFR), which increases by almost 50% during pregnancy, decreases in preeclamptic pregnant women, and renal blood flow decreases.
Thrombocytopenia
Microangiopathic hemolytic anemia: If excessive hemolysis occurs, hemoglobinemia, hemoglobinuria, hyperbilirubinemia and a decrease in haptaglobulin levels are observed.
There is also a higher probability of HELLP syndrome occurring.
Cardiac afterload increases due to hypertension.
Intravascular fluid decreases and fluid transfer occurs to the extravascular space. Therefore, cardiac preload decreases.
The amount of extracellular fluid increases
Plasma oncotic pressure decreases. Cardiac output decreases (normally increases in pregnancy).
Hemoconcentration occurs.
Blood volume decreases. For this reason, preeclamptic pregnant women can tolerate blood loss less.
Periportal hemorrhage may be observed in the liver. If HELLP syndrome occurs, subcapsular hematoma and rupture occur.
Visual impairment (blurred vision, diplopia) occurs
Uteroplacental insufficiency, placental abruption
The risk of IUGR in the baby increases perinatal mortality and morbidity.
9) How does the situation that causes maternal and infant death develop?
Due to the increase in resistance in the capillaries, which are small capillaries, and damage to the capillary vessels, insufficiency occurs in the uteroplacental bed (where the blood-nutrient exchange between the mother and the baby takes place) and poses a significant risk for the baby.
It causes the baby to have less blood and less oxygen, causing serious distress. There is an increase in pressure in the utero-placental bed and the placenta separates prematurely. For this reason, the baby loses its life in the womb.
In the disorder that occurs in the capillary vessel, platelets are damaged, and the amount of platelets in the blood decreases. As a result of this situation, the body's clotting factors decrease day by day. DIC (Disseminated Intravascular Coagulation) develops and results in death.
10) What should be done to prevent preeclampsia (pregnancy poisoning) from recurring?
First of all, the expectant mother should lose weight to prevent recurrence of preeclampsia.
Twin pregnancies are a serious risk factor for recurrence of preeclampsia.
Weight gain in the first weeks of pregnancy is not a risk factor for recurrence of preeclampsia.
Paying attention to a balanced and regular diet, staying away from stress, sleeping regularly, and gaining weight within normal limits are important in preventing the recurrence of preeclampsia.
It is extremely important for expectant mothers who have experienced preeclampsia in their previous pregnancy to have their blood pressure monitored and blood tests done routinely.
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