Pregnancy toxemia /hypertension

Pregnancy Toxemia / Hypertension

Pregnancy toxemia, also known as hypertensive disorders of pregnancy, encompasses a range of conditions characterized by high blood pressure during pregnancy. These conditions can have significant implications for both maternal and fetal health. The most well-known form of pregnancy toxemia is preeclampsia, but the spectrum also includes gestational hypertension, chronic hypertension, and eclampsia.

Classification

Pregnancy toxemia is classified into several categories based on the timing and severity of hypertension:

• Gestational Hypertension: This condition is diagnosed when a pregnant woman develops high blood pressure after 20 weeks of gestation without the presence of proteinuria. It is considered a temporary condition that resolves postpartum.

• Chronic Hypertension: This refers to high blood pressure that was present before pregnancy or diagnosed before 20 weeks of gestation. Women with chronic hypertension are at increased risk for developing preeclampsia.

• Preeclampsia: A more severe form of pregnancy toxemia, preeclampsia is characterized by high blood pressure and significant proteinuria after 20 weeks of gestation. It can lead to serious complications if not managed properly.

• Eclampsia: This is a severe complication of preeclampsia, marked by the onset of seizures in a woman with preeclampsia. Eclampsia is a medical emergency requiring immediate intervention.

Pathophysiology

The exact cause of pregnancy toxemia is not fully understood, but it is believed to involve abnormal placentation, immune maladaptation, and endothelial dysfunction. The placenta plays a central role, with inadequate trophoblastic invasion leading to poor placental perfusion and the release of factors that cause widespread endothelial damage.

Risk Factors

Several risk factors have been identified for pregnancy toxemia, including:

• First pregnancy
• Multiple gestations (e.g., twins or triplets)
• Maternal age over 35
• Obesity
• Pre-existing medical conditions such as diabetes or kidney disease
• Family history of preeclampsia

Clinical Features

Symptoms of pregnancy toxemia can vary but often include:

• Hypertension (blood pressure ≥ 140/90 mmHg)
• Proteinuria (≥ 300 mg/24 hours)
• Edema, particularly in the hands and face
• Severe headaches
• Visual disturbances
• Upper abdominal pain

Diagnosis

Diagnosis is based on clinical findings and laboratory tests. Blood pressure measurements, urine analysis for proteinuria, and blood tests to assess liver and kidney function are commonly used.

Management

Management strategies depend on the severity of the condition and the gestational age:

• Mild cases may be managed with close monitoring and lifestyle modifications.
• Severe cases often require hospitalization, antihypertensive medications, and sometimes early delivery to prevent complications.

Complications

If left untreated, pregnancy toxemia can lead to serious complications such as:

• Placental abruption
• Preterm birth
• Fetal growth restriction
• HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count)
• Maternal organ damage

Prognosis

With appropriate management, most women with pregnancy toxemia can have successful pregnancies. However, they remain at increased risk for cardiovascular disease later in life.

Also see

• Gestational diabetes
• Placental abruption
• HELLP syndrome
• Preterm birth