Preeclampsia

Disease Description (Causes and Symptoms)

• Definition summary: Pre-eclampsia is diagnosed when newly developed hypertension after 20 weeks of pregnancy (systolic ≥140 mmHg or diastolic ≥90 mmHg) is accompanied by proteinuria (24-hour urine protein ≥300 mg or a protein/creatinine ratio ≥0.3), or when there are signs of organ damage even without proteinuria (such as thrombocytopenia, elevated liver enzymes, renal dysfunction, pulmonary edema, or cerebral or visual symptoms). In severe cases, it may progress to eclampsia (seizures, eclampsia).
• Causes and pathophysiology: Poor trophoblast invasion of the placenta causes inadequate uteroplacental blood flow, triggering systemic vascular endothelial dysfunction, vasoconstriction, and inflammatory responses that can harm the mother and fetus. Obesity, diabetes, and a history of pre-eclampsia in a previous pregnancy are risk factors.
• Main symptoms: Often asymptomatic in the early stages. When symptoms occur, they may include headache, visual disturbances (flashing lights, blurred vision), upper abdominal (right upper quadrant) pain, generalized edema, decreased urine output, shortness of breath (pulmonary edema), excessive weight gain, and decreased fetal movement.

Treatment Methods

• Treatment goals: To ensure the safety of the mother and fetus (prevent severe complications) and, when possible, delay delivery until the fetus has matured.
• Definitive treatment: Delivery is the definitive treatment. Depending on the clinical condition (maternal and fetal status, gestational age, and severity), induction of labor or cesarean section is selected.
• Drug treatment
  • Seizure prevention: In severe pre-eclampsia, intravenous magnesium sulfate is administered (loading + maintenance therapy).
  • Blood pressure control (in emergencies or severe hypertension): Intravenous fluids and antihypertensive drugs are used — commonly used medications include labetalol, sustained-release/oral nifedipine, and hydralazine. The goal is to lower dangerously high blood pressure (≥160/110 mmHg) while avoiding a sudden drop in blood pressure.
  • Promotion of fetal lung maturity (when delivery is expected at a preterm gestational age): Betamethasone (a steroid) is administered.
• Approach according to severity
  • Mild (mainly at 37 weeks or later): Consider delivery (induction of labor), or outpatient/inpatient observation and periodic testing.
  • Severe (blood pressure ≥160/110, visual or cerebral symptoms, thrombocytopenia, elevated liver enzymes, etc.): Hospitalization, intensive monitoring, magnesium sulfate, active blood pressure control, and consideration of early delivery.
• Lifestyle management and precautions
  • Regular prenatal examinations (checking blood pressure, urine, blood tests, and fetal status) are essential.
  • Excessive activity restriction or strict bed rest is not generally recommended (follow the doctor’s instructions depending on the condition).
  • If emergency symptoms occur (severe headache, visual disturbances, upper abdominal pain, shortness of breath, a sharp decrease in urine output, etc.), visit the emergency department immediately.
• Prognosis summary: Reports indicate that approximately 15–25% of patients with gestational hypertension develop pre-eclampsia accompanied by proteinuria. The earlier it develops (from early to mid-pregnancy), the greater the risk of a severe course, fetal growth restriction, and preterm birth.

Checklist Before an Outpatient Visit (Items to Bring and Topics to Prepare)

• Items/materials to bring
  • A list of medications currently being taken (including prescription drugs, over-the-counter drugs, and herbal medicines)
  • Recent blood pressure records (including a log, if home blood pressure measurements have been taken)
  • Recent urinalysis and blood test results (copies of the test results, if possible)
  • Gestational age and previous prenatal examination results (including ultrasound results)
  • A record of changes in symptoms: headache, visual abnormalities, upper abdominal pain, edema (where and how much), changes in urine volume, changes in fetal movement, etc.
  • Allergies and past medical history (especially hypertension, diabetes, kidney disease, and a history of pre-eclampsia in a previous pregnancy)
• Key information to show the doctor during the outpatient visit
  • Blood pressure readings (including the time and position), whether protein was detected in the urine, recent amount of weight change, and whether medications have been taken

Examples of General Questions to Ask the Doctor

• "Do my current blood pressure and test results meet the criteria for pre-eclampsia? How do you determine whether it is severe?"
• "What is the purpose of the medication you plan to prescribe, and what are its main side effects?"
• "How do you decide the timing and method of delivery (induction vs. cesarean section)? What measures will be taken to promote fetal maturity?"
• "What symptoms should prompt me to go to the hospital immediately? What are the criteria for emergency symptoms?"

Examples of Disease-Specific Questions

• "I am (for example, 32 weeks pregnant) and have been diagnosed with pre-eclampsia. Should I receive steroids to promote fetal lung maturity? How long can delivery be delayed?"
• "I had pre-eclampsia in a previous pregnancy. Should I start low-dose aspirin as prevention during this pregnancy? When should I start it, and how much should I take?"

Additional information (prevention): For high-risk individuals, guidelines recommend low-dose aspirin during prenatal care (generally around 81 mg/day) starting in the early to middle stages of pregnancy; consult the attending doctor to make a decision. In areas where calcium intake is insufficient, calcium supplementation may help with prevention.