Preeclampsia is a pregnancy disorder at 20 weeks or more which is characterized by an increase in blood pressure above 140/90 mmHg and kidney disorders in the form of protein in the urine.
If preeclampsia is not treated properly, it can cause serious complications and can even lead to seizures/eclampsia or other more severe disorders/HELLP syndrome (Hemolysis, Elevated Liver Enzyme, Low Platelet). What needs to be underlined here is that we can prevent these preeclampsia complications if we clearly understand the causative factors and also the pathophysiology of preeclampsia.
The occurrence of complications from preeclampsia must be interpreted as a failure of antenatal care provided by health workers to pregnant women.
Preeclampsia Risk Factors
We can screen groups of pregnant women who are at risk of experiencing preeclampsia during their pregnancy:
- Women who become pregnant when they are over 35 years old.
- A woman who is pregnant under the age of 20 years.
- Have had eclampsia in a previous pregnancy.
- Having chronic hypertension before pregnancy.
- Having kidney problems or diabetes before pregnancy.
Although there are groups of pregnant women who have risk factors for experiencing preeclampsia, sometimes preeclampsia can occur in pregnant women who we consider normal.
Pathophysiology of Preeclampsia
One of the most widely followed theories about the cause of preeclampsia is that there is an abnormality in placentation.
Failure of remodeling of the spiral arteries to provide nutrition during pregnancy will cause disturbance of blood circulation from the mother to the fetus in the womb. The disturbance can be mild to severe, depending on the response of the pregnant woman's body to the disturbance.
Prevention of Preeclampsia
1. Giving Aspilet
Administration of low dose acetyl salicylate/aspirin (80-100 mg) can provide anti-platelet aggregation effect and reduce fetomaternal circulation disorders in the myometrial spiral arteries. The presence of anti-platelet aggregation effect will disguise placentation disorders in preeclampsia, thus reducing the risk of worsening preeclampsia symptoms.
2. Giving Vitamin D3
Preeclampsia is related to the body's excessive response to placental disorders that should be responded to as local disorders, but the body responds systemically. Therefore, one theory of preeclampsia is an autoimmune process where an excessive reaction in the body will cause preeclampsia to sometimes worsen.
Vitamin D3 has an important process in the hormonal mechanism of action and the mechanism of the body's chain of actions and reactions in responding to metabolic disorders. Therefore, vitamin D3 is often also called a prohormone vitamin. Normal levels of vitamin D3 in normal blood are between 50-100 nmol/L. There are several literatures that state that levels above 30 nmol/L are still considered normal, but optimally above 50 nmol/L to get protection against pregnancy complications such as preeclampsia.
3. D-dimer examination
In pregnancy, an increase in D-dimer is still considered normal. In the first trimester of pregnancy, an increase of 167–721 ng/mL can occur, in the second trimester an increase of 298–1653 ng/mL occurs, and in the third trimester a normal increase occurs between 483–2256 ng/mL.
High D-dimer levels above 2500 ng/mL should be a concern as a factor that can cause disorders in pregnant women. Sometimes, during pregnancy, we often forget to include D-dimer as an important indicator in pregnancy, and only focus on routine blood tests.
As we know, during this post-COVID period, we need to check the D-dimer levels of pregnant women, especially if they have previously been infected with COVID-19. In preeclampsia patients, this is also the case if placental disorders become severe. Moreover, if the D-dimer of the pregnant woman is high, it will be at risk of developing preeclampsia in a more severe direction.
Administration of heparin during pregnancy should be considered if D-dimer levels in the blood of pregnant women are found to be more than >2500 ng/mL and there is impaired blood circulation between the mother and fetus.
4. Administration of Magnesium and Corticosteroids
In the event of preeclampsia, it requires a good and comprehensive understanding from the health care provider to ensure optimal management. Magnesium sulfate is often used to prevent seizures in pregnant women with severe preeclampsia. On the other hand, corticosteroids can also be given to help fetal lung maturation if preterm delivery is the best solution for the mother and fetus.
Article written by dr. Kondang Usodo Sp.OG (Obstetrics and Gynecology Specialist Doctor, EMC Alam Sutera & Tangerang Hospital).