Η προεκλαμψία είναι μια πάθηση της κύησης και ορίζεται ως υψηλή αρτηριακή πίεση και περίσσεια λευκώματος στα ούρα μετά από τις 20 εβδομάδες κύησης σε μια γυναίκα που προηγουμένως είχε φυσιολογική αρτηριακή πίεση. Ακόμα και μια μικρή αύξηση στην πίεση του αίματος μπορεί να είναι ένα σημάδι της προεκλαμψίας. Εάν αφεθεί χωρίς θεραπεία, η προεκλαμψία μπορεί να οδηγήσει σε σοβαρές – ακόμη και θανατηφόρες – επιπλοκές τόσο για εσάς και το μωρό σας.
Αν έχετε προεκλαμψία, η μόνη θεραπεία είναι ο τοκετός του μωρού σας.
Αιτίες
Η προεκλαμψία ονομαζόταναι παλαιότερα τοξιναιμία, επειδή πιστεύεται ότι προκαλείται από μια τοξίνη στο αίμα μιας εγκύου γυναίκας. Αυτή η θεωρία έχει απορριφθεί, αλλά οι ερευνητές δεν έχουν ακόμη καθορίσει τι προκαλεί την προεκλαμψία. Πιθανές αιτίες μπορεί να περιλαμβάνουν:
- Ανεπαρκή ροή αίματος στη μήτρα
- Βλάβη στα αιμοφόρα αγγεία
- Πρόβλημα με το ανοσοποιητικό σύστημα
- Κακή διατροφή
- Άλλες διαταραχές υψηλής πίεσης του αίματος κατά τη διάρκεια της εγκυμοσύνης
Ταξινόμηση
Η προεκλαμψία χαρακτηρίζεται ως μία από τις τέσσερις παθήσεις υψηλής αρτηριακής πίεσης που μπορεί να προκύψουν κατά τη διάρκεια της εγκυμοσύνης. Οι άλλες τρεις είναι:
- Υπέρταση κύησης: Οι γυναίκες με υπέρταση κύησης έχουν υψηλή αρτηριακή πίεση, αλλά όχι περίσσεια λευκώματος στα ούρα τους. Μερικές γυναίκες με υπέρταση κύησης μπορεί τελικά να αναπτύξουν προεκλαμψία.
- Χρόνια υπέρταση: Χρόνια υπέρταση είναι η υψηλή πίεση του αίματος που εμφανίζεται πριν από τις 20 εβδομάδες κύησης ή διαρκεί περισσότερο από 12 εβδομάδες μετά τον τοκετό. Συνήθως, η χρόνια υπέρταση προϋπήρχε – αλλά δεν ανιχνεύθηκε – πριν από την εγκυμοσύνη.
- Η προεκλαμψία επάνω σε χρόνια υπέρταση: Αυτή η κατάσταση εμφανίζεται σε γυναίκες που πάσχουν από χρόνια υψηλή πίεση του αίματος πριν από την εγκυμοσύνη που αναπτύσσουν στη συνέχεια επιδείνωση της αρτηριακής πίεσης και πρωτεΐνη στα ούρα κατά τη διάρκεια της εγκυμοσύνης.
Παράγοντες κινδύνου
Η προεκλαμψία αναπτύσσεται μόνο κατά τη διάρκεια της εγκυμοσύνης. Οι παράγοντες κινδύνου περιλαμβάνουν:
- Ατομικό ιστορικό προεκλαμψίας. Ένα ατομικό ή οικογενειακό ιστορικό προεκλαμψίας αυξάνει τον κίνδυνο για εκδήλωση της πάθησης.
- Πρώτη εγκυμοσύνη. Ο κίνδυνος για εμφάνιση προεκλαμψίας είναι υψηλότερος κατά την πρώτη εγκυμοσύνη σας.
- Νέος σύντροφος. Κάθε εγκυμοσύνη με ένα νέο σύντροφο αυξάνει τον κίνδυνο εμφάνισης προεκλαμψίας.
- Ηλικία. Ο κίνδυνος προεκλαμψίας είναι υψηλότερος για τις έγκυες γυναίκες ηλικίας κάτω των 20 και άνω των 40 ετών.
- Η παχυσαρκία. Ο κίνδυνος προεκλαμψίας είναι υψηλότερος εάν είστε παχύσαρκες.
- Η πολύδυμη κύηση. Η προεκλαμψία είναι πιο συχνή στις γυναίκες που κυοφορούν δίδυμα, τρίδυμα.
- Παρατεταμένο διάστημα μεταξύ των κυήσεων. Αυτό φαίνεται να αυξάνει τον κίνδυνο εμφάνισης προεκλαμψία.
- Διαβήτης και διαβήτης κύησης. Οι γυναίκες που αναπτύσουν διαβήτη κύησης έχουν υψηλότερο κίνδυνο να αναπτύξουν προεκλαμψία, καθώς η εγκυμοσύνη προχωρά.
Επιπλοκές
Οι περισσότερες γυναίκες με προεκλαμψία θα γεννήσουνε υγιή μωρά. Η προεκλαμψία είναι σοβαρότερη όσο νωρίτερα εμφανίζεται στην εγκυμοσύνη σας, με μεγαλύτερο κίνδυνο για εσάς και το μωρό σας. Τοκετός με Καισαρική τομή δεν είναι πάντα απαραίτητος σε αυτές τις περιπτώσεις. Ωστόσο, ο γιατρός σας μπορεί να συστήσει καισαρική τομή, λόγω προωρότητας του μωρού σας.
Οι επιπλοκές της προεκλαμψίας μπορεί να περιλαμβάνουν:
Μειωμένη ροή αίματος προς τον πλακούντα
Η προεκλαμψία επηρεάζει τις αρτηρίες που μεταφέρουν το αίμα στον πλακούντα. Εάν ο πλακούντας δεν αιματώνεται σωστά, το μωρό σας μπορεί να λαμβάνει λιγότερο οξυγόνο και λιγότερα θρεπτικά συστατικά. Αυτό μπορεί να οδηγήσει σε επιβράδυνση της ανάπτυξης, χαμηλό βάρος γέννησης, πρόωρο τοκετό και αναπνευστική δυσχέρεια στο μωρό σας.
Αποκόλληση του πλακούντα
Η προεκλαμψία αυξάνει τον κίνδυνο αποκόλλησης του πλακούντα, όπου ο πλακούντας χωρίζει από το εσωτερικό τοίχωμα της μήτρας σας, πριν από τον τοκετό. Σοβαρή αποκόλληση πλακούντα μπορεί να προκαλέσει βαριά αιμορραγία, η οποία μπορεί να είναι απειλητική για τη ζωή σας και το μωρό σας .
HELLP σύνδρομο
HELLP – που σημαίνει αιμόλυση ( καταστροφή των ερυθρών αιμοσφαιρίων ), αυξημένα ηπατικά ένζυμα και χαμηλό αριθμό αιμοπεταλίων – το σύνδρομο αυτό μπορεί γρήγορα να γίνει απειλητικό για τη ζωή σας και του μωρού σας. Τα συμπτώματα του συνδρόμου HELLP περιλαμβάνουν ναυτία και έμετο, κεφαλαλγία και άνω δεξιό κοιλιακό άλγος.
Εκλαμψία
Όταν η προεκλαμψία δεν ελέγχεται, μπορεί να επέλθει εκλαμψία – η οποία είναι ουσιαστικά προεκλαμψία με κρίσεις. Τα συμπτώματα της εκλαμψίας περιλαμβάνουν δεξιό άνω κοιλιακό άλγος, έντονο πονοκέφαλο, προβλήματα όρασης και αλλαγή της νοητικής κατάστασης , όπως μειωμένη εγρήγορση. Η εκλαμψία μπορεί να βλάψει μόνιμα τα όργανα ζωτικής σημασίας, συμπεριλαμβανομένου του εγκεφάλου, του ήπατος και των νεφρών σας. Εάν αφεθεί χωρίς θεραπεία, η εκλαμψία μπορεί να προκαλέσει κώμα, εγκεφαλική βλάβη και θάνατο τόσο για εσάς και το μωρό σας.
Καρδιαγγειακή νόσο
Έχοντας προεκλαμψία μπορεί να αυξήθει ο κίνδυνος μελλοντικής καρδιαγγειακής νόσου.
Συμβολή υπερήχων στη έγκαιρη διάγνωση:
Από τις 12 εβδομάδες κύησης μπορούμε να εκτιμήσουμε τον αριθμό των γυναικών που βρίσκονται σε αυξημένο κίνδυνο να αναπτύξουνε πρώιμη προεκλαμψία (πριν τις 34 εβδομάδες), μετρώντας με την εξέταση Doppler τη ροή αίματος στις μητριαίες αρτηρίες της εγκύου.
Η ίδια εξέταση επαναλαμβάνεται στις 22 εβδομάδες (υπερηχογράφημα Β επιπέδου).
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