Pre-eclampsia
Pre-eclampsia is a hypertensive disorder of pregnancy leading to multiorgan dysfunction in the mother.
Besides high blood pressure, usually commencing after 20 weeks of gestation, these mothers could present with swelling of the face, hands, and feet, severe headaches, changes in vision, upper abdominal pain, and difficulty in breathing.
It can lead to serious, even fatal, complications for both mother and baby.
There may be no symptoms.
High blood pressure and protein in the urine are key features.
Implementing screening for conditions such as pre-eclampsia and fetal growth restriction in the first trimester, along with managing high-risk pregnancies according to established protocols, is paramount.
Since pre-eclampsia is a systemic disorder, clinical criteria alone are inadequate to predict adverse outcomes.
Therefore, combined screening by maternal history, demographics, colour doppler ultrasound, mean arterial pressure, placental biomarkers, and timely pharmacological intervention for the high-risk cohort in the first trimester, play a crucial role in identifying and managing these high-risk pregnancies.
The second and third-trimester screening for pre-eclampsia are useful for surveillance, early identification of pre-eclampsia, and establishing time of delivery.
Comprehensive care throughout all trimesters, with colour Doppler ultrasound as the cornerstone, is essential to optimise maternal and fetal outcomes.
Pre-eclampsia can often be managed with oral or IV medication (intravenous medication) until the baby is sufficiently mature to be delivered.
This often requires weighing the risks of early delivery versus the risks of continued pre-eclampsia symptoms.
Maternal care
The future of our babies and our nation rests in the hands of stakeholders across perinatal care — from obstetricians and radiologists to fetal medicine specialists, neonatologists, and more.
Even frontline workers such as Accredited Social Health Activist and Anganwadi workers play pivotal roles in ensuring proper antenatal care, underscoring the collective responsibility we bear.
Prematurity, low birth weight, growth restriction, and pre-eclampsia consequent to hypertensive disorders of pregnancy (HDP), are among the preventable conditions that contribute to maternal and neonatal morbidity and mortality on a global scale.
There are also long-term complications of HDP on the health of a mother and the baby.
They are susceptible to adulthood hypertension, metabolic syndrome, heart disease, dyslipidemia, and stroke, adding significantly to the economic burden of the health-care system.
Emerging evidence suggests that pre-eclampsia is associated with a four-fold increase in the risk of heart failure and a two-fold increase in the risk of coronary heart disease, stroke, and cardiovascular mortality for the mother.
A focus on postnatal cardiovascular assessment after delivery would go a long way to improve the cardiovascular and cerebrovascular health of the woman.
Nevertheless, it is unfortunate that post-partum maternal cardiovascular health after pre-eclampsia is a largely neglected area of research.
In India, that accounts for nearly a quarter of the world’s adverse pregnancy outcomes, addressing these health concerns is not just a moral imperative but also an economic necessity.
The National Family Health Survey (NFHS-5) statistics speak volumes: perinatal mortality rates stand at 32 for 1,000 pregnancies, neonatal mortality rates at 25 for 1,000 live births, and hypertensive disorders in pregnancy remain a leading cause of maternal death.
Indian Initiative
The need of the hour is to combat pre-eclampsia by spreading awareness about this serious hypertensive disorder of pregnancy, which is predictable and preventable.
The Indian Radiological and Imaging Association (IRIA), through its flagship programme “Samrakshan”, has embarked on a mission to extend the reach of safe motherhood initiatives across all districts of India.
With a pledge to reduce pre-eclampsia from 8%-10% to 3%, and fetal growth restriction from 25%-30% to 10% by the turn of the decade, IRIA Samrakshan exemplifies the dedication needed to address and mitigate the risks faced by pregnant women and newborns.
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