preconception care Medical care for a woman who is planning pregnancy before she becomes pregnant. It focuses on the conditions and risk factors that could affect a woman if she becomes pregnant, as well as factors that can affect a fetus or infant. Preconception care should begin at least three months before a planned pregnancy. Among the issues involved are taking prenatal vitamins and folic acid supplements to prevent neural tube defects, rubella vaccination to prevent congenital rubella syndrome, stopping smoking and alcohol consumption and detecting and treating exist- ing health conditions to prevent complications in the mother and reduce the risk of birth defects. These conditions include diabetes, hypothyroidism, HIV/AIDS, hepatitis B, PKU (phenylketonuria), hypertension (high blood pressure), blood diseases and eating disorders. The physician should review medications that can affect the fetus or mother, such as epilepsy medicine (see also DRUG USE AND PREGNANCY), reviewing pregnancy history (has she lost a baby before?), family planning and counsel- ing to avoid unwanted pregnancies and counseling to promote healthy behavior (nutrition, exercise, oral health). Preconception care can be provided by a gynecologist or primary-care physician.
See also PRENATAL CARE.
preeclampsia Also pregnancy-induced hypertension, PIH, metabolic toxemia of late pregnancy, toxemia. The development, in the last trimester of pregnancy, of hypertension (high blood pressure), proteinuria (protein in the urine) and edema (fluid retention) associated with a rapid weight gain. If not treated, this condition can progress to ECLAMPSIA and pos- sibly death. Moreover, the progression from pre- eclampsia to eclampsia can be very rapid (a matter of hours), and therefore preeclampsia requires very prompt treatment.
The precise cause of preeclampsia is not known, but recent research indicates it is caused by an imbalance between two kinds of factor, those that turn on and those that shut down new blood vessel growth. Early in pregnancy more blood vessels are needed to supply the fetus; later this process must be reversed lest the woman bleed heavily. In preeclampsia the shutdown occurs too early. Why the condition develops in approximately 5 to 8% of all pregnancies is not known. It occurs most often in first pregnan- cies and in women who already have hypertension or vascular disease. Indeed, some authorities lump together preeclampsia, eclampsia and hypertension that develops in late pregnancy, calling them ?hypertensive disorders of late pregnancy,? but one cannot exclude already hypertensive women who become pregnant. The hypertension of preeclampsia is caused by vasospasm, that is, constriction of the blood vessels that inhibits the flow of blood, especially to the liver, uterus and kidneys. Older women have a greater risk of preeclampsia, as do women carrying more than one fetus. Also, the risk rises if either the woman?s mother or her husband?s mother had preeclampsia.
Since the symptoms of preeclampsia occur with varying severity, and some, such as edema and weight gain, are characteristic of just about all women in late pregnancy, specific standards have been established. In true preeclampsia hyperten- sion must be present along with either proteinuria or edema. Hypertension is defined as a rise of at least 30 mm (millimeters) Hg over the usual systolic blood pressure or an absolute systolic pressure of 140 or more; a rise of at least 15 mm Hg over usual diastolic pressure, or an absolute diastolic level of 90 or more; and these high levels must be observed on two or more occasions at least six hours apart with the patient resting on her left side (see under HYPERTENSION for explanation of these measurements). Proteinuria is defined as urinary protein in concentrations greater than 0.3 grams per liter in a 24-hour collection (all urine passed is collected over a 24-hour period), or 1 gram per liter or more in a random clean sample on two occa- sions at least six hours apart. Edema is defined as generalized fluid accumulation in the tissues (not just swollen feet or ankles), especially if it is associ- ated with rapid weight gain (at least 1 kilo, or 2.2 pounds, per week). Severe preeclampsia is defined as a blood pressure of 160/110 or higher, proteinuria of 5 grams or more in 24 hours and diminished urine output (400 ml or less in 24 hours), with cerebral or visual disturbance, pulmonary edema or cyanosis, liver capsule tenderness and hyperre- flexia (exaggerated reflexes).
The only specific treatment for severe preeclampsia is terminating the pregnancy; delivery alone can prevent convulsions and the death of the baby. Because the baby usually will be premature, there may be a temptation to delay until its chances of survival increase, but severe preeclampsia itself may kill the baby, and it is much safer for the mother not to wait.
Preeclampsia probably cannot be wholly pre- vented. In earlier times, some clinicians tried to do so by strictly limiting a pregnant woman?s weight gain and sodium (salt) intake, and by almost rou- tinely prescribing diuretics to prevent fluid retention. However, it was found that these measures themselves can be dangerous, leading to protein deficiency, sodium-electrolyte imbalance and other problems. More recently studies indicated that aspirin can forestall high blood pressure during pregnancy among those already at high risk for preeclampsia, but it does not confer any benefits to women who are at moderate or low risk. Early detection, on the other hand, may prevent devel- opment of life-threatening eclampsia. It is for this reason that good PRENATAL CARE calls for increas- ingly frequent checkups in the last trimester and routinely includes checking weight gain, blood pressure and testing the urine for albumin (pro- tein). One promising development is the discovery of a marker for the disease in pregnant women?s blood that appears about five weeks before its onset. It is a gene, sFlt1, that blocks growth factors, but it can be counteracted by growth-stimulating drugs. Also being worked on is a urine test for a protein, placental growth factor, low in women at high risk.
Once symptoms appear, most physicians believe the woman should have complete bed rest on her left side, at home or in the hospital. Weight, blood pressure and urine must be checked frequently. A protein-rich diet is used, and at least one author- ity believes that such a diet throughout pregnancy will prevent the development of preeclampsia. If the condition cannot be controlled with these measures or hypertension is present before pregnancy, small amounts of medication to reduce blood pressure are considered safe. If these do not work, strong sedation and anticonvulsant drugs may be given to prevent eclampsia. The principal drug used is magnesium sulfate, which may lessen symptoms and prevent convulsions. Because the condition may persist after delivery, the drug is often continued for 24 hours after birth. If high blood pressure persists as well, beta-blockers or other medication may be used until blood pressure returns to normal.
Research indicates that women who have had preeclampsia are at higher risk for cardiovascu- lar problems later in life. It is not clear whether women who get preeclampsia were already at risk for these problems or whether preeclampsia predis- poses them toward them.
Source: http://www.girls-fitness.com/preconception-care-and-preeclampsia/
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