General Pregnancy

Pre-eclampsia: What is it and advances in diagnostics

Written by guest

According to UNICEF, approximately 295,000 women and girls worldwide die each year from complications related to pregnancy and childbirth. Of these, approximately 14% (41,300 deaths) are caused by hypertensive disorders, especially eclampsia.  Sub-Saharan Africa and South Asia account for 86% of maternal deaths worldwide. This means that each year, there are more than 35,000 deaths from pre-eclampsia in these areas.  

 

These deaths are often preventable when healthcare providers have access to necessary medical devices and medicines that enable higher-quality obstetric care.

What is pre-eclampsia:

Preeclampsia is a condition that can develop during pregnancy characterized by high blood pressure (hypertension) and protein in the urine (proteinuria). If not properly diagnosed and managed pre-eclampsia can progress to eclampsia, which is defined as the development of seizures in a woman with pre-eclampsia. 

 

Pre-eclampsia usually occurs from the start of the second half of the pregnancy and can continue until soon after the baby is delivered. It is a serious condition that requires immediate treatment. If left untreated it can be fatal to both the mother and baby.

What causes pre-eclampsia:

The cause of pre-eclampsia remains unknown. Numerous proposed theories have led to various attempts at prevention and intervention strategies, none of which have proven to be overwhelmingly successful. There is, however, general agreement that the placenta plays a key role in pre-eclampsia, and women with chronic hypertension and certain metabolic diseases like diabetes are more susceptible.

Symptoms of pre-eclampsia:

  • Sharp rise in blood pressure
  • Severe headaches that don’t go away even with medication
  • Swelling of face and hands
  • Weight gain of more than 5 pounds in one week
  • Difficulty breathing, gasping, or panting
  • Nausea after mid-pregnancy and vomiting
  • Changes in vision (spots, light flashes, or vision loss)
  • Upper right belly pain

Prevention of pre-eclampsia:

The WHO recommends that in areas where dietary calcium intake is low, calcium supplementation during pregnancy (at doses of 1.5–2.0 g elemental calcium/day) is recommended for the prevention of pre-eclampsia in all women.

Low-dose acetylsalicylic acid (aspirin, 75 mg) is recommended for the prevention of pre-eclampsia in women at high risk of developing the condition.

Antenatal screening for preeclampsia by measuring blood pressure and checking for extra protein in the urine (called proteinuria) is considered part of Good Clinical Practices in ANC.

How is pre-eclampsia diagnosed?

A health care provider will check a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the healthcare provider will likely perform blood tests and more extensive lab tests to check for proteinuria as well as other symptoms.

Current testing methods for proteinuria:

The “gold standard” of testing for proteinuria is via a 24-hour urine test. The test measures the amount of albumin in the patient’s urine over a 24-hour period.

However, in many parts of the world, this type of test is not available, so a urine sample is taken. The healthcare provider will then use a protein dipstick which will provide a protein reading in 60 seconds. The limitation with this type of test is that it does not take into consideration the hydration levels of the patient which can affect the outcome of the test.

New technology in pre-eclampsia testing:

LifeAssay Diagnostics have recently released Test-It PrCrTM which isa urine dipstick that tests for protein as well as creatinine. Determining the ratio of protein-to-creatinine (PrCr), improves the accuracy of proteinuria detection compared to testing for protein-only. This is because it compensates for the dilution of the patient’s urine sample.

This is a simple urine dipstick test that provides a result in 60 seconds. After 60 seconds the healthcare provider can read the results and compare them to a chart to get the ratio between the protein and the creatinine.

This test does not require any laboratory or refrigeration and is therefore very relevant to the Sub-Saharan Africa and South Asia where these facilities are often not available.

Next Steps:

LifeAssay Diagnostics have won many grants and accolades for Test-it PrCrTM , these include two Grand Challenges Grants from the Bill and Melinda Gates Foundation.

With the help of various donors and the foundations, LifeAssay has been able to make these tests available to the people most in need.

More information about this test can be found here: https://www.lifesadxformothers.org or from LifeSADX at https://lifesadx.com.

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