Pre-eclampsia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
The only known treatment for eclampsia or advancing preeclampsia is delivery, either by induction or Caesarean section. However, post-partum pre-eclampsia may occur up to 6 weeks following delivery even if symptoms were not present during the pregnancy. Post-partum pre-eclampsia is dangerous to the health of the mother since she may ignore or dismiss symptoms as simple post-delivery headaches and edema. Hypertension can sometimes be controlled with anti-hypertensive medication, but any effect this might have on the progress of the underlying disease is unknown. Studies have suggested that the father's semen when introduced into the mother, most effectively orally but also through intercourse,[1] prior to pregnancy reduces chances of preeclampsia, as it exposes the mother to foreign proteins of her partner.==Treatment==
Treatment
Medical Therapy
Magnesium sulfate
In some cases women with preeclampsia or eclampsia can be stabilized temporarily with magnesium sulfate intravenously to forestall seizures while steroid injections are administered to promote fetal lung maturation. Magnesium sulfate as a possible treatment was considered at least as far back as 1955,[2] but only in recent years did its use in the UK replace the use of diazepam or phenytoin.[3] Evidence for the use of magnesium sulfate came from the international MAGPIE study.[4] When induced delivery needs to take place before 37 weeks gestation, it is accepted that there are additional risks to the baby from premature birth that will require additional monitoring and care.
Contraindicated medications
Pre-eclampsia medical therapy is considered an absolute contraindication to the use of the following medications:
Other investigated treatments
Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia.[5]
Studies into supplementation with antioxidant vitamins C and E found no change in preeclampsia rates.[6] Doctors Padayatty and Levine with NIH in a "Letter to the Editor" stated that the studies and another "Letter to the Editor" overlooked a key reason for the lack of vitamin C on the prevention of preeclampsia. Because plasma ascorbate concentrations were not reported, we estimated them from known data, the placebo and treatment groups in the study probably had similar plasma and tissue ascorbate concentrations. Doses of 1 g per day have little effect on plasma or intracellular ascorbate concentrations.[7] Calcium supplementation in women with low-calcium diets found no change in preeclampsia rates but did find a decrease in the rate of severe preeclamptic complications.[8] Aspirin supplementation is still being evaluated as to dosage, timing, and population and may provide a slight preventative benefit in some women, however significant research has been done on aspirin and the results thus far are unimpressive.[9] There is insufficient evidence to recommend either exercise[10] or bedrest[11] as preventative measures. Studies of protein/calorie supplementation have found no effect on preeclampsia rates, and dietary protein restriction does not appear to increase preeclampsia rates.[12]
Sexual Health
It has been suggested that fellatio may, through "immune modulation", have a beneficial role in preventing dangerous complications during pregnancy. Specifically, a research group reported that pre-eclampsia, a life threatening complication that sometimes arises in pregnancy, is much less frequent in couples who have practiced oral sex, and even more rare in couples where fellatio ended with the semen swallowed. Both results were statistically significant. This is consistent with other evidence that semen contains an agent that prevents preeclampsia, and with the theory that preeclampsia is an immunological condition. According to that view, preeclampsia is caused by a failure of the mother organism to accept the fetus and placenta, which both contain "foreign" proteins from the father's genes. Regular exposure to the father's semen might cause her immune system to gradually "grow accustomed" to their proteins. Other studies also found that, while any exposure to the partner's sperm during sex appears to decrease the chances of various disorders, women in couples who have practiced "other sex acts" than intercourse are half as likely to suffer pre-eclampsia. It is not known whether this represents a protective effect of "other sex acts" including oral sex, or a correlation between these sexual practices and some other protective factor: for example, greater overall frequency of sex. The standard way to resolve such questions (confounding) in medical science would be through a randomized trial, but there are unique challenges to research in sexual health.
When reporting the findings of the first research group mentioned above, New Scientist magazine thought it worth mentioning that some of the research team were women (including the lead author). Candidates for a protective agent in semen may include serum hormone leutinizing agent and transforming growth factor beta.
References
- ↑ PMID 10706945
- ↑ PRITCHARD J (1955). "The use of the magnesium ion in the management of eclamptogenic toxemias". Surgery, gynecology & obstetrics. 100 (2): 131–40. PMID 13238166.
- ↑ Compare descriptions in 1977 between a British and American paper.
* Hibbard B, Rosen M (1977). "The management of severe pre-eclampsia and eclampsia". British journal of anaesthesia. 49 (1): 3–9. PMID 831744.
* Andersen W, Harbert G (1977). "Conservative management of pre-eclamptic and eclamptic patients: a re-evaluation". Am. J. Obstet. Gynecol. 129 (3): 260–7. PMID 900196. - ↑ Frayling, Frayling (2004). "The Magpie Trial follow up study: outcome after discharge from hospital for women and children recruited to a trial comparing magnesium sulphate with placebo for pre-eclampsia [ISRCTN86938761]". 4 (1): 5. PMID 15113445.
- ↑ Lisa M. Bodnar, Janet M. Catov, Hyagriv N. Simhan, Michael F. Holick, Robert W. Powers, James M. Roberts (2007
url=http://jcem.endojournals.org/cgi/content/abstract/92/9/3517). "Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia". line feed character in
|year=at position 5 (help); Check date values in:|year=(help) - ↑ Rumbold A, Crowther C, Haslam R, Dekker G, Robinson J (2006). "Vitamins C and E and the risks of preeclampsia and perinatal complications". N Engl J Med. 354 (17): 1796–806. PMID 16641396.
- ↑ Padayatty SJ, Levine M. (2006). "Vitamin C and E and the Prevention of Preeclampsia - Letter" (PDF). NEJM. 355 (10): 1065–1066.
- ↑ Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali M, Zavaleta N, Purwar M, Hofmeyr J, Nguyen T, Campódonico L, Landoulsi S, Carroli G, Lindheimer M (2006). "World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women". Am J Obstet Gynecol. 194 (3): 639–49. PMID 16522392.
- ↑ Duley L, Henderson-Smart D, Knight M, King J (2004). "Antiplatelet agents for preventing pre-eclampsia and its complications". Cochrane Database Syst Rev (1): CD004659. PMID 14974075.
- ↑ Meher S, Duley L (2006). "Exercise or other physical activity for preventing pre-eclampsia and its complications". Cochrane Database Syst Rev (2): CD005942. PMID 16625645. Unknown parameter
|month=ignored (help) - ↑ Meher S, Duley L (2006). "Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure". Cochrane Database Syst Rev (2): CD005939. PMID 16625644. Unknown parameter
|month=ignored (help) - ↑ Kramer M, Kakuma R (2003). "Energy and protein intake in pregnancy". Cochrane Database Syst Rev (4): CD000032. PMID 14583907.