Previous Preeclampsia: What to Expect in a New Pregnancy?

• I had preeclampsia in my previous pregnancy, what can happen in the
  next pregnancy?
  Mariela had very severe preeclampsia with HELLP syndrome at 26 weeks of gestation.
  pregnancy, admission to the semi-intensive obstetric care unit to try
  to gain a few days for their baby, Imane, however they only managed to extend 6
  days later, the pregnancy worsened considerably. Mariela's and her baby's condition deteriorated significantly. Mariela
  He had a severe headache, blurred vision, and his liver showed signs of
  severe inflammation, plus Imane wasn't receiving enough blood and the placenta was
  The uterine cord detached, the doctors rushed to perform a cesarean section, Imane survived but...
  After 35 days of life, she could not survive and died as a result of complications from the
  Prematurity. Mariela had many complications after delivery, with hemorrhage and
  After multiple blood transfusions, his life was also in danger and he was in the ICU
  several days, but he managed to recover physically but not emotionally, they have
  Two years have passed and she is still traumatized and very afraid of another one.
  gestation.
  Cases as severe as Mariela's are exceptional; preeclampsia occurs
  severe and early in 1 out of every 200 pregnancies, however these are very serious cases and
  with significant consequences for mother and baby, although in most
  Sometimes the mother and child are saved, but the consequences for both the woman and the child are severe.
  babies are important. At the maternal level, women who have preeclampsia
  Those who are born early have a higher risk of long-term kidney and cardiovascular complications
  in the long term (see article), and the vast majority also have post-traumatic stress similar to
  suffered by people who go through natural disasters, wars, accidents
  traffic and have a higher risk of suffering from postpartum depression and attachment disorders.
  A significant percentage do not become mothers again due to fear of another pregnancy.
• What is the risk of experiencing another episode of preeclampsia?
  All women who have experienced any complication related to the
  Women with hypertension in pregnancy should receive pre-conception counseling for management
  of future pregnancies. The risk of recurrent preeclampsia depends on the
  The moment when preeclampsia occurred. Whether preeclampsia led to delivery
  Before 28 weeks, as in Mariela's case, the risk of it recurring
  happening in a subsequent pregnancy is 55%. However, if the delivery took place between
  Between 28 and 34 weeks the risk is 25%. If preeclampsia occurred between 34 and
  At term, the recurrence risk of 16%. However, it is important to note that
  In only 51% of cases is preeclampsia as severe as in the first pregnancy, and in the vast majority of cases it usually debuts later and therefore has a better prognosis for mother and child.

• What tests do I need before a new pregnancy?

A blood pressure test is recommended to check if it is due to the
In cases of preeclampsia, high blood pressure is also present; a study of the
kidney to check that there are no sequelae at this level. In 10% of the cases the
Preeclampsia occurs in the context of an autoimmune disease called syndrome
Antiphospholipid syndrome is associated with episodes of thrombosis and with
complications of pregnancy, and its diagnosis consists of performing a
determination of antiphospholipid antibodies in blood. In addition, in a
A small proportion of women may have thrombophilia, disorders of the
blood clotting that predisposes to preeclampsia and other complications and
which may also be useful to evaluate with an analysis.

• Is there anything that can be done to prevent it from happening again?

Today it has been shown that treatment with low-dose aspirin (150 mg)
once a day at night) from 12 weeks of gestation until 36.6
It reduces the risk of preeclampsia occurring before 32 weeks by 82%.
to say that Mariela in a future pregnancy, if she takes aspirin, her risk was that she was in a
55% is significantly reduced, and if preeclampsia recurs
It will probably be much later in the pregnancy and less serious.

Furthermore, recent studies indicate that in at-risk patients, such as in the case of
Mariela, they could benefit from combining heparin (an anticoagulant that is
administered subcutaneously at low doses) and low-dose aspirin from the
early pregnancy, further decreasing the possibility of preeclampsia
severe and early in a subsequent pregnancy.

Finally, it is very important that this new pregnancy be monitored by a
specialist in maternal-fetal medicine to detect early any sign or
symptom of the disease and monitor blood pressure, kidney function, levels
of angiogenic factors in maternal blood as well as fetal growth and function
placental (see article on angiogenic factors)

Finally, we recommend follow-up with a psychologist specializing in mental health.
perinatal care to treat and care for the anxiety-fear aspects that this new situation entails
gestation.