**Pregnancy, Hypertension and oedema:(Preeclampsia):***Ayurvedic opinion:--
-Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys.
-Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia.
*Sign and Symptoms of Preeclampsia:-
1)High blood pressure ,that exceeds 140/90 mm Hg or greater — documented on two occasions, at least four hours apart — is abnormal.
2)Other signs and symptoms of preeclampsia may include:
• Excess protein in urine (proteinuria) or additional signs of kidney problems
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath, caused by fluid in lungs
• Sudden weight gain and swelling (edema) — particularly in your face and hands — may occur with preeclampsia.
***Visit the doctor immediately if have severe headaches, blurred vision or other visual disturbance, severe pain in your abdomen, or severe shortness of breath.****
---------Causes of preeclampsia:----
The exact cause of preeclampsia involves several factors.
-Experts believe it begins in the placenta .
‘Placenta is the organ that nourishes the fetus throughout pregnancy.’
**How preeclampsia occurs: -?***
-Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta.
- women with preeclampsia, these blood vessels don't seem to develop or function properly. These vessels are narrower than normal blood vessels and react differently to hormonal signals.This phenomenon limits the amount of blood that can flow through them.
**Causes of these abnormal development of blood vessels may include:****
• Insufficient blood flow to the uterus
• Damage to the blood vessels
• A problem with the immune system
• Certain genes
*Classification of Preeclampsia:- Preeclampsia is classified as one of four high blood pressure disorders that can occur during pregnancy.
•1) Gestational hypertension:-
Women with gestational hypertension have high blood pressure but no excess protein in their urine or other signs of organ damage.
• 2) Chronic hypertension:-
Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy.
•3) Chronic hypertension with superimposed preeclampsia :-
This condition occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.
-Risk factors:------
Risk factors include:
•a) History of preeclampsia.
A personal or family history of preeclampsia significantly raises risk
• b) Chronic hypertension. If the patient already have chronic hypertension, have a higher risk of developing preeclampsia.
• c) First pregnancy. The risk of developing preeclampsia is higher in first pregnancy.
•d) New paternity. Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner.
•e) Age. The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 40.
• f) Obesity. The risk of preeclampsia is higher in obese.
•g) Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples.
•h) Interval between pregnancies. Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia.
• i) History of certain conditions.
Having certain conditions before become pregnant
— such as chronic high blood pressure,
- migraines,
- type 1 or type 2 diabetes,
-kidney disease,
-a tendency to develop blood clots, or lupus.
These above factors increases risk of preeclampsia.
• j) In vitro fertilization. (Test tube baby) risk of preeclampsia is increased if baby conceived with in vitro fertilization.
*****Complications of Preeclampsia:---
• Fetal growth restriction
• Preterm birth,
• Placental abruption, condition in which the placenta separates from the inner wall of uterus before delivery.
• HELLP syndrome.
H stands for hemolysis (the destruction of red blood cells)
EL- elevated liver enzymes and LP- low platelet count
This syndrome is a more severe form of preeclampsia, and can rapidly become life-threatening .
• Eclampsia. When preeclampsia isn't controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop.
• Other organ damage. Preeclampsia may result in kidney, liver, lung, heart, or eyes, and may cause a stroke or other brain injury.
• Cardiovascular disease. Having preeclampsia may increase risk of future heart and blood vessel (cardiovascular) disease.
*****Prevention of Preeclampsia:-****
No clear strategies have emerged to prevent Preeclampsia.
* Eating less salt, changing your activities, restricting calories, or consuming garlic or fish oil doesn't reduce risk.
*Increasing intake of vitamins C and E,D hasn't have a benefit.
**In certain cases
• Low-dose aspirin.
• Calcium supplements.
May reduce preeclampsia.
Diagnosis of preeclampsia:-
After 20th weeks of pregnancy
A) high blood pressure
B) and one or more of the following complications ,
1)Protein in your urine (proteinuria)
2)A low platelet count
3)Impaired liver function
4)Signs of kidney trouble other than protein in the urine
5)Fluid in the lungs (pulmonary edema)
6)New-onset headaches or visual disturbances
***Certain tests, including:-
• Blood tests. liver function tests, kidney function tests and also platelets
• Urine analysis(culture). urine for 24 hours, for protein in urine.
• Obstetrics ultrasound.
• Nonstress test ,biophysical profile.
****Treatment:---
- only cure for preeclampsia is delivery.
***Medications:-
Possible treatment for preeclampsia may include:
-Medications to lower blood pressure..
• Corticosteroids. an important step in preparing a premature baby for life outside the womb.
• Anticonvulsant medications.such as magnesium sulfate, to prevent a first seizure.
-Hospitalization
Severe preeclampsia may require hospitalized.
******Preeclampsia in AYURVEDA *******
In Ayurveda there is no direct mention of hypertension during pregnancy or preeclampsia but some symptoms as complication of pregnancy have been described they are
:1)शोथ(Oedema)का.सं.चि.2/8,खि.10/126,162,यो.र.स्री.रो.चि.page no.284 )हा.सं.तृतीयस्थान51/13,च.सं.सु.18/6,अ.सं.नि.13/18,30अ.हृ.नि.13/26,28
2),मुत्रग्रह, मुत्रविबंध,मुत्ररोध(retention of urine) का.सं.खि.10,हा.सं.तृती.51/11 ,
3) मुर्छा, नेत्रे मुस्तोत्थिताकारे woman becomes repeatedly unconscious,eyes swollen)
का.सं.खि.10/161,162
सु.सं.नि.8/6अ.सं.शा.4/31
4)आक्षेप (convulsions) का.सं.खि.10/111-117, सु.सं.नि.8/6अ.सं.शा.4/31
5)संज्ञानाश ( coma) का.सं.खि.10/170-171.
TREATMENT
1) Treatment of oedema-
a)-Oral route-
Decoction of root of Varshabhu mixed with Devdar,/Bhadradaru,Murva with honey का.सं.खि.10/126,का.सं.चि.2/5
-Decoction of Prushniparni,Bala,Vasaयो.र.स्त्री.रो.चि.,page no 280
b) External application-
-Sudation with hot waterहा.सं.तृती51/13
-A paste made up of Chandan,Madhuka,Ushir, Nagkeshar,Til,Ajashrungi, Mangistha,Ravimula,Punarnava is beneficial. यो.र.स्त्री.रो.चि
*Contraindication: -Should never give strong purgatives in Shotha(oedema). हा.सं.तृती51/13
2) Treatment of retention of urine:
Oral route -Decoction,paste, medicated milk of Shatavari,Darbha root,Madhuka,Kheermorat,Pashanbheda,Usheer,Katakphala is beneficial
का.सं.खि.10/144,145
-Powdered seeds of snake cucumber and cumber ,Magadhi,Sheelabheda,Sugar, with Tandul water.
हा.सं.तृती.51/11
2) Treatment for convulsion
का.सं .खि.10/111-117
* In vata predominance:-
- juice of Matulunga (one type of lemon) with vid salt and rock salt)
-decoction of Agnimantha and Varuna
-soup of meat of quail or partridge mixed with fat.
-juice or decoction of drugs capable of suppressing the Vata.
*In Pitta predominance:-
-Sweetened meat soup of wild animals or decoction of medicines of Madhura group mixed with pomegranate is useful.
*In Vata Kapha predominance,
Meat soup of wild animals with Yawakshara is always beneficial.
*****Sushruta says that if the condition is untreatable and intolerable, abortion should be induced . Available short time should be use promptly to save the life of the pregnant woman. Available time should not be wasted*****
सु.सं.चि.15/11,डल्हण टीका
It is important that don’t take any medications, vitamins or supplements without consulting to the doctor.
