Pregnancy is a phase in the life of a woman that many look forward to and experience the joy of giving birth to a life, whilst some have reservations over getting pregnant. These are individual choices that women make and therefore needs to be respected.
The birth of a healthy baby is a result of good care that a pregnant woman receives right through her pregnancy – from her family, her doctor and also because she takes good care of herself with healthy, nutritious diet, adequate rest and exercise, positive thoughts etc.,   Whilst most pregnancies result in healthy babies, some pregnancies develop complications, resulting in adverse outcomes for both the mother and the baby. One such complication in pregnancy that is now increasingly being noticed is Preeclampsia or Gestosis.
Medical text books describe preeclampsia as a hypertensive disorder in pregnancy. Sudden and high blood pressure during the course of pregnancy especially from the 5th month onwards along with elevated levels of biochemistry tests suggestive of liver / kidney damage or circulatory problems from low haemoglobin and platelets are typically how Preeclampsia presents itself. Hypertensive disorders in pregnancy is estimated to be nearly 20-25% of all pregnancies in India, which is quite high, given the high incidence of lifestyle diseases such as obesity, diabetes, late pregnancies etc., Whilst normal blood pressure is 120 / 80mm Hg,  preeclampsia results in blood pressure shooting up suddenly and unexpectedly to 140 / 90mmHg or more. Bleeding, epileptic fits, neurological complications are other serious complications that can arise if not diagnosed and managed properly. A few symptoms include puffiness of the face, swelling of feet, episodes of abdominal pain, sudden and additional weight gain of 3-6 kg instead of 1-1.5 kg, within 2-4 weeks unexpectedly etc., Preeclampsia results in delivery of many babies earlier than the term of 38-40 weeks (preterm birth) as delaying the delivery can result in survival issues for the baby and in some cases the mother as well.
The causative factors of preeclampsia are not well understood yet. It is believed to be of metabolic origin causing the placenta to become dysfunctional. A dysfunctional placenta causes a host of downstream events, such as elevation in blood pressure, organ damage etc., as described above. Most obstetricians are able to detect preeclampsia after the disorder has expressed itself. Diagnoses and detection are through a combination of clinical assessment, lab and ultrasound reports. If preeclampsia presents itself closer to the term of the pregnancy, emergency intervention and delivery of the baby are the usual ways of managing the disorder.   The challenge is, in case the disorder manifests itself before 34 weeks of gestation. Early onset preeclampsia as it is called in medical parlance, may require admission of the baby in neonatal ICU and often the mother too after delivery and where indicated. Every extra day / week that is gained to deliver the baby closer to 34 weeks of gestation is that much more beneficial for the baby as it helps improve survival rates.
Diagnoses and detection of Preeclampsia is through a combination of clinical assessment, ultrasound reports and lab tests. Individually each of these methods have low sensitivity and poor predictability hence the need to do them together to improve detection. Researchers have been aiming to unravel the origin of preeclampsia and to determine suitable biomarkers that can confirm the presence of the disorder at an early stage and also to predict its onset.  Advanced research using mass spectrometry, protein sequencing etc., have helped identify a number of proteins that were found to be activated / over expressed in preeclampsia. One of the protein biochemical markers that was investigated quite early, and as far back as 1984 is Fibronectin. Fibronectin plays several important roles in the human body. In pregnancy fibronectin is thought to play an important role in embryogenesis (development of the foetus).  A set of researchers have shown that the protein, Fibronectin gets elevated in preeclampsia, by measuring the protein in different stages of the pregnancy and in pregnancies that developed preeclampsia.
It is now easy to assess the risk of preeclampsia in pregnancies by measuring the concentration of this protein. A device similar to a blood sugar meter is now available in India that enables Fibronectin to be measured in 10 minutes from a finger stick sample of the pregnant woman. The test can be done in the clinic of the obstetrician and is found to be helpful in the assessment of risk. A trained nurse or technician can run the test as it is simple and easy to use. This saves valuable time for the doctor and the pregnant woman and helpful where there is rapid progression of disease and an intervention decision needs to be made.
The test of Fibronectin in the blood also gives results which help the clinician to categorise the patient as mild , moderate and severe. This test can be placed in the pregnancy surveillance at 12 weeks’ gestation as a screening tool especially in women identified as at risk of developing gestosis. The test can also be performed when the woman presents with raised Blood pressure and thus help in identifying the mothers needing closer surveillance and monitoring and those who can be managed on the outpatient basis. For more information feel free to contact the author.
About the Author
With 27 years of experience in clinical practice and teaching gynecology, Dr. Girija Wagh is an expert Gynecologist. As a renowned academician, she has many research papers published. She always keeps herself updated with the current knowledge and latest trends. Dr. Girija through her position in FOGSI has advocated for women’s health issues to the government. She has been a member of the CSB PCPNDT Act and national mentor under the LaQshiya initiative. She also specializes in complicated pregnancy conditions and infertility. Not limiting to just this, Dr. Girija is a compassionate doctor and counselor.
