American sprinter Tori Bowie died in April when she was eight months pregnant. The autopsy report published on June 12 reveals the causes of her death, which would be linked to pre-eclampsia, a serious complication of pregnancy.
Olympic vice-champion in the 100 meters in 2016 and world champion the following year, American athlete Tori Bowie died on April 23, 2023, when she was eight months pregnant. Worried, her relatives who could not reach her, alerted the authorities who found her at her home in Orange County, California. According to several American media that revealed an autopsy report, the death of the sprinter would be linked to pre-eclampsia. The media US Today also specifies that the work had started at the time of the death. How does pre-eclampsia manifest in pregnant women? We take stock of the causes and risks of this pregnancy complication with midwife Anh-Chi Ton.
What is pre-eclampsia?
Pre-eclampsia is a disease Really pregnancy specific : “Preeclampsia does not occur outside of pregnancy and heals postpartum. It is characterized by the combination of two criteria: a high blood pressure (>140/90mmHg) and the presence of protein in urine better than 0.3g/24h)“, precise Anh-Chi Ton. In most cases, expectant mothers give birth to a healthy baby and get back on their feet very quickly, but the risk of complications for her as for the child are very real, and potentially serious.
“Pre-eclampsia is characterized by the combination of two criteria: arterial hypertension (>140/90mmHg) and the presence of protein in the urine greater than 0.3 g/24h)”
What are the symptoms of pre-eclampsia?
“Ihypertension can manifest as headaches, tinnitus or phosphenes (the appearance of spots in front of the visual field). Proteinuriaeven if we sometimes observe a decrease in urine in case of aggravation, is on the other hand generally asymptomatic, hence the need for the urine dipstick test“, says the midwife. Here are the symptoms that can occur in case of pre-eclampsia during pregnancy:
- high blood pressure
- protein in the urine
- Swelling of the face or limbs
- Significant and rapid weight gain
- Signs of gastroenteritis and pain in the upper abdomen, in the back
- Visual disturbances including flies in front of the eyes
- Persistent headaches.
- Edemas of sudden onset, especially in the head, hands and feet, which begin to swell. Concretely, we feel difficulties to put on the usual shoes or rings.
- Pain in the epigastric bar or in the liver
- Severe nausea and vomiting
- Sharp deep tendon reflexes (if worsening)
- Other symptoms of complications will only show up on a blood test
- With regard to the baby, pre-eclampsia is sometimes associated with a growth retardation visible on ultrasound.
Pre-eclampsia can cause a large number of symptoms. During pregnancy, it is therefore very important that the mother-to-be be attentive to the signs sent to her by her body, and that she does not hesitate to consult in the event of unusual, persistent or worsening signs.
In which month of pregnancy can you have pre-eclampsia?
Pre-eclampsia mostly occurs at third trimester of pregnancy. We speak of early pre-eclampsia before 34 weeks of amenorrhea (in 50% of cases), but these are very feared by doctors because the risks associated with prematurity are then greater.
What are the causes of pre-eclampsia?
Some mothers-to-be are more at risk than others of develop pre-eclampsia. Anh-Chi Ton details the most common risk factors:Maternal age, multiple pregnancy, obesity, diabetes, history of hypertension or pre-eclampsia in a previous pregnancy, autoimmune disease, history of thrombosis or kidney disease, but also a history within the family in the mother or a sister“.
The midwife also draws attention to risk factors from an immunological point of view, pre-eclampsia being linked to dysfunction of the placenta which will less ensure the exchange of oxygen and proteins and release toxic substances in the maternal body. “The mother’s body can treat the placenta, genetically 50% coming from the father, as a foreign body. There is therefore a greater risk of pre-eclampsia with a new partner, in the case of a pregnancy obtained with insemination by sperm from a donor, if the couple has used condoms for a long time.“says the specialist.
Is pre-eclampsia a risk for the baby?
A pre-eclampsia can progress rapidly, especially during the third trimester of pregnancy and cause serious complications in 10% of cases, thus putting into play, in the short term, the vital prognosis of the mother and her future baby.
For the child, the major risk is that of growth retardation and prematurity, when labor must be induced early. The midwife explains that the decrease in the amount of amniotic fluid also has consequences for the child:he must adapt to this lack of supply and oxygenation and can therefore be in pain“. In case of acute complications or long or brutal suffering, pre-eclampsia can unfortunately lead to fetal death.
What are the risks of pre-eclampsia for the mother?
In the mother, pre-eclampsia can affect the kidneys (glomerular lesions), liver (microthromboses), the brain (micro thrombosis). It can also cause bleeding disorders and various complications such as HELLP-syndrome (severe liver damage), DIC (pathological activation of coagulation), retroplacental hematoma or retinal detachment which can lead to blindness.
The other major complication of pre-eclampsia being of course eclampsiafortunately rare: “It is a deadly complication that will lead to convulsions, sometimes a coma, but can also cause cerebral hemorrhage which is the main cause of death for mothers. This accident requires an emergency delivery“.
What treatment, what to do in case of pre-eclampsia?
Pre-eclampsia as such cannot be treated, although there are treatments intended to lower blood pressure. The mother-to-be is then hospitalized and monitored with regular examinations (blood pressure, proteinuria, uricemia and creatinine). The baby’s vitality is also constantly monitored, as is the amount of amniotic fluid.
Should we induce labor in case of pre-eclampsia?
The midwife recalls that “the only real treatment is the termination of the pregnancy, especially the delivery of the placenta. We can therefore induce a premature delivery to save the mother or the child.“.
What postpartum follow-up following pre-eclampsia?
After pre-eclampsia, the young mother will remain under close surveillance for several weeks. As long as the arterial hypertension persists, she will have to follow a antihypertensive treatment. A medical check is then necessary 6 weeks postpartum to make sure everything is back to normal.
Pre-eclampsia can also increase the long-term risk of developing certain conditions such as chronic hypertension, cardiovascular disease, recurrence of pre-eclampsia in a subsequent pregnancy or kidney disease. Blood pressure monitoring and regular testing for the presence of protein in the urine is required, as well as testing for other cardiovascular risk factors.
A risk of pre-eclampsia after childbirth?
Most often, pre-eclampsia occurs before childbirth. However, a quarter of cases occur postpartum, most often in the first days after birth. It can sometimes trigger up to 6 weeks postpartum. This is why women identified as at risk during their pregnancy must remain vigilant and attend their postnatal follow-up appointments without fail. If symptoms of pre-eclampsia appear, consult immediately.
Thanks to Anh-Chi Ton, midwife