Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
7/25/2002

TOXEMIA OF PREGNANCY

    Last week's column dealt with a condition called schizophrenia which undoubtedly has a basic chemical flaw in the brain that is yet to be identified. It would have been my impression that with all the science and technology that we have today, schizophrenia would have been solved long ago. Indeed, we do have drugs that help the problem even though we are not aware of the specific chemical abnormalities causing the problem.

    There is another disease which undoubtedly has a simple basic flaw in the body's chemistry that scientists still haven't solved. This condition is called toxemia of pregnancy or technically "pre-eclampsia/eclampsia". This is a condition that seems to occur in the last three months of a woman's pregnancy. The first noticed abnormality is a slight increase in the lady's blood pressure. If a urine is checked at that time, it may be seen that there is a small amount of protein present which is very abnormal. The third thing noted is that the lady maybe develop worsening fluid retention and excessive weight gain. Her ankles maybe more swollen than normal. When this combination of four findings occur in the last three months of a lady's pregnancy, the condition is called "pre-eclampsia". If the condition progresses to the point where the lady has seizures, the condition is called "eclampsia". When the condition reaches this stage, there is a very high incidence of loss of the baby and life-threatening consequences for the woman.

    This condition is relatively easy to recognize and relatively common. And yet for all of the work over many years time, as yet there is no identified abnormality to explain the problem. In Chicago, Illinois at the one of the obstetrical hospitals, there is a very large rock sitting in  front of the hospital. Etched in this rock is a plaque stating that this rock is placed to commemorate the person who eventually will solve the mystery of toxemia of pregnancy. Thus far, there is no name is on this rock.

    Toxemia of pregnancy seems to involve an abnormality of the clotting mechanisms such that clotting tends to occur diffusely within the blood vessels within the body. Within the walls of our blood vessels are chemicals that keep our blood from clotting on the inside of the blood vessels. Everyone knows that if your blood gets onto a foreign surface such as table or a  rag, it will clot. Blood is not supposed to clot within your blood vessels but this seems to be what happens in ladies that have pre-eclampsia.

    Just as in schizophrenia, where we have some effective therapys even though we don't know the cause of the disease, there are effective therapy's for pre-eclampsia even though wedon't know the cause of this disease. The most important steps in care involve control of the blood pressure and effective salt restriction. Lastly, there is something magic about bedrest. Ladies that are developing pre-eclampsia have a resolution of the problem with  bedrest and the above mentioned blood pressure control and salt restriction. Most of the  time, these three measures will reverse the toxemia problem. In those few women who  do progress inspite of this, the use of large doses of magnesium is very often preventive for further progression of the toxemia of pregnancy problem.  Failing that, delivery of the baby may reverse the problem.

    The most important aspect of treating toxemia of pregnancy is early attention to the problem and institution of adequate blood pressure control. In addition to the family practitioners who have cared for pregnancies for many years, there are now three obstetricians in Pierre who go to outlying clinics in the surrounding area. Dr. Jim Minder goes to the obstetrics clinic in Eagle Butte. Dr. Brent Lindbloom goes to the Rural Health, Inc. Clinic in Gettysburg and to the Ft. Thompson Clinic. The newest obstetrician to Pierre is Dr. Shelley Neilson, who goes to the Rural Health, Inc. Clinic in Highmore,  to the clinic in Miller, South Dakota, and to the Lower Brule Public Health Service Hospital. In addition, the Nurse Practitioners, Physician Assistants and Family Practitioners who service the local medical clinics are well aware of this condition and the need for special attention to the lady who is developing these problems during the last three months of her pregnancy. Prenatal care is very, very important  for both the health of the baby and the health of the mother.

    Lastly, we are still waiting for that person who is going to solve the mystery of what causes this problem to begin with and get a name etched in that rock in Chicago, Illinois