A few days ago I had to do a caesarean section for a young lady in her first pregnancy. She was only 28 weeks into her pregnancy. Unfortunately she had developed severe preeclampsia, a condition of the placenta characterised by high blood pressure, swelling and protien in the urine. She had underlying essential hypertension which was probably inherited and subsequently developed this condition. As her blood pressure became uncontrollable despite all medications, I made the decision to deliver her as it would otherwise have endangered her life and that of her baby.
There have been many proposals put forward over the years to prevent this condition but none proven. These include, a high protein diet but the World Health Authority concluded that in the abscence of a deficiency it would not be of benefit. Fish oil supplementation once proposed but subsequent trials have shown no benefit. There are more ongoing studies in New Zealand and Scandinavia. Calcium supplementation was shown initially to have some benefit in small trials but a large trial published by the New England Journal showed that there was no benefit in 1997. Low dose aspirin has been shown to have some benefit in those who have had previously had a pregnancy with preeclampsia and at risk in subsequent pregnancies so this may be of benefit but only on hindsight. The most recent study by the British Medical Journal showed that high doses of L-arginine together with anti-oxidants are of benefit but further studies need to be done.
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