MY family and I are currently going through a very sad period of our lives. My wife just delivered our first baby, and it was stillborn. As you can imagine, our grief is tremendous. What is stillbirth and when did my baby die?

A stillbirth is defined as any baby born with no signs of life after 24 weeks of pregnancy. If a baby or a foetus is born before 24 weeks of pregnancy, this is known as an abortion or a miscarriage. In many cases, the cause of death cannot be established. But many have postulated the following as a possible cause of the baby's death:

• Pre-existing diabetes or high blood pressure in the mother.

• If the pregnant mother (who did not previously have high blood pressure) develops high blood pressure in pregnancy.

• If the pregnant mother develops fits (eclampsia) in pregnancy.

• If there are placental problems.

• If there is an infection in the mother, which transmits to the baby, such as toxoplasmosis, Group B strep, listeriosis or German measles.

• Rhesus factor disease.

• Premature rupture of the membranes surrounding the baby.

My wife did not have high blood pressure before her pregnancy. But in her fifth month, she started to develop hypertension. Why is this so?

Hypertension is actually the most common medical problem encountered in mothers during pregnancy. It occurs in about 2 to 3 % of all pregnancies and has to be taken seriously.

Hypertension in pregnancy can be divided into four general types:

• Chronic hypertension -- this happens when the mother gets an elevated BP of over 140/90 mm Hg either before her pregnancy or before reaching 20 weeks of pregnancy. In this case, the mother is probably already a hypertensive even before her pregnancy. In cases where she didn't know she was hypertensive, her pregnancy actually unmasked it. This is the most common cause of hypertension in pregnancy.

• Pre-eclampsia/eclampsia.

• Pre-eclampsia superimposed on chronic hypertension.

• Gestational hypertension -- this is transient or temporary hypertension, or chronic hypertension identified in the second half of pregnancy. It used to be called PIH or pregnancy-induced hypertension.

This is very confusing. What is pre-eclampsia?

In pre-eclampsia, doctors have postulated the problem to be due to spasm or contraction of the walls (endothelium) of the blood vessels. This is called "vasospasm".

What causes this spasm? No one knows for sure till this day, but it is theorised that an abnormal placental development may be the cause. The abnormal placental development causes the blood vessels to be problematic, which in turn leads to poor blood flow to the placenta, thus complicating the placental damage even further.

There is also another theory suggesting that the mother may have an abnormal immune response to the "new" placenta/foetal tissue, leading to her white blood cells and immune response mediators "fighting" her own placenta and baby. All this leads to blood vessel damage and dysfunction.

At which part of pregnancy do I get pre-eclampsia ? In the first few months or throughout pregnancy ?

Pre-eclampsia usually occurs in the third trimester of pregnancy ( the last three months. ) However, you can also get early pre-eclampsia, which can happen in the second or early third trimester. You must always go to the doctor for frequent check-ups. Do not take the risk of defaulting treatment just because you think everything is okay in the first few months of your pregnancy.

Why are some women more at risk for pre- eclampsia in pregnancy? Is it because they are older? Or is it due to a certain lifestyle?

Here are some risk factors for pre-eclampsia:

• If you become a mother when you are very young (below 18 years of age) or older than your "peak" reproductive period (above 35 years of age). Also, when you are above 35 years old, the chances of you getting hypertension as a disease itself, outside of pregnancy, is higher.

• If you are having your first pregnancy.

• If you are having your pregnancy with a new partner/husband.

• If you had a history of pre-eclampsia with your previous pregnancies.

• If your mother or sister had pre-eclampsia.

• If you have hypertension before your pregnancy.

• If you have high cortisol levels, high aldosterone levels or anything that can cause secondary hypertension.

• If you have pre-existing diabetes mellitus.

• If you have kidney disease or systemic lupus (SLE).

• If you are obese.

• If you are having twin or multiple simultaneous pregnancies.

How will I know I have pre-eclampsia? Is it only diagnosed through BP measurement?

Some patients may experience visual disturbances like dark spots or zig zags in the eyes due to vasospasm. You can also have a headache localised more to the front, pretty much like migraine.

Some experience abdomen pain, swollen ankles and rapid weight gain due to water retention.

Your BP is of course elevated. And no, if you have pre-eclampsia, it doesn't always mean you will go on to eclampsia (fits.) You can control it with medication and assisted birth.

Pregnant ... under pressure