Preeclampsia

How to recognize this potentially dangerous condition

What is preeclampsia?

If you're ever tempted to skip one of your prenatal checkups, consider this: Checkups are often the only way to detect serious complications of pregnancy, such as preeclampsia, that show few outward symptoms.

Preeclampsia is a toxic condition marked by increasing protein in the urine and hypertension (high blood pressure) which makes blood vessels tighten or constrict.

The condition increases your risk of seizures, stroke, liver and kidney damage, blood clotting problems, and damage to the heart, brain, lung, and eyes. Left unchecked, the condition can be life-threatening -- and in rare cases, even fatal -- for both mother and child.

Regular prenatal care is one of the key ways to pick up on early signals of preeclampsia, which affects 5 to 8 percent of all pregnant women. There are several groups at high risk for preeclampsia, but it can happen to any woman during any pregnancy, so regular visits are important for every woman who is pregnant.

Sometimes called toxemia, preeclampsia typically occurs during the second half of pregnancy, usually after the 20th to 28th week. It can also show up at the time of delivery, or even up to several weeks postpartum.

The risk of preeclampsia increases as the pregnancy progresses, and that's why the frequency of visits requested by the doctor increases after 28 to 32 weeks. Doctors monitor the blood pressure and check the urine for protein so they can be sure the baby is doing well -- and so that they can pick up any signs of preeclampsia before something bad happens.

The cause of preeclampsia remains a mystery -- some theories suggest that insufficient blood flow, blood vessel damage, dietary deficiencies, or genetics may play a role.

Who is at risk for the condition?

Anyone can get preeclampsia, but there are certain groups that have a greater likelihood of experiencing it than others. Here are some of the high-risk factors for the mother-to-be:

  • carrying more than one baby
  • older than 40
  • teen-age pregnancy
  • first pregnancy
  • immediate relatives (mothers, sisters, grandmothers, aunts) had the disease
  • history of high blood pressure, diabetes, or kidney disease
  • autoimmune disease such as lupus or rheumatoid arthritis
  • polycystic ovarian syndrome
  • extreme overweight

Scientists have recently come to believe that if you are pregnant and have gum disease, you may also be at increased risk for preeclampsia. A study of 1,115 pregnant women published in Obstetrics and Gynecology found that even after researchers adjusted for age, race, smoking, and insurance status, the odds that women with severe gum disease at delivery would develop preeclampsia were 2.4 times higher than for those who did not.

How do doctors test for preeclampsia?

There is no single test for preeclampsia, but there are several key signs that clinicians look for. If you have the disorder, the first clue that there's something wrong will probably come during your regular checkup. Every prenatal exam includes a check of your blood pressure and urine. A subtle change in blood pressure -- even as low as 10 to 20 points over your baseline measurements -- is often the first sign of preeclampsia. The protein test for urine is also very important -- just 1+ on the dipstick on a clean-catch urine sample can be enough to raise concern. If your regular urine test arouses suspicions of preeclampsia, your clinician will often order a 24-hour urine collection to determine whether there's significant protein leaking from the kidneys. Your doctor may also order kidney, liver, and blood tests.

However, recent guidelines fromm the American College of Obstetricians and Gynecologists allow physicians to diagnose preeclampsia even in the absence of protein in the urine. Other significant signs of preeclampsia include high blood pressure, impaired liver function, fluid in the lungs, progressive loss of kidney function, a low platelet count, and new brain or visual disturbances.

Doctors may also ask whether you've had persistent swelling (edema) in your face, hands, or feet. Some women also experience headaches, blurred vision, or sudden weight gain (a pound a day or more). The condition can come on gradually or flare up quickly and unexpectedly.

If I develop high blood pressure during pregnancy, does that mean I have preeclampsia?

Not necessarily. Pregnancy-induced hypertension is a separate condition from preeclampsia, but high blood pressure is often present in patients with preeclampsia.

In a pregnant woman, high blood pressure is defined as a blood pressure reading of 140/90 millimeters of mercury (mm Hg) or higher, measured on two separate occasions no more than six hours apart. But if your normal or baseline blood pressure reading tends to be on the lower side -- say, 90/60 mm Hg -- even an increase to 110/70 may be enough to arouse concern that you are developing a problem with your pregnancy. High blood pressure caused by pregnancy is not as serious as preeclampsia, but it also bears special watching, as it usually evolves into preeclampsia. Even when there is no preeclampsia, pregnancy-induced hypertension can require special treatment.

My shoes are too tight. Does this swelling mean that I have preeclampsia?

Swelling on its own doesn't mean you have the disease (although it's important to let your doctor know about it). In fact, some swelling is a perfectly normal discomfort associated with pregnancy. So don't worry if you simply can't fit into your shoes. Swelling is more of a concern if it doesn't go away after elevating your legs, if it's very apparent in your hands and face, or if it's the result of a rapid weight gain (five pounds or greater in a week).

To be safe, the American Academy of Family Physicians recommends that you call your doctor immediately if you have any of these possible warning signs of preeclampsia:

  • increased swelling
  • an increase in blood pressure
  • vomiting blood, or any excessive vomiting
  • reduced amounts of urine or no urine
  • blood in the urine
  • rapid heartbeat
  • dizziness
  • extreme nausea
  • ringing or buzzing in the ears
  • drowsiness
  • fever
  • sudden blindness
  • double vision
  • pain in the abdomen

If your healthcare practitioner suspects you have preeclampsia -- a sudden spike in your blood pressure can be an early sign -- he or she will probably want to see you on a weekly or even daily basis.

How can preeclampsia affect my pregnancy?

Left untreated, preeclampsia is one of the leading causes of maternal and fetal illness and death. The high blood pressure associated with preeclampsia constricts the blood vessels to your uterus, preventing the placenta -- the tissue that provides nutrients and oxygen to your baby -- from getting enough blood. If the placenta isn't properly nourished, that means your baby gets less air and food as well. This can lead to low birth weight and other troubles for your newborn.

Preeclampsia is also one of the leading causes of premature birth in the United States. Premature newborns can experience a variety of health problems ranging from breathing difficulties immediately after birth to lifelong challenges such as learning disabilities, cerebral palsy, epilepsy, blindness, and deafness.

Is there any cure for preeclampsia?

The only "cure" for preeclampsia is delivery of your baby; the condition typically goes away within 48 hours after birth. Once your baby is delivered, you will both be monitored for any problems before you go home.

If it's too early for your baby to be delivered safely, your doctor will usually recommend bed rest -- either at home or in the hospital -- to lower your blood pressure. Some experts recommend lying on your left side to take the weight of the baby off major blood vessels supplying the fetus with nutrients and oxygen. You may also be given medications to help control your blood pressure, and your doctor will want to keep a close eye on both you and the baby.

If your blood pressure can't be controlled through medication or other therapies, and your health or your baby's health is at risk, you may be given steroid drugs to help your growing baby's lungs mature so she can be delivered ahead of schedule.

If I need to give birth early will I have to have a c-section?

Not necessarily. A cesarean section is more likely if your health or your baby's health is in danger. With a severe case of preeclampsia, you may develop what is called the HELLP syndrome (hypertension, elevated liver enzymes, and low platelets). In this case, immediate delivery is usually required, and sometimes there is no choice but to deliver the baby even earlier than 36 weeks. For mild cases of preeclampsia, your doctor may use a drug such as oxytocin to kick-start your labor so that you can go on to have a vaginal delivery.

Can preeclampsia lead to other problems?

Most women with preeclampsia give birth to perfectly healthy babies. But if preeclampsia is not treated, the mother can go into potentially life-threatening seizures -- a condition called eclampsia. Fortunately this condition is rare, occurring in about 1 in 1,500 pregnancies. Proper prenatal care will usually catch preeclampsia before it has a chance to get this serious. However, be sure to call your doctor immediately if you suffer the following warning signs of eclampsia:

  • pain in the upper right side of your abdomen
  • severe headache
  • seeing flashing lights or having trouble with your vision
  • decreased mental alertness

Roughly 4 to 12 percent of women who have preeclampsia will develop HELLP syndrome. HELLP can occur before preeclampsia is even detected, so it's important to seek immediate medical attention if you experience the following warning signs:

  • pain in the right shoulder and upper right abdomen
  • nausea and vomiting
  • headache

Preeclampsia also increases the risk that your placenta will detach from your uterine wall before birth. In severe cases, this can cause heavy bleeding and shock, endangering both you and your baby.

Fortunately, complications can usually be prevented if you get regular prenatal care and your preeclampsia is spotted early.

What can I do to prevent preeclampsia?

There's no way to guarantee you won't get preeclampsia, but there are things you can do to make it less likely. The most important thing you can do is to keep all your prenatal appointments, since the condition is often caught during routine urine tests and blood pressure checks.

To better participate in your own care, you can find out your baseline blood pressure reading (your numbers prior to pregnancy) and ask what your numbers are at each prenatal visit. If you want to keep closer tabs, check your blood pressure at home using a monitor from a pharmacy -- just be sure to take it to your doctor's office to have it properly calibrated, so that you get the same readings at home as you do at the doctor's office. Keep a log, and note your numbers at the same time and after the same activity each day.

In a hospital setting, some health providers advise mothers-to-be to take magnesium sulfate during labor and immediately afterwards to help prevent eclampsia. (This requires special monitoring.). You can talk these options over with your health professional to see if they're right for you.

Some other tips to help you stay healthy are:

  • Eat a balanced diet without fried or fatty foods.
  • Drink six to eight glasses of water every day.
  • Get regular exercise.
  • Avoid alcohol and caffeine.
  • Get plenty of rest.
  • Check with your doctor on how much salt you should consume (but don't severely restrict salt without checking with your doctor).
  • Elevate your feet when you can during the day.
  • Take whatever vitamins and medications your doctor recommends.
  • Don't smoke.

Most important, if you notice any warning signs of preeclampsia, call your doctor right away.

References

Preeclampsia Foundation. Frequently Asked Questions. http://www.preeclampsia.org/FAQ.asp

When diagnosing preeclampsia, think widely. Medscape. Nov. 18, 2013.

American Congress of Obstetricians and Gynecologists. High Blood Pressure During Pregnancy. Patient Education Pamphlet, #AP034.

American Academy of Family Physicians. Preeclampsia. http://familydoctor.org/064.xml

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