Preeclampsia is a condition in which high blood pressure (pregnancy-induced hypertension), proteinuria (protein in the urine), edema (swelling) and excessive weight gain occur during pregnancy. The condition usually occurs after the 20th week of pregnancy.
The placenta is the spongy material in the mother's uterus that nourishes the fetus. Some experts believe that a problem with the placenta causes preeclampsia. The mother has spasms of the blood vessels, which increase her blood pressure. The blood flow to the placenta is impaired. If the blood pressure is not controlled, it can damage the placenta and cause death of the baby.
Preeclampsia develops in 5% of pregnant women. It usually occurs after the 20th week of pregnancy. It may be mild or severe. The high blood pressure can affect the brain, kidneys, liver, and lungs.
If the woman develops seizures or coma, the condition is known as eclampsia.
The cardinal signs of preeclampsia are; hypertensionproteinuria (protein in the urine)edemaexcessive weight gain
The symptoms and other signs of preeclampsia may include: agitation and confusionchanges in mental statusdecreased urine outputheadachesnausea and vomitingpain in the right upper part of the abdomenshortness of breathsudden weight gain over 1 to 2 daysswelling of the face or handsvisual impairmentweight gain of more than 2 pounds per week
Factors that increase a woman's risk of preeclampsia are: a first pregnancyAfrican American ethnicitydiabeteshigh blood pressure or chronic renal disease before pregnancyfamily history of pregnancy-induced hypertensionlow socioeconomic statusmaternal age below 20 or over 35molar pregnancy, an abnormal condition that mimics a normal pregnancy but is actually a tumormultiple gestation such as twins or tripletspreeclampsia or eclampsia in previous pregnanciesshe or the baby's father was born of a pregnancy with preeclampsia or eclampsiaone of the thrombophiliasantiphospholipid syndromeobesity
No one knows why some women with preeclampsia develop the seizures associated with eclampsia. Theories about why seizures might occur in pregnancy involve: small clots that block blood vessels in the brain and restrict oxygennarrowing of tiny arteries in the brainareas of bleeding in the brainhigh blood pressuredietary risksgenetic risksa problem with the brain or nervous system
There are no known ways to prevent preeclampsia. All pregnant women should have early prenatal care. Blood pressure changes should be watched closely.
Diagnosis of preeclampsia begins with a medical history and physical exam. The woman's blood pressure will be measured. The healthcare provider may order the following tests: blood tests to check clotting and liver functioncomplete blood count, or CBC, to look for abnormal blood cell countscranial CT scan to check for bleeding or strokepregnancy ultrasound to check the age and condition of the babyurinalysis to look for protein in the urine
Preeclampsia may cause pregnancy complications, including the following: increased risk for cesarean birthintrauterine growth restriction (IUGR), a lack of normal growth of the baby within the wombplacenta abruptio, or separation of the placenta from the uterine wallpremature laborstillbirthsuffocation at birth, or asphyxia
Preeclampsia can also cause the following health problems that affect both mother and baby: acute renal failure, or kidney failuredisseminated intravascular coagulation, or DIC, a clotting problem that causes widespread bleedingeclampsia, with high blood pressure, coma, and seizuresHELLP syndrome, which includes liver and blood disordersintracerebral hemorrhage and stroke
Preeclampsia is not contagious. Both mother and baby are at risk for complications of preeclampsia.
Giving birth is the only cure for preeclampsia. Preeclampsia limits blood flow to the placenta and the baby. If a woman has symptoms, flow may already be reduced by 50%.
The healthcare provider may decide to induce labor or to wait for labor to occur naturally. The following factors will determine the decision: condition of the mother and her babydilation of the cervixeclampsiafailure of growth of the baby in the uterus as measured by pregnancy ultrasoundsgestational age of the babydistress of the babyfluid in the lungspresence of laborseverity of the conditionthe wishes of the mother
If the symptoms are mild, outpatient treatment is common. This includes bed rest at home and biweekly exams in the provider's office. If symptoms do not improve, hospitalization may be needed.
Testing of the unborn child will be done to decide if early delivery is possible. In severe cases, the provider may decide to induce labor with medications.
Delivery may be induced if any of the following conditions occur: destruction of red blood cells, known as hemolysiselevated liver function testsfalling platelet countpain in the right upper abdomenpersistent and severe headache signs of kidney failure very high blood pressure for more than 24 hours
Treating severe preeclampsia means controlling the woman's blood pressure. A Cesarean birth may be needed. Medications to treat eclampsia include intravenous magnesium sulfate, hydralazine (i.e., Apresoline), and, if necessary, diazoxide (i.e., Hyperstat, Proglycem). Anticonvulsants may be used to prevent seizures.
A cesarean birth may cause bleeding, infection, or even death. Medicines used to treat eclampsia may cause low blood pressure, breathing difficulties, nausea, or allergic reactions.
After the baby is born, a woman may still have seizures for up to 6 weeks. Her provider will closely monitor blood pressure, urine and blood tests, and any other symptoms. If a baby is born prematurely and has health problems, hospitalization and care will be needed.
Twenty-five percent of women with eclampsia will have hypertension in subsequent pregnancies, but only 5% of these will be sever and only 2% will be eclamptic again.
Also, multiparous women with eclampsia (eclampsia in a pregnancy that is not the first pregnancy) are at higher risk for essential hypertension later in life and are at a higher risk for higher mortality in subsequent pregnancies.
Preeclampsia may recur in later pregnancies. Early prenatal care is key to recognizing warning signs and managing the condition. Any new or worsening symptoms should be reported to the healthcare provider.
