Preeclampsia
What is preeclampsia?
Preeclampsia, also known as toxemia, is a complex disorder that affects about 5 to 8 percent of pregnant women. You’re diagnosed with preeclampsia if you have high blood pressure and protein in your urine after 20 weeks of pregnancy. The condition most commonly shows up after you’ve reached 37 weeks, but it can develop any time in the second half of pregnancy, as well as during labor or even after delivery (usually in the first 24 to 48 hours). It’s also possible to get preeclampsia before 20 weeks, but only in rare cases, such as with a molar pregnancy. Preeclampsia can range from mild to severe, and it can progress slowly or rapidly. The only way to get better is to deliver your baby.
How can preeclampsia affect my health and my baby’s?
The more severe your preeclampsia and the earlier it occurs in your pregnancy, the greater the risks for both you and your baby. Most women who get preeclampsia develop a mild version near their due date and they and their babies do fine with proper care. But when preeclampsia is severe, it can affect many organs and cause serious or even life-threatening problems. That’s why you’ll need to deliver early if your condition is severe or getting worse.
Preeclampsia causes your blood vessels to constrict, resulting in high blood pressure and a decrease in blood flow that can affect many organs in your body, such as your liver, kidneys, and brain. When less blood flows to your uterus, it can mean problems for your baby, such as poor growth, decreased amniotic fluid, and placental abruption — when the placenta separates from the uterine wall before delivery. In addition, your baby may suffer the effects of prematurity if you need to deliver early to protect your health.
Changes in your blood vessels caused by preeclampsia may cause your capillaries to “leak” fluid into your tissues, which results in swelling (known as edema). And when the tiny blood vessels in your kidneys leak, protein from your bloodstream spills into your urine. (It’s normal to have a tiny amount of protein in your urine but more than a little bit can signal a problem.)
In rare cases, preeclampsia can lead to seizures, a condition called eclampsia. In fact, “pre-eclampsia” was so named because it was first identified as the condition that leads to these seizures. All women with severe preeclampsia are given magnesium sulfate, an anti-seizure medication. That’s because the seizures can be hard to predict — though they’re often preceded by symptoms such as severe or persistent headache, blurred vision or seeing spots, or intense upper abdominal pain).
Up to 20 percent of women with severe preeclampsia will develop a condition called HELLP syndrome. HELLP stands for Hemolysis, the breakdown of red blood cells; Elevated Liver enzymes; and Low Platelets, the blood cells that are necessary for blood clotting. Having this condition puts you and your baby at a higher risk for the same kinds of problems you would have with severe preeclampsia. Once you develop preeclampsia, you’ll have your blood tested periodically for signs of HELLP syndrome.
How would I know if I had preeclampsia?
Preeclampsia often has no obvious symptoms, particularly in the early stages, so you may not feel sick. What’s more, some symptoms of preeclampsia, such as swelling and weight gain, may seem like normal pregnancy complaints. So you might not know you have the condition until it’s discovered at a routine prenatal visit, when a nurse takes your blood pressure and checks your urine for protein. (This is one of the reasons it’s so important not to miss your appointments.)
Your blood pressure is considered high if you have a systolic reading of 140 or greater or a diastolic reading of 90 or higher. Because blood pressure can fluctuate during the day, you’ll need to have more than one reading to confirm that it’s consistently high. The nurse will also dip a test strip into your urine sample to look for protein. The amount of protein in urine can also fluctuate during the day, so if your practitioner suspects there’s a problem, she’ll have you collect your urine for 24 hours so it can be tested.
Preeclampsia can also come on suddenly between prenatal appointments, so it’s important to be aware of the possible symptoms. Call your midwife or doctor right away if you notice swelling in your face or puffiness around your eyes, more than slight swelling of your hands, or excessive or sudden swelling of your feet or ankles. This is caused by water retention that can also lead to a rapid weight gain — so also let your caregiver know if you gain more than 4 pounds in a week. (Be aware, though, that not all women with preeclampsia have swelling.) With more severe preeclampsia you may have other symptoms as well, including:
• A severe or persistent headache
• Vision changes, including double vision, blurriness, seeing spots or flashing lights, light sensitivity, or temporary loss of vision
• Intense pain or tenderness in your upper abdomen
• Nausea or vomiting
How is preeclampsia managed?
It depends on how severe it is, how far along you are, and how your baby’s doing. You’ll probably be hospitalized at least for an initial assessment and possibly for the rest of your pregnancy. Besides blood pressure and urine testing, your practitioner will do a number of blood tests to find out how serious the problem is. You’ll also have a sonogram to check your baby’s growth, and a biophysical profile (BPP) and nonstress test (NST) to see how your baby’s doing.
If you have mild preeclampsia and you’re 37 weeks or more, you’ll likely be induced right away, especially if your cervix is starting to thin out and dilate. Or, if there are signs that you or your baby can’t tolerate labor, you’ll have a c-section.
If you’re not yet at 37 weeks, your condition is mild and appears stable, and your baby’s in good condition, you probably won’t need to deliver right away. Instead, you might be sent home and told to take it easy, or your practitioner might want you to remain in the hospital so that you can rest in bed and be monitored. Although no definitive studies show that bedrest improves the outcome for you and your baby when you have preeclampsia, it’s true that blood pressure is generally lower when you’re at rest. So most practitioners will recommend restricting your activities or going on modified bedrest. (Complete bedrest, in which you’re confined to bed for an extended period, is probably not helpful and increases your risk for blood clots.)
Whether at home or in the hospital, you and your baby will be monitored closely for the rest of your pregnancy. If you’re at home, this will mean coming in to see your practitioner for frequent blood pressure checks and urine tests, as well as going in for periodic sonograms and NSTs, and doing daily fetal kick counts. If at any time your symptoms indicate that your preeclampsia is getting worse or that your baby isn’t thriving, you’ll be re-admitted to the hospital and will probably need to deliver.
If you’re diagnosed with severe preeclampsia, you’ll definitely have to spend the rest of your pregnancy in the hospital. And you may be transferred to a hospital where you can be cared for by a high-risk pregnancy specialist. You’ll be given magnesium sulfate intravenously to prevent seizures, and another medication to lower your blood pressure if it’s extremely high. If you’re 34 weeks or more, you’ll be induced or delivered by c-section. If you’re less than 34 weeks, you’ll be given corticosteroids to help your baby’s lungs mature faster. If you don’t deliver immediately, both you and your baby will be monitored extremely closely. You’ll be induced (or, in certain situations, delivered by cesarean section) at the first sign that the preeclampsia is getting worse (including if you have HELLP or eclampsia) or your baby is not thriving inside, regardless of where you are in your pregnancy.
If you develop preeclampsia during labor, you’ll be monitored closely. Depending on your situation, you may be given magnesium sulfate to prevent seizures and medication to reduce your blood pressure.
After delivery, you’ll remain under close supervision for a few days to keep tabs on your blood pressure and watch for signs of other complications. Many cases of eclampsia and HELLP syndrome happen after delivery, usually during the first 48 hours. So expect to continue having your blood pressure taken frequently. Most women, particularly those with mild preeclampsia, see it start to go down in a day or so. More severe cases often remain elevated for longer. Those women are given magnesium sulfate through an IV for at least 24 hours after delivery to help prevent seizures, and may end up going home on blood pressure medication.
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