Preeclampsia

Answer 1

Definition

Preeclampsia is a pregnancy condition in which high blood pressure and protein in the urine develop after the 20th week (late 2nd or 3rd trimester) of pregnancy.

Alternative Names

Toxemia; Pregnancy-induced hypertension (PIH)

Causes, incidence, and risk factors

The exact cause of preeclampsia is not known. Possible causes include:

• Autoimmune disorders
• Blood vessel problems
• Diet
• Genes

Preeclampsia occurs in a small percentage of pregnancies. Risk factors include:

• First pregnancy
• Multiple pregnancy (twins or more)
• Obesity
• Older than age 35
• Past history of diabetes, high blood pressure, or kidney disease

Symptoms

Often, women who are diagnosed with preeclampsia do not feel sick.

Symptoms of preeclampsia can include:

• Swelling of the hands and face/eyes (edema)
• Weight gain
  • More than 2 pounds per week
  • Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with pregnancy.

Symptoms of more severe preeclampsia:

• Headaches that are dull or throbbing and will not go away
• Abdominal pain, mostly felt on the right side, underneath the ribs. Pain may also be felt in the right shoulder, and can be confused with heartburn, gallbladder pain, a stomach virus, or the baby kicking
• Agitation
• Decreased urine output, not urinating very often
• Nausea and vomiting (worrisome sign)
• Vision changes -- temporary loss of vision, sensations of flashing lights, auras, light sensitivity, spots, and blurry vision

Signs and tests

The doctor will perform a physical exam and order laboratory tests. Signs of preclampsia include:

• High blood pressure, usually higher than 140/90 mm/Hg
• Protein in the urine (proteinuria)

The physical exam may also reveal:

• Swelling in the hands and face
• Weight gain

Blood and urine tests will be done. Abnormal results include:

• Protein in the urine (proteinuria)
• Higher-than-normal liver enzymes
• Platelet count less than 100,000 (thrombocytopenia)

Your doctor will also order tests to see how well your blood clots, and to monitor the health of the baby. Tests to monitor the baby's well-being include pregnancy ultrasound, non-stress test, and a biophysical profile. The results of these tests will help your doctor decide whether your baby needs to be delivered immediately.

Women who began their pregnancy with very low blood pressure, but had a significant rise in blood pressure need to be watched closely for other signs of preeclampsia.

Treatment

The only way to cure preeclampsia is to deliver the baby.

If your baby is developed enough (usually 37 weeks or later), your doctor may want your baby to be delivered so the preeclampsia does not get worse. You may receive different treatments to help trigger labor, or you may need a c-section.

If your baby is not fully developed and you have mild preeclampsia, the disease can often be managed at home until your baby has a good chance of surviving after delivery. The doctor will probably recommend the following:

• Getting bed rest at home, lying on your left side most or all of the time
• Drinking extra glasses of water a day and eating less salt
• Following-up with your doctor more often to make sure you and your baby are doing well
• Taking medicines to lower your blood pressure (in some cases)

Immediately call your doctor if you gain more weight or have new symptoms.

In some cases, a pregnant woman with preeclampsia is admitted to the hospital so the health care team can more closely watch the baby and mother.

Treatment may involve:

• Medicines given into a vein to control blood pressure, as well as to prevent seizures and other complications
• Steroid injections (after 24 weeks) to help speed up the development of the baby's lungs

You and your doctor will continue to discuss the safest time to deliver your baby, considering:

• How close you are to your due date. The further along you are in the pregnancy before you deliver, the better it is for your baby.
• The severity of the preeclampsia. Preeclampsia has many severe complications that can harm the mother.
• How well the baby is doing in the womb.

The baby must be delivered if you have signs of severe preeclampsia, which include:

• Tests (ultrasound, biophysical profile) that show your baby is not growing well or is not getting enough blood and oxygen
• The bottom number of the mother's blood pressure is confirmed to be over 110 mmHg or is greater than 100 mmHg consistently over a 24-hour period
• Abnormal liver function tests
• Severe headaches
• Pain in the belly area (abdomen)
• Eclampsia
• Fluid in the mother's lungs (pulmonary edema)
• HELLP syndrome
• Low platelet count (thrombocytopenia)
• Decline in kidney function (low amount of urine, large amount of protein in the urine, increase in the level of creatinine in the blood)

Expectations (prognosis)

Usually the high blood pressure, protein in the urine, and other effects of preeclampsia go away completely within 6 weeks after delivery. However, sometimes the high blood pressure will get worse in the first several days after delivery.

A woman with a history of preeclampsia is at risk for the condition again during future pregnancies. Often, it is not as severe in later pregnancies.

Women who have high blood pressure problems during more than one pregnancy have an increased risk for high blood pressure when they get older.

Death of the mother due to preeclampsia is rare in the U.S. The infant's risk of death depends on the severity of the preeclampsia and how prematurely the baby is born.

Complications

Preeclampsia can develop into eclampsia if the mother has seizures. Complications in the baby can occur if the baby is delivered prematurely.

There can be other severe complications for the mother, including:

• Bleeding problems
• Premature separation of the placenta from the uterus before the baby is born (placental abruption)
• Rupture of the liver
• Stroke
• Death (rarely)

However, these complications are unusual.

Severe preeclampsia may lead to HELLP syndrome.

Calling your health care provider

Call your health care provider if you have symptoms of preeclampsia during your pregnancy.

Prevention

Although there is no known way to prevent preeclampsia, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as preeclampsia early.

Proper prenatal care is essential. At each pregnancy checkup, yor health care provider will check your weight, blood pressure, and urine (through a urine dipstick test) to screen you for preeclampsia.

As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals, and the basic food groups is important. Cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol, and any medication not prescribed by a doctor is essential. Talk to your health care provider before taking any supplements, including herbal preparations.

References

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.

Cunnigham FG, Leveno KL, Bloom SL, et al . Hypertensive disorders in pregnancy. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 34.

Answer 2

Hypertension caused by preeclampsia can adversely affect the fetus by causing constriction of the placental arteries. Arterial constriction may result in severe reduction in the blood flow to areas of the placenta. If the blood flow remains constricted, areas of the placenta may "die", putting the baby in distress.

Reviewed By

Review Date: 09/12/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Definition

Preeclampsia is when a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.

Alternative Names

Toxemia; Pregnancy-induced hypertension (PIH)

Causes, incidence, and risk factors

The exact cause of preeclampsia is unknown. Possible causes include:

• Autoimmune disorders
• Blood vessel problems
• Your diet
• Your genes

Risk factors include:

• First pregnancy
• Multiple pregnancy (twins or more)
• Obesity
• Being older than age 35
• History of diabetes, high blood pressure, or kidney disease

Symptoms

Often, women who have preeclampsia do not feel sick.

Symptoms of preeclampsia can include:

• Swelling of the hands and face/eyes (edema)
• Sudden weight gain over 1-2 days, more than 2 pounds a week

Note: Some swelling of the feet and ankles is considered normal during pregnancy.

Symptoms of severe preeclampsia include:

• Headache that does not go away
• Belly pain on the right side, below the ribs. Pain may also be felt in the right shoulder, and can be confused with heartburn, gallbladder pain, a stomach virus, or the baby kicking
• Irritability
• Decreased urine output, not urinating very often
• Nausea and vomiting (worrisome sign)
• Vision changes, including temporary blindness, seeing flashing lights or spots, sensitivity to light, and blurry vision

Signs and tests

The doctor will perform a physical exam. This may show:

• High blood pressure, usually higher than 140/90 mm/Hg
• Swelling in the hands and face
• Weight gain

Blood and urine tests will be done. This may show:

• Protein in the urine (proteinuria)
• Higher-than-normal liver enzymes
• Platelet count less than 100,000 (thrombocytopenia)

Tests will also be done to:

• See how well your blood clots
• Monitor the baby's health

The results of a pregnancy ultrasound, non-stress test, and other tests will help your doctor decide whether your baby needs to be delivered immediately.

Women who had low blood pressure at the start of their pregnancy, followed by a significant rise in blood pressure need to be watched closely for other signs of preeclampsia.

Treatment

The only way to cure preeclampsia is to deliver the baby.

If your baby is developed enough (usually 37 weeks or later), your doctor may want your baby to be delivered so the preeclampsia does not get worse. You may receive medicines to help trigger labor, or you may need a c-section.

If your baby is not fully developed and you have mild preeclampsia, the disease can often be managed at home until your baby has a good chance of surviving after delivery. The doctor will probably recommend:

• Bed rest, lying on your left side most or all of the time
• Drinking extra glasses of water a day
• Eating less salt
• Frequent doctor visits to make sure you and your baby are doing well
• Medicines to lower your blood pressure (sometimes)

Immediately call your doctor if you gain more weight or have new symptoms.

Sometimes, a pregnant woman with preeclampsia is admitted to the hospital so the health care team can more closely watch the baby and mother.

Treatment in the hospital may include:

• Medicines given into a vein to control blood pressure and to prevent seizures and other complications
• Steroid injections (after 24 weeks) to help speed up the development of the baby's lungs

You and your doctor will continue to discuss the safest time to deliver your baby, considering:

• How close you are to your due date. The further along you are in the pregnancy before you deliver, the better it is for your baby.
• The severity of the preeclampsia. Preeclampsia has many severe complications that can harm the mother.
• How well the baby is doing in the womb.

The baby must be delivered if there are signs of severe preeclampia, including:

• Tests that show your baby is not growing well or is not getting enough blood and oxygen
• The bottom number of your blood pressure is over 110 mmHg or is greater than 100 mmHg consistently over a 24-hour period
• Abnormal liver function test results
• Severe headaches
• Pain in the belly area (abdomen)
• Eclampsia
• Fluid in the mother's lungs (pulmonary edema)
• HELLP syndrome
• Low platelet count (thrombocytopenia)
• Reduce urine output, a lot of protein in the urine, and other signs that your kidneys aren't working properly

Expectations (prognosis)

Sign and symptoms of preeclampsia usually go away within 6 weeks after delivery. However, the high blood pressure sometimes get worse the first few days after delivery.

If you have had preeclampsia, you are more likely to develop it again in another pregnancy. However, it is not usually as severe as the first time.

If you have have high blood pressure during more than one pregnancy, you are more likely to have high blood pressure when you get older.

Death of the mother due to preeclampsia is rare in the U.S. The infant's risk of death depends on the severity of the condition and how early the baby is born.

Complications

Preeclampsia can develop into eclampsia if the mother has seizures. Complications in the baby can occur if the baby is delivered prematurely.

There can be other severe complications for the mother, including:

• Bleeding problems
• Premature separation of the placenta from the uterus before the baby is born (placental abruption)
• Rupture of the liver
• Stroke
• Death (rarely)

However, these complications are unusual.

Severe preeclampsia may lead to HELLP syndrome.

Calling your health care provider

Call your health care provider if you have symptoms of preeclampsia during your pregnancy.

Prevention

There is no known way to prevent preeclampsia. It is important for all pregnant women to start prenatal care early and continue it through the pregnancy.

At each pregnancy checkup, yor health care provider will check your weight, blood pressure, and urine (through a urine dipstick test) to screen you for preeclampsia.

Pregnant women should follow a healthy diet and take prenatal vitamins with folic acid. You should cut back on processed foods, refined sugars, and avoid caffeine, alcohol, and any medication not prescribed by a doctor. Talk to your health care provider before taking any supplements, including herbal preparations.

References

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.

Cunnigham FG, Leveno KL, Bloom SL, et al . Hypertensive disorders in pregnancy. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 34.

Reviewed By

Review Date: 09/12/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.