The vast majority of women who become pregnant have few complications during their pregnancy but, in some women, complications can occur. One of the most serious complications of pregnancy is that of preeclampsia/eclampsia – a condition that, if not diagnosed early and managed correctly, can result in serous problems for both the pregnant woman and the developing fetus.
What is preeclampsia?
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. It can also occur shortly after delivery.
Early signs of preeclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria). The earlier preeclampsia is diagnosed and monitored, the better the outlook for the pregnant woman and baby.
If undiagnosed, preeclampsia can lead to eclampsia, a serious condition that can put the pregnant woman and her baby at risk and, in rare cases, causes death. Women with preeclampsia who have seizures are considered to have eclampsia. There is no cure for preeclampsia at this time. Symptoms usually disappear once the baby is delivered.
What causes preeclampsia?
The exact causes of preeclampsia and eclampsia — a result of a placenta that does not function properly — are not known at this time, although some researchers suggest that genetics plays a key role, while others think that insufficient blood flow to the uterus plays a role as well. Poor nutrition or high body fat are also thought to be key factors.
Who is at risk for getting preeclampsia?
Preeclampsia is most often seen in first-time pregnancies, in pregnant teenagers, and in women over 40 years. Other risk factors include the following:
• A history of preeclampsia
• Having a mother or sister who had preeclampsia
• A history of obesity
• Carrying more than one baby
• History of diabetes, kidney disease, lupus, or rheumatoid arthritis
How do you know if you have preeclampsia?
Some women might not know that they have this condition. This is another reason why all pregnant women should have regular prenatal visits and seen by a qualified healthcare provider who can detect early symptoms and signs.
Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring the woman’s blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.
Other signs and symptoms of preeclampsia may include:
• Excess protein in your urine (proteinuria) or additional signs of kidney problems. (You can have pre-eclampsia without proteinuria.)
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under the ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in the blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath, caused by fluid in your lungs
Sudden weight gain and swelling (oedema) — particularly in your face and hands — may occur with preeclampsia. It should be pointed out that these symptoms also occur in many normal pregnancies, so they are not considered reliable signs of preeclampsia.
Pregnant women should note that they can have preeclampsia without any symptoms.
Treating preeclampsia
If you are diagnosed with preeclampsia, you should be referred for an assessment by an experienced obstetrician.
If you are admitted to hospital, you will be monitored closely to determine how severe the condition is and whether a hospital stay is needed.
Bed rest used to be routinely recommended for women with preeclampsia. Research has not shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic and social lives. For most women with preeclampsia, bed rest is no longer recommended.
The only way to cure preeclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered. This will normally be at around 37-38 weeks of pregnancy, but it may be earlier in more severe cases. At this point, labour may be started artificially (induced) or you may have a caesarean section.
Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered.
What are some complications of preeclampsia?
Many cases of preeclampsia are mild but, in some women, it can cause rare but serious complications that include:
• Stroke
• Seizure
• Water in the lungs
• Heart failure
• Reversible blindness
• Bleeding from the liver
• Bleeding after delivery
Preeclampsia can also cause the placenta to suddenly separate from the uterus, which is called placental abruption. This can cause a stillbirth.
Prevention
Research continues into preeclampsia and ways to prevent preeclampsia, but so far no clear strategies have emerged. In some high-risk pregnancies, the obstetrician might recommend a daily low-dose aspirin — between 60 and 81 milligrams — beginning late in the first trimester. The general advice to all women is that, once they become pregnant, they should have regular prenatal care, take care of themselves and follow the advice of their healthcare providers. If preeclampsia is detected early, the woman and her doctor can work together to prevent complications and make the best choices for the woman and her baby.
Conclusion
Preeclampsia, formerly called toxemia, is a condition that pregnant women develop. It is marked by high blood pressure in women who have previously not experienced high blood pressure before. This condition usually appears late in pregnancy, generally after the 20-week gestation, although it can occur earlier. When preeclampsia is caught early, it is easier to manage. Delivery is the only cure for this disorder, but the obstetrician might delay delivery for several reasons, especially if the pregnancy is far from term. All women with preeclampsia require close monitoring until delivery and monitoring following delivery.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
