Preeclampsia is a pregnancy complication that, if left untreated, can lead to serious — even fatal — complications for both the pregnant woman and her developing fetus. Regular prenatal can help prevent this potentially serious disorder.
What is preeclampsia?
Preeclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered. Early signs of preeclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria). These signs can be picked up during regular prenatal visits. This is just one other reason why all pregnant women should have regular prenatal visits and be seen by qualified and experienced healthcare providers.
The earlier preeclampsia is diagnosed, and monitored, the better the outlook for mother and baby.
How do you know if you have preeclampsia?
Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring your 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
• Severe headaches
• Changes in vision, such as blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in your 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, but these also occur in many normal pregnancies, so they are not considered reliable signs of preeclampsia.
Who develops preeclampsia?
Any pregnant woman can develop preeclampsia but some pregnant women are more at risk than others.
There are a number of things that can increase a woman’s chances of developing preeclampsia. These include:
• having diabetes, high blood pressure or kidney disease before starting pregnancy
• having another condition, such as lupus
• having developed the condition during a previous pregnancy
Other things that can slightly increase the chances of developing preeclampsia include:
• having a family history of the condition
• being over 40 years old
• having been at least 10 years since your last pregnancy
• expecting multiple babies (twins or triplets)
• having a body mass index (BMI) of 35 or over
If you have 2 or more of these together, your chances are higher.
If you are thought to be at a high risk of developing preeclampsia, you should see an experienced obstetrician very early in the pregnancy – and you may be advised, among other things, to take a daily dose of low-dose aspirin from the 12th week of pregnancy until the baby is delivered.
What causes preeclampsia?
At this time it is not sure what causes preeclampsia but it is generally believed that the cause of preeclampsia involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy.
What are some complications of pre eclampsia?
The more severe your preeclampsia, and the earlier it occurs in your pregnancy, the greater the risks for you and your baby. Preeclampsia may require induced labour and delivery.
An obstetric provider will discuss with the pregnant woman what options of therapy are best for her.
Complications of preeclampsia may include:
• Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth.
• Preterm birth. If a woman has preeclampsia with severe features, she may need to be delivered early to save her life and the life of the baby. Prematurity can lead to breathing and other problems for the baby.
• Placental abruption. Preeclampsia increases the risk of placental abruption, a condition in which the placenta separates from the inner wall of the uterus (womb) before delivery. Severe abruption can cause heavy bleeding which can be life-threatening for both the pregnant woman and the developing fetus.
• HELLP syndrome. HELLP — which stands for haemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count — syndrome is a more severe form of preeclampsia, and can rapidly become life-threatening for both the pregnant woman and the fetus.
Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems. On occasion it may develop suddenly, even before high blood pressure is detected, or it may develop without any symptoms at all.
• Eclampsia. When preeclampsia is not controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia.
Often, there are no symptoms or warning signs to predict eclampsia. Eclampsia can have serious consequences for both the pregnant woman and fetus. Delivery becomes necessary, regardless of how far along the pregnancy is.
• Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia.
• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease.
Treatment
Once a pregnant woman is diagnosed with preeclampsia, she should be referred for an assessment by an experienced gynaecologist.
The most effective treatment for preeclampsia is delivery. The woman with pre eclampsia is at increased risk of seizures, placental abruption, stroke, and possibly severe bleeding, until her blood pressure decreases. Of course, if it is too early in the pregnancy, delivery may not be the best thing for the baby. This often poses a dilemma for the obstetrician.
If you are diagnosed with preeclampsia, your doctor will let you know how often you will need to come in for prenatal visits — likely more frequently than what is typically recommended for pregnancy. You will also need more frequent blood tests, ultrasounds, and other tests, than would be expected in an uncomplicated pregnancy.
Your obstetrician might prescribe various medications especially anti- hypertensive medications.
Bed rest
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, bed rest is no longer recommended.
Hospitalization
Severe preeclampsia may require that the pregnant woman be hospitalized. In the hospital various monitoring will be done – and a decision would be made on the time and type of delivery.
Conclusion
Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked by high blood pressure in women who have not had high blood pressure before. Preeclamptic women will have a high level of protein in their urine and other symptoms. Most of these symptoms and signs can be detected during routine prenatal visits to their midwife or obstetrician. Delivery of the baby is the most effective way to treat preeclampsia. Other medications might be needed to prevent other complications.
Ask Your Dr 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 with over thirty-six years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5928).
