Preeclampsia

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Introduction

What is preeclampsia?

Preeclampsia is a condition that can develop during pregnancy or in the postpartum period. The disorder results in high blood pressure and signs that organ systems are not working the way they should. Although it can affect any organ system, the kidneys commonly show signs of damage.

Experts estimate that preeclampsia happens in about 5 to 8% of pregnancies. Typically, it starts in the third trimester, but it can begin any time after 20 weeks. In rare cases, it occurs before 20 weeks. Preeclampsia can also develop up to six weeks after delivery.

There are several risk factors for preeclampsia. It tends to strike first-time moms, very young or older moms, and those who are carrying multiple babies. If you have already had preeclampsia with a pregnancy, you are more likely to get it again. Your risk is also higher if you have a family history of it, you are obese, or you have other medical conditions, such as diabetes.

It is possible to have preeclampsia with few or even no symptoms. This is one reason regular prenatal care is vital to your health and the health of your baby. Preeclampsia is a leading cause of preterm birth—delivery before 37 weeks of gestation. Left untreated, preeclampsia can lead to serious complications for you and your baby. It can also be fatal to one or both of you.

Preeclampsia can progress rapidly without noticeable symptoms. However, sometimes women do experience symptoms that should be red flags. Seek immediate medical care if you develop symptoms that could mean you are developing preeclampsia or its complications including:

Because pregnancy can be a time of discomfort and rapid body changes, it can be hard to tell if something is truly wrong or not. This is especially true for first-time moms. Do not hesitate to contact your doctor about new symptoms or concerns.

Delivery is the most effective treatment for preeclampsia. If this is not possible due to the baby’s age, your doctor will try and treat preeclampsia with medications to delay delivery. In severe cases, hospitalization may be necessary.

Symptoms

What are the symptoms of preeclampsia?

The hallmark sign of preeclampsia is high blood pressure in a woman who had normal blood pressure before pregnancy. It is usually the first sign that preeclampsia is developing. High blood pressure is called a silent disease because it usually does not cause any symptoms. Women with preeclampsia may not feel sick at all. There may be no symptoms to alert them that something is wrong.

The only way to detect high blood pressure is to measure it with a blood pressure monitor. A reading above 140/90 mmHg is high. A blood pressure check is a routine part of any medical exam, including a prenatal exam.

Another major sign of preeclampsia is protein in the urine, or proteinuria. Normally, protein remains in your blood when the kidneys filter out waste products from it. With preeclampsia, the kidneys sustain damage that changes their ability to filter blood. As a result, protein gets through the filtering system and shows up in the urine. Your doctor can detect proteinuria with a quick urine dipstick test, which is a routine part of a prenatal exam.

Serious symptoms that might indicate a life-threatening condition

Sometimes preeclampsia causes symptoms along with high blood pressure. Preeclampsia symptoms can include:

  • Abdominal pain that may radiate to the shoulder and can be severe

  • Headache that persists and can be severe

  • Nausea or vomiting that appears suddenly or that reappears after morning sickness has resolved

  • Shortness of breath that is more severe than what you have normally experienced with pregnancy and may accompany anxiety or a feeling of doom

  • Sudden weight gain of two or more pounds in one week

  • Swelling that is most noticeable in the hands and face

  • Vision problems including light sensitivity, blurry vision, and seeing flashing lights

Preeclampsia can be life-threatening to both you and your baby. Seek immediate medical care (call 911) if you, or someone you are with, have any preeclampsia symptoms.

During pregnancy, it can be difficult to tell what is normal and what is not. Women who are pregnant for the first time may struggle with this a lot. But even women who have been through it before may find each pregnancy is different with different symptoms and worries. Your doctor’s office is used to these concerns and is ready to help you at all times. Do not hesitate to call the office or page the doctor on call if you are having concerning symptoms.

Causes

What causes preeclampsia?

Doctors do not know exactly what causes preeclampsia in pregnancy. Finding a cause is a very active area of study. Medical researchers are exploring several theories. The most likely ones involve the placenta. Experts believe the answer may be with the way new blood vessels form to supply the placenta or with proteins the placenta produces. Other contributing factors may include the mother’s immune response, inflammation, and metabolic processes.

Risk Factors

What are the risk factors for preeclampsia?

A number of factors increase a woman’s chance of developing preeclampsia. However, not all women with risk factors will go on to develop it. The main risk factor is having preeclampsia with a previous pregnancy. Women who have already had preeclampsia are seven times as likely to develop it again.

Other risk factors for preeclampsia include:

  • African American race

  • Age younger than 20 or older than 40 years

  • Family history of preeclampsia in a mother or sister

  • First-time pregnancy or multiple pregnancy with more than one baby

  • Obesity and other medical conditions including blood clotting disorders, diabetes, high blood pressure, kidney disease, lupus, and obesity

Conception via in vitro fertilization (IVF) is considered a risk factor for preeclampsia according to the American College of Obstetricians and Gynecologists, but some studies show that women with IVF pregnancies are not at higher risk for preeclampsia than women with normally conceived pregnancies. 

Reducing your risk of preeclampsia

Risk reduction involves changing risk factors that are under your control. Unfortunately, very few preeclampsia risk factors are modifiable. Maintaining a healthy weight is one way you can reduce your risk. You may or may not be able to control your age at pregnancy. If you have a medical condition that puts you at risk, make sure your doctor knows about it. Controlling it before and during pregnancy may help avoid complications.

Treatment

How is preeclampsia treated?

The most effective treatment for preeclampsia is delivering your baby. Ideally, this should not occur before 37 weeks of gestation. However, severe cases of preeclampsia may require an earlier delivery.

For severe cases, your doctor may recommend inducing labor if your baby is at least 34 weeks of gestation and your condition is stable. If you are stable and your baby is less than 34 weeks, your doctor may admit you to the hospital to try to give the baby as much time as possible to develop. If your baby shows signs of distress, it may not be possible to wait. The safest course of action may be inducing labor immediately or performing an emergency C-section.

You will receive medications during hospitalization for severe preeclampsia. The first is a corticosteroid. It will help your baby’s lungs develop quickly in preparation for delivery. It can also help improve some of your own organ function. You will also receive medicines to lower your blood pressure and prevent seizures.

If your case is not severe, your doctor may be able to treat you on an outpatient basis. This will involve taking medicines to lower your blood pressure and attending frequent follow-up appointments. You will also need to monitor your blood pressure at home and keep a kick count diary of the baby’s activity. Your doctor will give you instructions for what to do if either of those numbers indicates a problem.

For postpartum preeclampsia, your doctor will prescribe medicines to control blood pressure.

Complications

What are the potential complications of preeclampsia?

In most cases, preeclampsia resolves within six weeks of delivery. The mother’s blood pressure returns to normal and symptoms resolve. However, preeclampsia can lead to complications in both the mother and the baby.

Complications in the mother include:

  • Eclampsia: Preeclampsia can progress rapidly to full eclampsia within days. In eclampsia, brain function deteriorates causing seizures and coma.

  • Heart and blood vessel disease: Preeclampsia increases your risk of cardiovascular disease in the future.

  • HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count): HELLP results in liver and blood cell damage. It also increases the risk of stillbirth.

  • Other organ damage: Preeclampsia can damage any organ system including the kidneys, heart, lungs and eyes.

  • Placental abruption: Preeclampsia can cause the placenta to detach from the uterine wall causing potentially life-threatening bleeding and pregnancy loss.

Complications in the baby include:

  • Fetal growth restriction: Preeclampsia can prevent your baby from getting enough oxygen and nutrients to grow properly. This can result in slow growth for gestational age and low birth weight. It can also increase the risk of diabetes, high blood pressure, and congestive heart failure.

  • Preterm birth: Preeclampsia may require you to deliver your baby early to save both your lives.

  • Stillbirth or infant death: Preeclampsia increases the risk of a baby dying before or after birth. The risk is highest with HELLP and placental abruption.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 8
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