What is preeclampsia

Preeclampsia is a pregnancy complication that occur as a serious blood pressure condition that develops during pregnancy. People with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria).

Preeclampsia typically develops after the 20th week of pregnancy. It can also affect other organs in the body and be dangerous for both the mom and her developing fetus. Because of these risks, preeclampsia needs to be treated by a healthcare provider.

Left untreated, preeclampsia can lead to serious even fatal complications for both the mother and baby.

Early delivery of the baby is often recommended. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are. Before delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications.

Preeclampsia may develop after delivery of a baby, a condition known as postpartum preeclampsia.

Symptoms of preeclampsia

Initially, pre-eclampsia causes:

• high blood pressure (hypertension)
• protein in urine (proteinuria)

You probably won’t notice any symptoms of either of these, but your GP or midwife should pick them up during your routine antenatal appointments.

High blood pressure alone doesn’t suggest pre-eclampsia.

But if protein in the urine is found at the same time as high blood pressure, it’s a good indicator of the condition.

As pre-eclampsia progresses, it may cause:

• severe headaches
• vision problems, such as blurring or seeing flashing lights
• pain just below the ribs
• vomiting
• sudden swelling of the feet, ankles, face and hands

When to see a Doctor

Make sure you attend your prenatal visits so that your health care provider can monitor your blood pressure. Contact your provider immediately or go to an emergency room if you have severe headaches, blurred vision or other visual disturbances, severe belly pain, or severe shortness of breath.

Because headaches, nausea, and aches and pains are common pregnancy complaints, it’s difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem especially if it’s your first pregnancy. If you’re concerned about your symptoms, contact your doctor.

You can also read about symptoms and treatment of high blood pressure

Causes of preeclampsia

The exact cause of preeclampsia likely involves several factors. Experts believe it begins in the placenta, the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.

In women with preeclampsia, these blood vessels don’t seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.

Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Other disorders can happen, too:

• Gestational hypertension is high blood pressure that begins after 20 weeks of pregnancy without problems in the kidneys or other organs. Some women with gestational hypertension may develop preeclampsia.
• Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. High blood pressure that continues more than three months after a pregnancy also is called chronic hypertension.
• Chronic hypertension with superimposed preeclampsia occurs in women diagnosed with chronic high blood pressure before pregnancy, who then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.

Risk factors of preeclampsia

Causes of preeclampsia are unknown, but several factors in addition to having a history of preeclampsia can put you at a higher risk for it, including:

• having high blood pressure or kidney disease before pregnancy
• family history of preeclampsia or high blood pressure
• being under age 20 and over age 40
• having twins or multiples
• having a baby more than 10 years apart
• being obese or having a body mass index (BMI) over 30

Complication of preeclampsia

Complications of preeclampsia may include:

• Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks.
• Eclampsia. Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can happen without any previously observed signs or symptoms of preeclampsia.Signs and symptoms that may appear before seizures include severe headaches, vision problems, mental confusion or altered behaviors. But, there are often no symptoms or warning signs. Eclampsia may occur before, during or after delivery.
• Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction.
• Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.
• hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome.HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.Signs and symptoms include nausea and vomiting, headache, upper right belly pain, and a general feeling of illness or being unwell. Sometimes, it develops suddenly, even before high blood pressure is detected. It also may develop without any symptoms.
• 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 how severe the preeclampsia is.
• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you’ve had preeclampsia more than once or you’ve had a preterm delivery.

You can also read about risk factors and complication of stroke

Prevention of preeclampsia

For people with risk factors, there are some steps that can be taken prior to and during pregnancy to lower the chance of developing preeclampsia. These steps can include:

• Controlling your blood pressure and blood sugar (if you had high blood pressure or diabetes prior to pregnancy).
• Losing weight if you have overweight/obesity (prior to pregnancy-related weight gain).
• Maintaining a regular exercise routine.
• Eating healthy foods that are low in salt and avoiding caffeine.
• Getting enough sleep

Taking a baby aspirin daily has been demonstrated to decrease your risk of developing preeclampsia by approximately 15%. If you have risk factors for preeclampsia, your healthcare provider may recommend starting aspirin in early pregnancy (by 12 weeks gestation).

Diagnosis of preeclampsia

During antenatal appointments, your blood pressure is regularly checked for signs of high blood pressure and a urine sample is tested to see if it contains protein.

If you notice any of the symptoms of pre-eclampsia between your antenatal appointments, see your midwife or GP for advice.

Blood pressure measurement

Blood pressure is a measure of the force of blood on artery walls (main blood vessels) as it flows through them.

It’s measured in millimetres of mercury (mmHg) and recorded as 2 figures:

• systolic pressure – the pressure when the heart beats and squeezes blood out
• diastolic pressure – the pressure when the heart rests between beats

Your GP or midwife will use a device with an inflatable cuff and a scale as a pressure gauge (a sphygmomanometer) to measure your blood pressure.

The systolic reading is taken first, followed by the diastolic reading.

If, for example, the systolic blood pressure is 120mmHg and the diastolic blood pressure is 80mmHg, the overall blood pressure will be 120 over 80, which is commonly written as 120/80.

High blood pressure during pregnancy is usually defined as a systolic reading of 140mmHg or more, or a diastolic reading of 90mmHg or more.

Blood test

If you’re between 20 weeks and 35 weeks pregnant and your doctors think you may have pre-eclampsia, they may offer you a blood test to help rule out pre-eclampsia.

It measures levels of a protein called placental growth factor (PIGF). If your PIGF levels are high, it’s highly likely that you do not have pre-eclampsia.

If your PIGF levels are low, it could be a sign of pre-eclampsia, but further tests are needed to confirm the diagnosis.

Urine tests

A urine sample is usually requested at every antenatal appointment. This can easily be tested for protein using a dipstick. 

A dipstick is a strip of paper that’s been treated with chemicals so it reacts to protein, usually by changing colour.

If the dipstick tests positive for protein, your GP or midwife may ask for another urine sample to send to a laboratory for further tests.

Further tests

If you’re diagnosed with pre-eclampsia, you should be referred to a specialist in hospital for further tests and more frequent monitoring.

Depending on the severity of your condition, you may be able to go home after an initial assessment and have frequent outpatient appointments.

In severe cases, you may need to stay in hospital for closer observation.

You can also read about diagnosis and treatment of abnormal uterine bleeding

Treatment of preeclampsia

If you’re close to full term (37 weeks pregnant or greater), your baby will probably be delivered early. Your healthcare provider will advise you on the best way to treat preeclampsia. Treatment generally depends on how severe your preeclampsia is and how far along you are in pregnancy.

You can still have a vaginal delivery, but sometimes a Cesarean delivery (C-section) is recommended. Your healthcare provider may give you medication to help the fetus’s lungs develop and manage your blood pressure until the baby can be delivered. Sometimes it is safer to deliver the baby early than to risk prolonging the pregnancy.

When preeclampsia develops earlier in pregnancy, you’ll be monitored closely in an effort to prolong the pregnancy and allow for the fetus to grow and develop. You’ll have more prenatal appointments, including ultrasounds, urine tests and blood draws. You may be asked to check your blood pressure at home. If you are diagnosed with severe preeclampsia, you could remain in the hospital until you deliver your baby.

Severe preeclampsia requires that you be in the hospital to monitor your blood pressure and possible complications. Your health care provider will frequently monitor the growth and well-being of your baby.

Medications to treat severe preeclampsia usually include:

• Corticosteroids to promote development of your baby’s lungs before delivery
• Antihypertensive drugs to lower blood pressure
• Anticonvulsant medication, such as magnesium sulfate, to prevent seizures

Before delivery

If you have preeclampsia that isn’t severe, your health care provider may recommend preterm delivery after 37 weeks. If you have severe preeclampsia, your health care provider will likely recommend delivery before 37 weeks, depending on the severity of complications and the health and readiness of the baby.

The method of delivery can vaginal or cesarean depending on the severity of disease, gestational age of the baby and other considerations you would discuss with your health care provider.

After delivery

You need to be closely monitored for high blood pressure and other signs of preeclampsia after delivery. Before you go home, you’ll be instructed when to seek medical care if you have signs of postpartum preeclampsia, such as severe headaches, vision changes, severe belly pain, nausea and vomiting.

Preeclampsia can be a fatal condition during pregnancy. If you’re being treated for this condition, make sure to see your healthcare provider for all of your appointments and blood or urine tests. Contact your obstetrician if you have any concerns or questions about your symptoms.

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