What is preeclampsia?
Preeclampsia is a condition unique to pregnancy that complicates up to 8% of all deliveries worldwide. It's characterized by high blood pressure (hypertension) and high levels of protein in the urine (proteinuria) in the mother. Preeclampsia typically happens in first-time mothers and in the later part of pregnancy (after 20 weeks gestation). It can also affect other organs in the body and can be dangerous for both the mom and her baby. Because of these risks, preeclampsia needs to be treated by a healthcare provider.
What are some of the risks with preeclampsia?
Risks of preeclampsia can include:
- Seizures in the mother.
- Stroke or bleeding in the brain.
- Temporary kidney failure.
- Liver problems.
- Blood clotting problems.
- Placental abruption: The placenta pulls away from the wall of the uterus, causing distress to the baby and bleeding in the mother.
- Poor growth of the baby.
- Premature (early) delivery of the baby.
- A cesarean delivery (C-section).
What is HELLP syndrome?
HELLP syndrome is a severe form of preeclampsia that develops in 4 to 12% of cases. The name stands for:
- (H): Hemolysis (breakdown of red blood cells).
- (EL): Elevated liver enzymes (from damage to the liver).
- (LP): Low platelets (platelets are important in helping blood clot).
HELLP syndrome can be present without many of the typical signs of preeclampsia — including high blood pressure (hypertension) and proteinuria (protein in the urine) — and in some cases the diagnosis can be missed or delayed.
Common symptoms of HELLP syndrome can include:
- Right side or mid abdominal pain.
The diagnosis of HELLP syndrome is usually made with blood tests. Delivery is generally necessary in order to treat HELLP syndrome and for the abnormalities to correct themselves. Complications associated with HELLP syndrome include rupture of the liver, massive bleeding, stroke and seizures.
What is eclampsia?
Eclampsia is a life-threatening complication that develops in approximately 1% of women with preeclampsia and results in seizures or coma. Warning signs to watch for can include:
- Severe headaches.
- Blurred or double vision.
- Seeing spots.
- Abdominal pain.
These women often will have overactive reflexes. Treatment is based on preventing further seizure activity and generally involves use of magnesium sulfate given intravenously (directly into the vein) for at least 24 to 48 hours. High blood pressure must be treated aggressively in these patients. Generally, once the mother’s condition has been stabilized, the baby is delivered. If the baby is extremely premature (less than 32 weeks), delivery may be delayed for 24 to 48 hours so that steroids may be given to the mother. These steroids help the baby’s lungs mature and prevent other complications related to premature birth. In some cases, eclampsia can occur following a seemingly normal delivery, even after the patient has gone home from the hospital.
Symptoms and Causes
What causes preeclampsia?
Preeclampsia is thought to arise from a problem with the health of the placenta (the organ that develops in the uterus during pregnancy and is responsible for providing oxygen and nutrients to the baby). It is thought that the blood supply to the placenta is decreased in preeclampsia, and this can lead to problems with both the mother and baby.
Who is at higher risk of developing preeclampsia?
A woman is more likely to develop preeclampsia if she:
- Is expecting her first child.
- Is under age 20 or over age 40.
- Has a history of chronic hypertension.
- Has had preeclampsia during past pregnancies.
- Has a family history of preeclampsia or chronic hypertension.
- Is overweight.
- Has an immune system disorder, such as lupus or rheumatoid arthritis.
- Has kidney disease.
- Is expecting multiple babies.
- Had in vitro fertilization.
- Is African American.
What are the symptoms of preeclampsia?
Symptoms patients with preeclampsia may have include:
Diagnosis and Tests
How is preeclampsia diagnosed?
Preeclampsia is often diagnosed during routine prenatal appointments, when your healthcare provider checks your weight gain, blood pressure and urine protein. If preeclampsia is suspected, additional blood tests may be ordered. In some cases, blood pressure readings will be observed in the hospital and a 24-hour urine collection is performed to check for proteinuria (protein in the urine). An ultrasound and fetal monitoring may also be used to provide more information about the baby.
Management and Treatment
How is preeclampsia treated?
Your healthcare provider will advise you on the best way to treat preeclampsia. Preeclampsia can only be cured with delivery. If you're at term (37 weeks gestational age or greater), the baby will be delivered. If preeclampsia develops earlier in pregnancy, you can be monitored closely in the hospital in an effort to prolong the pregnancy and allow for the baby to grow and develop. If the preeclampsia worsens or becomes more severe, the baby will be delivered. Women with preeclampsia can have a vaginal delivery through induction of labor — which is more likely to be successful if you're closer to term — or planned cesarean section. During labor and following delivery, women with preeclampsia are often given magnesium intravenously (directly into the vein) to prevent development of eclampsia.
Can preeclampsia be prevented?
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:
- Losing weight if you are overweight.
- Not smoking (smoking is never recommended during pregnancy).
- Getting your blood pressure under control, if you have chronic hypertension.
- Maintaining a regular exercise routine.
- Taking a baby aspirin (81 mg) daily after 12 weeks gestation in high-risk pregnancies.
Outlook / Prognosis
Does preeclampsia improve after delivery?
Preeclampsia typically goes away after your baby is delivered. Sometimes, your blood pressure can remain high for a few weeks after delivery, requiring treatment with medication. Your healthcare provider will work with you after your pregnancy to manage your blood pressure. People with preeclampsia — particularly those who develop the condition early in pregnancy — are at greater risk for high blood pressure (hypertension) and heart disease later in life. Knowing this information, those women can work with their primary care provider to take steps to reduce these risks.