What is Preeclampsia?
Preeclampsia is a serious condition unique to human pregnancy that can occur in the late 2nd (after 20 weeks) and 3rd trimester of a pregnancy and in the early post-partum period. It is one of four major hypertensive disorders of pregnancy. According to the Preeclampsia Foundation, it occurs in approximately 5-8% of all pregnant women in the US, and remains a major global health problem for mothers and babies everywhere. In the United States, 75% of cases of preeclampsia are mild, the other 25% being severe.
What causes Preeclampsia?
- First pregnancy
- Being pregnant with multiples
- Teenage pregnancy
- Maternal age greater than 40 years
- Preeclampsia in a previous pregnancy or family history of preeclampsia
- An interval of more than 10 years between pregnancies
- A medical history of:
- High blood pressure
- Kidney disease
What are the signs and symptoms?
Many women with Preeclampsia may actually feel well and be unaware of any emerging problems. Pregnant women are monitored for the condition at each prenatal visit with their providers. From the Preeclampsia Foundation, the signs and symptoms your provider monitors and those that you may notice are:
- Elevated blood pressure (usually higher than 140/90) on more than one occasion *Note: if you have a low or high baseline blood pressure, this number may not apply to you. Instead, your provider will monitor for a rapid rise in your blood pressure compared to your baseline.
- Protein in your urine (this is checked each time you give a urine sample at your prenatal appointments)
- Blood tests that show abnormal liver function and/or low platelets
- Rapid weight gain (usually more than 2 pounds in one week)
- Extreme facial swelling (some swelling, especially in the feet is normal during pregnancy and is not cause for immediate alarm)
- Headaches that don’t respond to over-the-counter medication
- Vision Changes (such as loss of vision, seeing flashes of light, etc.)
- Upper right-sided abdominal pain or shoulder pain (this is a serious sign that may indicate a problem with your liver)
- Nausea and vomiting
- A feeling that “something isn’t right” (i.e. you may have a racing pulse, a new sense of extreme anxiety, or shortness of breath)
Typically not one of these signs or symptoms alone is enough to diagnose a woman with Preeclampsia. It is often a combination of several above signs and symptoms that may lead a provider to think a woman is developing preeclampsia. If you notice any of the above symptoms, contact your provider immediately. If your symptoms are mild, your provider may monitor you more closely, through more frequent prenatal appointments, possible hospitalization, blood and urine tests, and/or ultrasounds. If your provider determines that you do have Preeclampsia, he/she will make the right decision based on your situation.
Is it treatable?
The only cure for Preeclampsia is delivery of the baby to end the pregnancy. This is successful in most women, yet it is unknown why a growing number of women continue to experience, or even develop, the condition in the early post-partum period. Preeclampsia is treated (or managed) based on the severity of the condition and how far along the pregnancy is at the time of diagnosis. Although most women who develop preeclampsia deliver a healthy baby, it can still be fatal for the mother and unborn baby, especially if the baby is delivered very prematurely or the disease progresses very quickly. The condition can progress to eclampsia (seizures) and other complications, such as placental abruption, stroke, and HELLP syndrome (which includes serious injury to the liver, a breakdown of red blood cells, and a low platelet count). With proper prenatal care, the risks of these complications are low, which is why it is important to keep all of your prenatal appointments and discuss any concerns you may have with your provider.
How is Preeclampsia managed?
Based on the gestational age of your baby and the severity of your symptoms, some of the following approaches may be taken to manage Preeclampsia during your pregnancy:
- Medications to lower your blood pressure
- Steroids (these can help with your liver and platelet function if they are affected by the condition, and can also help to mature your baby’s lungs more quickly before a premature delivery)
- Magnesium Sulfate, or other anti-seizure medications to prevent seizures if your symptoms are severe
- Bed Rest
- Frequent prenatal appointments
- Adequate hydration and a nutritious diet including plenty of protein, deeply colorful vegetables, and avoidance of processed foods and artificial additives
- Admission to a high-risk perinatal unit in the hospital (If you are at high risk of developing severe complications, but it is unsafe to deliver your baby at your current gestational period, you may be admitted to the hospital for close monitoring and IV administration of some of the medications listed above.)
- Delivery (If you are far enough along in your pregnancy, or if remaining pregnant would be too dangerous for you, your provider may recommend inducing a vaginal delivery or an emergency cesarean section.)
It is important for women who have experienced preeclampsia with any pregnancy to know the affect beyond the childbearing years for increasing the risk of heart disease and possibly diabetes later in life, and to know that you are not alone. The Preeclampsia Foundation offers a wealth of information and networks to raise awareness among the public and healthcare providers and to foster an atmosphere through on-line forums and helplines of support and empowerment for survivors and families who have devastatingly lost a child or mother to the disease.
Monitoring for complications such as preeclampsia in an otherwise healthy pregnant woman is part of good prenatal care, and we will be working with women to coordinate and deliver the safest setting for birth in such situations. This is why the midwives of Atlanta Birth Center will maintain their hospital privileges and collaborative agreements with physicians on our team.
For more reading on Preeclampsia, please visit the following references: