Preeclampsia is one of the concerns you'll have to keep an eye out for during your pregnancy. Your doctor will help you monitor for this condition. Let's talk about what preeclampsia is, and its symptoms.
Key Points
- Preeclampsia occurs in roughly five to eight percent of pregnancies in the United States.
- 15% of preeclampsia cases will develop into HELLP syndrome, a much more serious version of this complication.
- Delivery of the baby is almost always the only option for treating preeclampsia.
Preeclampsia Symptoms (Toxemia)
What are the symptoms of preeclampsia (toxemia)?
Women who develop preeclampsia may not have any symptoms to start. By the time obvious symptoms appear, the condition is often advanced. In some women, the first sign of preeclampsia (toxemia) may be a sudden weight gain– more than two pounds (about one kilogram) in a week or six pounds (about 2 3/4 kilograms) in a month. This weight gain is due to the abnormal retention of fluids, rather than the accumulation of fat. Swelling of the face and hands, headaches, and pain in the upper abdomen are other signs.
How is Preeclampsia Diagnosed?
The blood pressure readings your health care provider took during the first trimester of your pregnancy are compared with the ones taken now. Preeclampsia is diagnosed when your blood pressure is consistently elevated. Your blood pressure is considered to be elevated if the systolic pressure (the first number) has increased by 30 mm Hg or more, or if the diastolic pressure (the second number) has increased by 15 mm Hg or more, above the pressure in your first trimester. Generally, a blood pressure of 140/90 mm Hg or more is considered above the normal range.
In addition to high blood pressure, preeclampsia is also diagnosed by detecting large amounts of protein in the urine. This is determined in one of two ways. It can be done by using a test strip that is dipped into a sample of urine. A more accurate method is to collect all your urine over a 24-hour period and then analyze it for protein in a laboratory. Your doctor may also want to do some blood tests to see how well your liver and kidneys are functioning. Blood tests can also confirm that the number of platelets (which are necessary for blood to clot) in your blood is normal.
A syndrome called HELLP syndrome is a severe form of preeclampsia, distinguished from other milder forms of the condition by elevated liver enzyme values and a low blood platelet level. Around 15% of women with preeclampsia develop this condition. Death occurs in 25% of HELLP cases. In developed countries, 51 out of every 1,000 pregnancies that suffer from HELLP syndrome will end in a stillborn.
What Causes Preeclampsia and Who's at Risk?
Preeclampsia is a disease characterized by high blood pressure, swelling of the face and hands, and protein in the urine after the 20th week of pregnancy. If left untreated, it can lead to complications or death in the mother or the baby.
Currently, there is no known universal way to prevent preeclampsia. Low doses of aspirin may reduce the risk in some women who are predisposed to the condition. In the United States, roughly five to eight percent of all pregnancies suffer from preeclampsia. Scientists currently don't know why preeclampsia happens. It seems that women who are having multiple births, have high blood pressure, diabetes, kidney disease, or certain autoimmune diseases, and women who are obese are at greater risk. If you've previously had preeclampsia or have a family history of it, you're at higher risk.
85% of all cases occur in the first pregnancy. Preeclampsia is also more common in teenagers and in women older than 35.
Preeclampsia is Also Known as Toxemia
The term toxemia came about because the disease was once thought to be caused by a toxin in a pregnant woman's bloodstream. It is now known that preeclampsia is not caused by a toxin, although its true cause remains largely unknown. The only sure way to end the preeclampsia is to deliver the baby, sometimes despite the fact that the baby may be premature.
There are serious risks posed by preeclampsia to the mother and the baby which may necessitate premature delivery. The mother may suffer liver damage, kidney damage, bleeding problems, or seizures. The baby may not get enough oxygen or nutrients from the placenta. Preeclampsia can lead to growth restriction or fetal distress.
How are Preeclampsia Symptoms Managed?
The only “cure” for preeclampsia is delivery. Medications to treat high blood pressure in pregnancy are sometimes used, but other measures are usually preferred.
Bed rest at home is one way a physician may treat a mild case of preeclampsia. You will be asked to lie on your left or right side to allow blood to flow more freely to the placenta, and to call your doctor if any symptoms develop. Your doctor may want to see you twice a week to check your blood pressure and urine and to do blood tests, as well as to check on the status of the baby.
A more severe case of preeclampsia requires a stay in the hospital. Testing of the baby's well-being, with non-stress tests, contraction stress tests, or biophysical profiles, will be done on a regular basis. In addition to these tests, an ultrasound exam is often used to measure the volume of amniotic fluid. If the amount of amniotic fluid is too low, it is a sign that the blood supply to the baby has been inadequate, and delivery of the baby may be necessary.
When this occurs, the risks of early birth must be weighed against those of the less hospitable conditions inside the uterus. Before this decision is made, amniocentesis may be performed to determine whether the baby's lungs are fully mature. If the health of the mother is thought to be at significant risk, delivery may be necessary before the baby's lungs are fully mature.
Many cases of preeclampsia are mild enough, and arise close enough to the mother's due date, that they can be managed with rest and monitoring until labor starts on its own. In more severe cases, though, labor may have to be induced or a cesarean delivery performed. Magnesium sulfate is a drug that may be given intravenously to the mother with preeclampsia to increase uterine blood flow and to prevent seizures. A pregnancy complicated by preeclampsia is usually delivered before the 40 week point because of the increased risks to the fetus. The “ripeness” of the cervix (whether it is beginning to dilate, efface, and soften) may also be a factor in determining whether labor will be induced.
What's in Store for You If You Had Preeclampsia?
After delivery, the blood pressure usually returns to normal within several days to several weeks. If blood pressure medication is necessary, its use can usually be gradually stopped a month or two after delivery. Your doctor will monitor your blood pressure.
The risk that preeclampsia will recur in a subsequent pregnancy depends on how severe the symptoms were during the first pregnancy. With mild preeclampsia, the risk of recurrence is low, but it may be as high as 25 to 45 percent when preeclampsia was severe in a first pregnancy.
Whether preeclampsia will have an effect on your baby post-delivery depends on how far along your pregnancy was at the time of delivery. If your baby was delivered extremely premature, its survival chances are lower. With the right intensive care, however, your baby should be able to pull through.
If you've had preeclampsia in the past and are pregnant again, make sure your doctor is informed. If they know about your history with this condition, they'll be able to start monitoring you as soon as possible. Hopefully, this will allow them to catch a recurrence of preeclampsia as soon as possible.