Preeclampsia

Preeclampsia is a pregnancy condition in which high blood pressure and protein in the
urine develop after the 20th week (late 2nd or 3rd trimester) of pregnancy.

Causes, incidence, and risk factors

The exact cause of preeclampsia is not known. Possible causes include:

 Autoimmune disorders
 Blood vessel problems
 Diet
 Genes

Preeclampsia occurs in a small percentage of pregnancies. Risk factors include:

 First pregnancy
 Multiple pregnancy (twins or more)
 Obesity
 Older than age 35
 Past history of diabetes, high blood pressure, or kidney disease

Symptoms

Often, women who are diagnosed with preeclampsia do not feel sick.

Symptoms of preeclampsia can include:

 Swelling of the hands and face/eyes (edema)

 Weight gain
o More than 2 pounds per week
o Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with pregnancy.

Symptoms of more severe preeclampsia:

 Headaches that are dull or throbbing and will not go away

 Abdominal pain, mostly felt on the right side, underneath the ribs. Pain may also be
felt in the right shoulder, and can be confused with heartburn, gallbladder pain, a
stomach virus, or the baby kicking
 Agitation
 Decreased urine output, not urinating very often
 Nausea and vomiting (worrisome sign)
  Vision changes -- temporary loss of vision, sensations of flashing lights, auras, light
sensitivity, spots, and blurry vision

Signs and tests

The doctor will perform a physical exam and order laboratory tests. Signs of preclampsia
include:

 High blood pressure, usually higher than 140/90 mm/Hg

 Protein in the urine (proteinuria)

The physical exam may also reveal:

 Swelling in the hands and face

 Weight gain

Blood and urine tests will be done. Abnormal results include:

 Protein in the urine (proteinuria)

 Higher-than-normal liver enzymes
 Platelet count less than 100,000 (thrombocytopenia)

Your doctor will also order tests to see how well your blood clots, and to monitor the health
of the baby. Tests to monitor the baby's well-being include pregnancy ultrasound, non-
stress test, and a biophysical profile. The results of these tests will help your doctor decide
whether your baby needs to be delivered immediately.

Women who began their pregnancy with very low blood pressure, but had a significant rise
in blood pressure need to be watched closely for other signs of preeclampsia.

Treatment

The only way to cure preeclampsia is to deliver the baby.

If your baby is developed enough (usually 37 weeks or later), your doctor may want your
baby to be delivered so the preeclampsia does not get worse. You may receive different
treatments to help trigger labor, or you may need a c-section.

If your baby is not fully developed and you have mild preeclampsia, the disease can often
be managed at home until your baby has a good chance of surviving after delivery. The
doctor will probably recommend the following:

 Getting bed rest at home, lying on your left side most or all of the time
 Drinking extra glasses of water a day and eating less salt
  Following-up with your doctor more often to make sure you and your baby are
doing well
 Taking medicines to lower your blood pressure (in some cases)

Immediately call your doctor if you gain more weight or have new symptoms.

In some cases, a pregnant woman with preeclampsia is admitted to the hospital so the
health care team can more closely watch the baby and mother.

Treatment may involve:

 Medicines given into a vein to control blood pressure, as well as to prevent seizures
and other complications
 Steroid injections (after 24 weeks) to help speed up the development of the baby's
lungs

You and your doctor will continue to discuss the safest time to deliver your baby,
considering:

 How close you are to your due date. The further along you are in the pregnancy
before you deliver, the better it is for your baby.
 The severity of the preeclampsia. Preeclampsia has many severe complications that
can harm the mother.
 How well the baby is doing in the womb.

The baby must be delivered if you have signs of severe preeclampsia, which include:

 Tests (ultrasound, biophysical profile) that show your baby is not growing well or is
not getting enough blood and oxygen
 The bottom number of the mother's blood pressure is confirmed to be over 110
mmHg or is greater than 100 mmHg consistently over a 24-hour period
 Abnormal liver function tests
 Severe headaches
 Pain in the belly area (abdomen)
 Eclampsia
 Fluid in the mother's lungs (pulmonary edema)
 HELLP syndrome
 Low platelet count (thrombocytopenia)
 Decline in kidney function (low amount of urine, large amount of protein in the
urine, increase in the level of creatinine in the blood)

Expectations (prognosis)
Usually the high blood pressure, protein in the urine, and other effects of preeclampsia go
away completely within 6 weeks after delivery. However, sometimes the high blood
pressure will get worse in the first several days after delivery.

A woman with a history of preeclampsia is at risk for the condition again during future
pregnancies. Often, it is not as severe in later pregnancies.

Women who have high blood pressure problems during more than one pregnancy have an
increased risk for high blood pressure when they get older.

Death of the mother due to preeclampsia is rare in the U.S. The infant's risk of death
depends on the severity of the preeclampsia and how prematurely the baby is born.

Complications

Preeclampsia can develop into eclampsia if the mother has seizures. Complications in the
baby can occur if the baby is delivered prematurely.

There can be other severe complications for the mother, including:

 Bleeding problems
 Premature separation of the placenta from the uterus before the baby is born
(placental abruption)
 Rupture of the liver
 Stroke
 Death (rarely)

However, these complications are unusual.

Severe preeclampsia may lead to HELLP syndrome.

Prevention

Although there is no known way to prevent preeclampsia, it is important for all pregnant
women to start prenatal care early and continue it through the pregnancy. This allows the
health care provider to find and treat conditions such as preeclampsia early.

Proper prenatal care is essential. At each pregnancy checkup, yor health care provider will
check your weight, blood pressure, and urine (through a urine dipstick test) to screen you
for preeclampsia.

As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals, and the
basic food groups is important. Cutting back on processed foods, refined sugars, and cutting
out caffeine, alcohol, and any medication not prescribed by a doctor is essential. Talk to
your health care provider before taking any supplements, including herbal preparations.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001900

Preeclampsia

Definition

Preeclampsia is a condition of pregnancy marked by high blood pressure and excess

protein in your urine after 20 weeks of pregnancy. Preeclampsia often causes only modest
increases in blood pressure. Left untreated, however, preeclampsia can lead to serious —
even fatal — complications for both you and your baby.

If you have preeclampsia, the only cure is delivery of your baby. If you're diagnosed with
preeclampsia too early in your pregnancy for delivery to be an option, you and your doctor
need to allow your baby more time to mature, without putting you or your baby at risk of
serious complications.

Symptoms

Preeclampsia can develop gradually but often attacks suddenly, after 20 weeks of
pregnancy. Preeclampsia may range from mild to severe. If your blood pressure was
normal before your pregnancy, signs and symptoms of preeclampsia may include:

 High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or

greater — documented on two occasions, at least six hours but no more than seven
days apart
 Excess protein in your urine (proteinuria)
 Severe headaches
 Changes in vision, including temporary loss of vision, blurred vision or light
sensitivity
 Upper abdominal pain, usually under your ribs on the right side
 Nausea or vomiting
 Dizziness
 Decreased urine output
 Sudden weight gain, typically more than 2 pounds (.9 kilograms) a week

Swelling (edema), particularly in your face and hands, often accompanies preeclampsia.
Swelling isn't considered a reliable sign of preeclampsia, however, because it also occurs in
many normal pregnancies.

When to see a doctor

Contact your doctor immediately or go to an emergency room if you have severe
headaches, blurred vision or severe pain in your abdomen.

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.

Causes

Preeclampsia used to be called toxemia because it was thought to be caused by a toxin in a

pregnant woman's bloodstream. This theory has been discarded, but researchers have yet
to determine what causes preeclampsia. Possible causes may include:

 Insufficient blood flow to the uterus

 Damage to the blood vessels
 A problem with the immune system
 Poor diet

Other high blood pressure disorders during pregnancy

Preeclampsia is classified as one of four high blood pressure disorders that can occur
during pregnancy. The other three are:

 Gestational hypertension. Women with gestational hypertension have high blood

pressure, but no excess protein in their urine. Some women with gestational
hypertension eventually develop preeclampsia.
 Chronic hypertension. Chronic hypertension is high blood pressure that appears
before 20 weeks of pregnancy or lasts more than 12 weeks after delivery. Usually,
chronic hypertension was present — but not detected — before pregnancy.
 Preeclampsia superimposed on chronic hypertension. This term describes
women who have chronic high blood pressure before pregnancy and then develop
worsening high blood pressure and protein in the urine during pregnancy.

Risk factors

Preeclampsia develops only during pregnancy. Risk factors include:

 History of preeclampsia. A personal or family history of preeclampsia increases

your risk of developing the condition.
 First pregnancy. The risk of developing preeclampsia is highest during your first
pregnancy or your first pregnancy with a new partner.
 Age. The risk of preeclampsia is higher for pregnant women younger than 20 and
older than 40.
 Obesity. The risk of preeclampsia is higher if you're obese.
 Multiple pregnancy. Preeclampsia is more common in women who are carrying
twins, triplets or other multiples.
 Prolonged interval between pregnancies. This seems to increase the risk of
preeclampsia.
 Gestational diabetes. Women who develop gestational diabetes have a higher risk
of developing preeclampsia as the pregnancy progresses.
  History of certain conditions. Having certain conditions before you become
pregnant — such as chronic high blood pressure, migraine headaches, diabetes,
kidney disease, rheumatoid arthritis or lupus — increases the risk of preeclampsia.

Other associated factors

Other factors that may be associated with a higher risk of preeclampsia include:

 Having other health conditions. There's some evidence that both urinary tract
infections and periodontal disease during pregnancy are associated with an
increased risk of preeclampsia, which may indicate that antibiotics could play a role
in prevention of preeclampsia. More study is needed.
 Vitamin D insufficiency. There's also some evidence that insufficient vitamin D
intake increases the risk of preeclampsia, and that vitamin D supplements in early
pregnancy could play a role in prevention. More study is needed.
 High levels of certain proteins. Pregnant women who had high levels of certain
proteins in their blood or urine have been found to be more likely to develop
preeclampsia than are other women. These proteins interfere with the growth and
function of blood vessels — lending evidence to the theory that preeclampsia is
caused by abnormalities in the blood vessels feeding the placenta. Although more
research is needed, the discovery suggests that a blood or urine test may one day
serve as an effective screening tool for preeclampsia.

Complications

Most women with preeclampsia deliver healthy babies. The more severe your
preeclampsia and the earlier it occurs in your pregnancy, however, the greater the risks for
you and your baby. Preeclampsia may require induced labor and delivery by Caesarian
section. Complications of preeclampsia may include:

 Lack of blood flow to the placenta. Preeclampsia affects the arteries carrying
blood to the placenta. If the placenta doesn't get enough blood, your baby may
receive less oxygen and fewer nutrients. This can lead to slow growth, low birth
weight, preterm birth and breathing difficulties for your baby.
 Placental abruption. Preeclampsia increases your risk of placental abruption, in
which the placenta separates from the inner wall of your uterus before delivery.
Severe abruption can cause heavy bleeding, which can be life-threatening for both
you and your baby.
 HELLP syndrome. HELLP — which stands for hemolysis (the destruction of red
blood cells), elevated liver enzymes and low platelet count — syndrome can rapidly
become life-threatening for both you and your baby. Symptoms of HELLP syndrome
include nausea and vomiting, headache, and upper right abdominal pain. HELLP
syndrome is particularly dangerous because it can occur before signs or symptoms
of preeclampsia appear.
 Eclampsia. When preeclampsia isn't controlled, eclampsia — which is essentially
preeclampsia plus seizures — can develop. Symptoms of eclampsia include upper
 right abdominal pain, severe headache, vision problems and change in mental
status, such as decreased alertness. Eclampsia can permanently damage your vital
organs, including your brain, liver and kidneys. Left untreated, eclampsia can cause
coma, brain damage and death for both you and your baby.
 Cardiovascular disease. Having preeclampsia may increase your risk of future
cardiovascular disease.

Tests and diagnosis

Preeclampsia usually shows up during a routine prenatal blood pressure check and urine
test. The diagnosis depends on the presence of high blood pressure and protein in your
urine after 20 weeks of pregnancy. Certain markers in your blood and urine may be
indications of preeclampsia. That's why it's essential to seek early and regular prenatal
care throughout your pregnancy.

A blood pressure reading in excess of 140/90 mm Hg clearly is abnormal in pregnancy.

However, a single high blood pressure reading doesn't mean you have preeclampsia. If you
have one reading in the abnormal range — or a reading that's substantially higher than
your usual blood pressure — your doctor will closely observe your numbers. You may also
be asked to come in for additional blood pressure readings and urinary protein
measurements.

Additional tests
If you're diagnosed with preeclampsia, your doctor may recommend additional tests,
including:

 Blood tests. These can determine how well your liver and kidneys are functioning
and whether your blood has a normal number of platelets — the cells that help
blood clot.
 Prolonged urine collection test. Urine samples taken over at least 12 hours and up
to 24 hours can quantify how much protein is being lost in the urine, an indication of
the severity of preeclampsia.
 Fetal ultrasound. Your doctor may also recommend close monitoring of your
baby's growth, typically through ultrasound. This test directs high-frequency sound
waves at the tissues in your abdominal area. These sound waves bounce off the
curves and variations in your body, including your baby. The sound waves are
translated into a pattern of light and dark areas — creating images of your baby on a
monitor that can be recorded electronically or on film for a look at the inside of your
uterus.
 Nonstress test or biophysical profile. These make sure your baby is getting
enough oxygen and nourishment. A nonstress test is a simple procedure that checks
how your baby's heart rate reacts when your baby moves. Your baby is doing fine if
the heart rate increases at least 15 beats a minute for at least 15 seconds twice in a
20-minute period. A biophysical profile combines an ultrasound with a nonstress
 test to provide more information about your baby's breathing, tone, movement and
the volume of amniotic fluid in your uterus.

Treatments and drugs

The only cure for preeclampsia is delivery. You're at increased risk of seizures, placental
abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of
course, if it's too early in your pregnancy, delivery may not be the best thing for your baby.

If you've had preeclampsia in one or more previous pregnancies, some experts recommend
more frequent prenatal visits than normally recommended for pregnancy. Your doctor may
ask you to come in every two weeks between the 20th and 32nd week of your gestation,
and weekly after that until delivery.

Medications
Your doctor may recommend the following:

 Medications to lower blood pressure. These medications, called

antihypertensives, are used to lower your blood pressure until delivery.
 Corticosteroids. If you have severe preeclampsia or HELLP syndrome,
corticosteroid medications can temporarily improve liver and platelet functioning to
help prolong your pregnancy. Corticosteroids can also help your baby's lungs
become more mature in as little as 48 hours — an important step in helping a
premature baby prepare for life outside the womb.
 Anticonvulsive medications. If your preeclampsia is severe, your doctor may
prescribe an anticonvulsive medication, such as magnesium sulfate, to prevent a
first seizure.

Bed rest
If you aren't near the end of your pregnancy and you have a mild case of preeclampsia,
your doctor may recommend bed rest to lower your blood pressure and increase blood
flow to your placenta, giving your baby time to mature. You may need to lie in bed, only
sitting and standing when necessary. Or you may be able to sit on the couch or in bed and
strictly limit your activities. Your doctor may want to see you a few times a week to check
your blood pressure, urine protein levels and your baby's well-being.

If you have more severe preeclampsia, you may need bed rest in the hospital. In the
hospital, you may have regular nonstress tests or biophysical profiles to monitor your
baby's well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a
sign of poor blood supply to the baby.

Delivery
If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may
recommend inducing labor right away. The readiness of your cervix — whether it's
beginning to open (dilate), thin (efface) and soften (ripen) — also may be a factor in
determining whether or when labor will be induced.
In more severe cases, it may not be possible to consider your baby's gestational age or the
readiness of your cervix. If it's not possible to wait, your doctor may induce labor or
schedule a C-section earlier in your pregnancy. During delivery, you may be given
magnesium sulfate intravenously to increase uterine blood flow and prevent seizures.

After delivery, expect your blood pressure to return to normal within a few weeks.

Coping and support

Discovering that you have a potentially serious pregnancy complication can be frightening.
If you're diagnosed with preeclampsia late in your pregnancy, you may be surprised and
scared to know that you'll be induced right away. If you're diagnosed earlier in your
pregnancy, you may have many hours of bed rest to worry about your baby's health.

It may help to learn as much as you can about your condition. In addition to talking to your
doctor, do some research. On the other hand, if reading about preeclampsia and its possible
complications only makes you more nervous and worried, find a distraction. Make sure you
understand when to call your doctor, and then find something else to occupy your time.

Coping with bed rest

For the first few hours, bed rest may seem wonderful. But the reality of life in bed —
waiting and worrying — is often not so wonderful. You may feel frustrated by the forced
lack of activity, especially if you haven't had time to finish preparations for your baby's
arrival.

To make bed rest tolerable, consider these tips:

 Make sure you understand the ground rules. Ask your doctor for specifics. What
position should you use while lying down? Can you sit up at times? If so, for how
long? Are you allowed any other type of physical activity?
 Prepare your resting room. Whether you choose to spend your time in your
bedroom or a more central spot in your home, make sure everything you need is
within reach.
 Organize your day. The hours will pass more quickly if you have some sort of
routine. Schedule specific times to phone the office, watch television and read. It
may help to stick to some parts of your normal schedule, such as lunchtime and
lights out.
 Keep busy. Use your time to balance the checkbook, organize your photo albums or
catch up on phone calls. Shop for baby supplies, either online or from catalogs. Take
up a new hobby, such as knitting. Or learn relaxation and visualization techniques.
They'll help not only during bed rest but also during labor and delivery.

Make the best of the situation by focusing on the fact that you're doing what's best for you
and your baby.
http://www.mayoclinic.com/health/preeclampsia/DS00583