What is Preeclampsia?
Preeclampsia is a disease of pregnancy that
affects the lining of the mother's blood vessels causing high blood pressure, leaking of fluid
from the blood vessels, and damage to multiple organs. Preeclampsia is believed
to be caused by an abnormal placenta releasing higher than normal amounts of
substances that control the growth of blood vessels and the placenta. Preeclampsia tends to be milder when it
occurs late in pregnancy, but can progress very quickly at anytime to a severe
form with the development of very high blood pressure and seizures (eclampsia).
Severe preeclampsia can also cause fetal growth restriction (poor growth of the
baby) , placental
abruption (the placenta separates from the wall of the uterus), stroke, pulmonary edema
(fluid in the lungs) ,
bleeding disorders, kidney failure, and liver swelling.
Who gets Preeclampsia?Persistent headache not relieved by pain
medicationVisual disturbance such as double vision, sensitivity
to light, blurred vision,
dimmed vision., loss of vision, or flashing lights (fireworks)
Pain in right upper or middle upper abdomen
Nausea or vomiting
Difficulty breathing, new onset shortness of breath,
cough, or rapid breathing
Dark colored urine, blood in urine, or decreased amount of
Decreased fetal movement
Sudden weight gain
About 5% to 7% of all pregnancies are affected by preeclampsia Women are
more likely to develop preeclampsia during their first pregnancy, if they are
over the age of 40, have diabetes, a multiple gestation (twins), a
family history of preeclampsia, had preeclampsia in a previous pregnancy, or
they have had in
vitro fertilization. Women with antiphospholipid syndrome, chronic
hypertension, and chronic renal disease are ten times more likely to
develop preeclampsia than women without these conditions. Most women with early preeclampsia do not have symptoms. When symptoms
occur they usually occur in the second half of pregnancy and may include:
Call your doctor if
you notice any of the above symptoms
How is Preeclampsia Diagnosed?
The American College of Obstetricians and Gynecologists (ACOG) recommends
that preeclampsia should be diagnosed if the following conditions are met:
High blood pressure occurs for the first time after 20 weeks AND
Protein is in the urine
ANY OF THE FOLLOWING SEVERE FEATURES
Cerebral or visual disturbances (as above noted under
symptoms), pulmonary edema (fluid in the lungs), low number of platelets (cells
that help blood to clot), increased liver
enzymes (transaminase) , new or worsening kidney failure.
Women who develop high blood pressure for the first time
after 20 weeks, but do not have protein in their
urine or severe features of preeclampsia are diagnosed with
How is Preeclampsia Treated?
Blood pressure medications are given to reduce the
chance of strokes, heart failure, and kidney injury in women with SBP
greater than or equal to 160 mm Hg or DBP greater than or equal to 110
mm Hg .
Magnesium sulfate is given to treat eclampsia (new
onset grand mal seizures), or to prevent eclampsia
during labor ,during cesarean section, and after delivery in women with SBP greater than or equal to 160
mm Hg , DBP greater than or equal to 110 mm Hg , OR with severe
features of preeclampsia, or hyperactive reflexes
Medication (corticosteroid) to help the fetal lungs mature
and reduce other complications of being born prematurely are given to women
with a viable fetus who must be delivered before 34 weeks' .
Delivery is the only cure for preeclampsia.
However, the timing of delivery will depend on the severity of the disease and
age of the fetus. The mode of delivery (vaginal or cesarean) is determined by
the age of the fetus, presentation, cervical status, and maternal or fetal conditions.
ACOG recommends Preeclampsia with severe features at 34 weeks or after should be delivered
when the mother's condition is stable.Gestational hypertension
(GHTN) or preeclampsia without severe features at 37 weeks or after should be delivered
Preeclampsia with severe features after viability
and before 34 weeks should be hospitalized at a facility with maternal and
neonatal intensive care resources.
Women with GHTN or preeclampsia without severe features
before 37 should have
- Monitoring for symptoms,
- Instruction on daily kick counts,
- Twice weekly blood pressure measurement,
- Blood drawn to assess platelet count, liver enzymes (AST,
ALT) , and serum creatinine at least every week .
- Ultrasound to evaluate the baby's growth should be
performed every three weeks,
- Amniotic fluid level should be checked at least once
- Patients with GHTN should also have their blood
pressure taken, urine checked for protein, and nonstress tests
(NSTs) once weekly.
- Patients with preeclampsia without severe features
should have NSTs twice weekly.
- Strict bedrest or a low sodium diet are not
- Patients should be hospitalized if they develop
severe hypertension, severe features of preeclampsia, or fetal growth
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