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What is Preeclampsia?
Preeclampsia (or toxemia) is a severe disease that only occurs in pregnancy. It complicates between 5 and 10% of pregnancies. It has been classically characterized by elevated blood pressures, protein loss in the urine, and increased swelling, or edema. Preeclampsia when severe can also become associated with blood disorders such as HELLP syndrome, low platelets and liver dysfunction, neurological symptoms because of swelling in the brain, seizures, stroke and heart attacks. In addition to the maternal complications, preelampsia also affects the fetus, usually causing diminished growth and fetal compromise that when severe can lead to stillbirth. Preeclampsia can occur any time in pregnancy, but is usually more severe when it occurs earlier in the pregnancy, between 22 and 34 weeks. It rarely occurs before 22 weeks, unless a multiple pregnancy is involved or a very abnormal, "molar" pregnancy. HELLP syndrome occurs in about 5% of preeclamptic pregnancies. This severe complication cannot be treated. Patient's with HELLP syndrome should be delivered.
What are the Risk Factors for Preeclampsia?
• Multiple Pregnancy.
• First Pregnancy.
• History of Preeclampsia in a Prior Pregnancy.
• African American ethnicity.
• Maternal Underlying Blood Clotting Disorders, or Thrombophilias.
• Maternal Preexisting Diabetes.
• Maternal Chronic Hypertension.
• Abnormalities on the triple, quad, or AFP screen in the Pregnancy.
What are the Signs of Preeclampsia?
The signs of preeclampsia are often minimal, and may not become concerning for the pregnant woman until the disease is quite severe. Often women are asymptomatic early in the course of the disease and are incidently found to have elevated blood pressures during a routine prenatal visit. When women do have symptoms the most common signs of preeclampsia are: increased weight gain, increased swelling of the hands and face, headaches, spots in their vision, and abdominal pain. One of the most concerning signs of preeclampsia is decreased fetal movement, which can indicate severe disease with severe fetal compromise or even stillbirth.
How does my Doctor Diagnose Preeclampsia?
First they obtain serial examinations of the blood pressure. They will also test your urine for protein loss. This involves a spot check and more thoroughly a 24 hour urine collection. They will send a panel of blood tests as well. Usually, this involves a temporary hospitalization for observation. During this time they will monitor the fetus and should check a thorough ultrasound that looks at growth, fluid, movement profiles, and blood flow patterns for the baby. Once they have gained sufficient information they will decide if the preelampsia is mild at this time, or severe.
What is the Management of Preeclampsia?
If you develop preeclampsia, the only treatment is delivery. Depending upon the gestational age, you may be delivered immediately or your doctor may try to gain some additional time if you are premature. This will all depend upon the severity of your disease. If you are beyond 37 weeks the safest thing for you and your baby is delivery. If you are premature, your doctor may try to obtain 48 hours of steroid therapy, to help the baby mature and prepare for delivery. If you are extremely premature, your doctor may even try to buy even more time with bedrest and very, very close surveillance. One exceptions, as above, is in the setting of HELLP syndrome. Patients and fetuses with HELLP syndrome do not benefit from conservative management, and delivery should be undertaken. In the absence of HELLP syndrome, delivery timing soley depends on the complete picture of how severe your disease is, and how you and your baby are being affected. This is a wonderful area to email me on, Then we can discuss your specific circumstances. www.AskAnOB.com/questionsfortheobgyn
If you have severe disease, or you are late in your pregnancy, your doctor will probably decide it is best to deliver you. You may be induced to try for a vaginal delivery, but if you are very early this is unlikely to be successful. Your doctor with likely put you on magnesium therapy during your induction, because this is the most common time for a woman to develop eclampsia, which is a seizure disorder that is the ultimate progression of preeclampsia. Magnesium may make you feel awful, but it is really important because it is the most effective prevention of seizures.
Patient with HELLP syndrome may be treated with steroids. This has been shown to help keep platelet counts higher, but it has not been shown to improve maternal outcomes.
Luckily, within a few days to weeks of delivery, your disease will be gone. You should have your blood pressures followed up on to make sure you do not have an underlying blood pressure disorder even outside of pregnancy. You should watch your blood pressures closely postpartum. For some reason, the disease can get worse in the first days to weeks after delivery. This is not well-understood. If you do have higher blood pressures, or develop symptoms as above, you should call your doctor immediately.
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