Preeclampsia is a form of high blood pressure that is caused by pregnancy. The condition was previously called toxemia because doctors thought a toxin in the blood caused mothers to become very sick. Affecting 5 to 10 percent of all pregnant women, preeclampsia is also responsible for 10 to 15 percent of all maternal deaths in the world. 1 Maternal mortality–deaths associated with pregnancy and childbirth–occurs in twenty-four per hundred thousand births in the United States. In parts of the developing world, however, maternal mortality remains as high as fourteen hundred per hundred thousand births. 2 Many theories exist about the cause of preeclampsia, including immune system dysfunction, abnormalities of the placenta, blood vessel damage, and genetic predisposition. However, none of these theories have been proven and the cause is still unknown. Preeclampsia occurs after twenty weeks of gestation, and 75 percent of cases will occur after thirty-seven weeks.
Risk factors for developing preeclampsia include the following:
High blood pressure before pregnancy
History of preeclampsia in a previous pregnancy
Age greater than thirty-five
African American ethnicity
Pregestational or gestational diabetes
Pregnant with twins or multiples
Autoimmune problems, such as Lupus
Preexisting kidney problems
Underlying blood clotting disorders
Obesity (BMI of 30 kg/m-2or greater)
Preeclampsia is diagnosed when a pregnant woman has persistently elevated blood pressure and protein in the urine. It may also be associated with swelling of the feet, hands, and face, although these symptoms are often seen in normal pregnancies as well. At each of your prenatal visits, your doctor will check your blood pressure and urine for signs of preeclampsia. In most cases, a mom with preeclampsia will feel completely normal.
If a woman is found to have elevated blood pressure during an office visit, she will be observed over the next few hours and evaluated by blood and urine tests. If the blood pressure remains elevated for more than six hours, the diagnosis of preeclampsia is made.
Preeclampsia is categorized as mild or severe. The criteria for making a diagnosis of mild preeclampsia follow:
Persistent SBP (systolic blood pressure, the number on the top) of 140 to 160 mm Hg, or DBP (diastolic blood pressure, the number on the bottom) between 90 and 110 mm Hg, or both. A normal blood pressure reading should be less than 140/90.
Protein in the urine: more than 300 milligrams within a twenty-four-hour urine collection. A normal value is less than 300 mg.
The criteria for severe preeclampsia are as follows:
Persistent SBP greater than or equal to 160 mm Hg, or DBP greater than or equal to 110 mm Hg, or both.
Protein in the urine: more than five grams within a twenty-four-hour urine collection.
Symptoms of headache, blurred vision, or abdominal pain in the upper-right quadrant or just below the breastbone.
HELLP syndrome: HELLP stands for hemolysis, elevated liver enzymes, and low platelets. In this condition, blood cells are broken down, causing anemia and blood clotting problems. In addition, the liver swells, leading to elevation of liver enzymes in the blood.
Decreased urine output.
Eclampsia, which includes the symptoms of preeclampsia seen above, plus a seizure.
Although numerous attempts have been made to prevent preeclampsia, none have been successful. Scientists have studied low-salt diets, calcium, magnesium, zinc, DHA, evening primrose oil, aspirin, bloodthinners, vitamins E and C, and traditional blood pressure medications. Unfortunately, none of them work.
The only cure for preeclampsia is delivery of the baby and the placenta. Because the cause of preeclampsia is different from that of traditional hypertension, blood pressure medications have little effect on preeclampsia. However, your doctor may use blood pressure medications to temporarily control your blood pressure until your baby can be delivered. In some cases, the progression of the disease can be slowed if the mom remains at strict bed rest. If a mom is diagnosed with preeclampsia at term, delivery is usually recommended at that time.
The situation is more complicated if the condition occurs earlier in the pregnancy. In these cases, we try to balance what is best for the baby–growing inside the uterus–versus what is best for the mother’s health. When the risk to the mom outweighs the risk to the baby, we will deliver the baby. The worst time for preeclampsia to hit is in the second or early third trimester. At that stage, the baby, if delivered, could face many complications, but the danger to the mother’s health may force the premature birth.
Never in a million years did I think I would become the poster child for preeclampsia. Before becoming pregnant, I had never had any medical problems, I ate well, and I exercised regularly.
When I was thirty-three, I became pregnant with my son Luke. I was working full time and had every intention of continuing until my due date. I thought I would be in the office, run over to the hospital, pop out the baby, and be back in the swing of things within a few weeks. Little did I know how my plans would change.
One day, as I entered my twenty-ninth week, I was driving to work and had a mild headache. By the time I arrived at the office, I was feeling a bit cloudy. I set off on my normal day, seeing patients in the office, answering phone calls, and delivering two babies. Toward the end the day, I could tell something wasn’t right. My nurse checked my blood pressure and found it was 160/100. Immediately, I found myself in a wheelchair on the way down the hall to the hospital.
When I arrived, the nurse again checked my blood pressure. I gazed at the machine in disbelief as the numbers climbed over 160. How could this be happening to me? I asked the nurse to bring a different blood pressure cuff, as I was sure this one was broken. But to my dismay, the new machine showed the same result. The next thing I knew, I was receiving steroids in anticipation of a premature delivery.
For a short time, my blood pressure stabilized as long as I remained completely flat in bed. I stayed in the hospital like that for two weeks, getting up only to use the bathroom. Staying in bed for those weeks felt like an eternity, and some days I thought of sneaking out and going home. But I knew I wouldn’t even make it down the hall without my blood pressure going up.
At thirty-one weeks, my blood pressure skyrocketed to 180/110 and I developed HELLP syndrome. My liver tests went haywire and my blood clotting ability started to drop. It was time to get the baby out. My labor was induced and went very quickly. I delivered my son, who weighed only three and a half pounds. I was able to see him just for a minute before he was whisked away to the NICU on a respirator.
During the labor and after the birth, I was given a medication called magnesium sulfate, which is used to prevent seizures in women with severe preeclampsia. This medicine made me feel horrible! I was dizzy, nauseous, and hot, and my vision was blurred. I didn’t know if the symptoms were from the magnesium or if I was having a stroke. I was afraid to tell anyone how I felt because I didn’t want to worry them, so I just closed my eyes and tried to sleep. More than twenty-four hours went by, and my blood pressure finally started to come down. As soon as the magnesium was turned off, I felt so much better. I was able to visit my son for the first time.
Even though I’ve been in the NICU a thousand times, nothing could prepare me for seeing my own child there. Luke was on a respirator, hooked to multiple monitors, and had IVs in his belly button and on his scalp. He was so skinny and red. I could stay with him for only a short time because my blood pressure would start to go up again when I was out of bed.
I went home after a few days and took blood pressure medicine for nearly two months until my numbers finally went back to normal. After an up-anddown course, Luke was discharged from the NICU after thirty-five days, weighing just four pounds, fifteen ounces. Thankfully, today Luke is a healthy eight-year-old with no consequences from his early arrival.
My experience educated me in a way that is different from reading about preeclampsia in a textbook. This disease changed my life. First, I was so grateful for prenatal care, knowing that in many parts of the world, my condition would have gone undiagnosed, and Luke and I may have died. In addition, having preeclampsia helped me understand that blank stare I get when I tell patients they have this condition. It truly is a disease that seems to come out of nowhere: no warning, no symptoms. I was in denial with the best of them.Allison
As Allison’s ordeal shows, often there are few or no symptoms before preeclampsia strikes. Many women feel fine even while they have preeclampsia and have no clue what’s going on inside their bodies. A woman can hear her doctor tell her, "Your blood pressure is really high" and yet she feels completely normal. The next thing she knows, she’s in the hospital having her baby.
The importance of consistent prenatal care cannot be overemphasized for this condition because it may be detected or anticipated by following your blood pressure trends. If we notice that your blood pressures are rising above your baseline, we may see you more frequently in the office or ask you to monitor your blood pressure at home. And by being vigilant, we may be able to prolong the pregnancy, keeping the baby inside longer before delivery.
If left undetected, the complications of preeclampsia are serious and include seizures, stroke, liver rupture, water in the lungs, and organ failure. Complications for the baby include placental abruption, decreased blood flow and growth problems, and low amniotic fluid volume. Luckily, after preeclampsia is diagnosed and the baby and the placenta are delivered, the symptoms usually resolve within a few days and the new mother is cured. On occasion, the elevated blood pressure persists, requiring the temporary use of blood pressure medications.
M. Heron, D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, and B. Tejada-Vera, "Deaths: Final Data for 2006," National Vital Statistic Reports 57 (April 17, 2009). http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf (accessed February 14, 2011); "Maternal mortality" Fact sheet, World Health Organization (November 2010). http://www.who.int/mediacentre/factsheets/fs348/en/ (accessed February 14, 2011).
UNICEF’s maternal mortality statistics. http://www.unicef.org/index.php (accessed February 10, 2011).
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