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Preeclampsia
Definition
Preeclampsia is when a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.
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Alternative Names
Toxemia; Pregnancy-induced hypertension (PIH)
Causes
The exact cause of preeclampsia is unknown. Possible causes include:
- Autoimmune disorders
- Blood vessel problems
- Your diet
- Your genes
Risk factors include:
- First pregnancy
- Multiple pregnancy (twins or more)
- Obesity
- Being older than age 35
- History of diabetes, high blood pressure, or kidney disease
Symptoms
Often, women who have preeclampsia do not feel sick.
Symptoms of preeclampsia can include:
- Swelling of the hands and face/eyes (edema)
- Sudden weight gain over 1-2 days, more than 2 pounds a week
Note: Some swelling of the feet and ankles is considered normal during pregnancy.
Symptoms of severe preeclampsia include:
- Headache that does not go away
- Belly pain on the right side, below 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
- Irritability
- Decreased urine output, not urinating very often
- Nausea and vomiting (worrisome sign)
- Vision changes, including temporary blindness, seeing flashing lights or spots, sensitivity to light, and blurry vision
Exams and Tests
The doctor will perform a physical exam. This may show:
- High blood pressure, usually higher than 140/90 mm/Hg
- Swelling in the hands and face
- Weight gain
Blood and urine tests will be done. This may show:
- Protein in the urine (proteinuria)
- Higher-than-normal liver enzymes
- Platelet count less than 100,000
Tests will also be done to:
- See how well your blood clots
- Monitor the baby's health
The results of a pregnancy ultrasound, non-stress test, and other tests will help your doctor decide whether your baby needs to be delivered immediately.
Women who had low blood pressure at the start of their pregnancy, followed by 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 medicines 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:
- Bed rest, lying on your left side most or all of the time
- Drinking plenty of water
- Eating less salt
- Frequent doctor visits to make sure you and your baby are doing well
- Medicines to lower your blood pressure (sometimes)
Sometimes, a pregnant woman with preeclampsia is admitted to the hospital so the health care team can more closely watch the baby and mother.
Treatment in the hospital may include:
- Close monitoring of the mother and baby
- Medicines to control blood pressure and 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 there are signs of severe preeclampia, including:
- Tests that show your baby is not growing well or is not getting enough blood and oxygen
- The bottom number of your blood pressure is over 110 mmHg or is greater than 100 mmHg consistently over a 24-hour period
- Abnormal liver function test results
- Severe headaches
- Pain in the belly area (abdomen)
- Seizures or changes in mental function (eclampsia)
- Fluid in the mother's lungs (pulmonary edema)
- HELLP syndrome (rare)
- Low platelet count or bleeding
- Low urine output, a lot of protein in the urine, and other signs that your kidneys aren't working properly
Outlook (Prognosis)
Sign and symptoms of preeclampsia usually go away within 6 weeks after delivery. However, the high blood pressure sometimes get worse the first few days after delivery.
If you have had preeclampsia, you are more likely to develop it again in another pregnancy. However, it is not usually as severe as the first time.
If you have high blood pressure during more than one pregnancy, you are more likely to have high blood pressure when you get older.
Possible Complications
Rare but severe complications for the mother can include:
- Bleeding problems
- Premature separation of the placenta from the uterus before the baby is born
- Rupture of the liver
- Stroke
- Death (rarely)
When to Contact a Medical Professional
Call your health care provider if you have symptoms of preeclampsia during your pregnancy.
Prevention
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.
References
Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 35.
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.
