Pre-eclampsia (preeclampsia) (PE) is defined as a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine. The disorder usually occurs in the third trimester of pregnancy and gets worse over time. Current known risk factors for preeclampsia include: obesity, prior hypertension, older age, and diabetes mellitus. If Pre-eclampsia is left untreated, it can result in seizures at which point it is known as eclampsia.
Quote: "Whether a woman with preeclampsia is at home or in the hospital, she and her baby will be monitored closely for the remainder of her pregnancy."
Preeclampsia is a serious condition that affects around 5% of women who are pregnant and usually begins after 20 weeks of pregnancy. Increased blood pressure is the main symptoms, yet there might be other symptoms such as liver or kidney abnormalities, protein in the urine, vision changes, or persistent headaches.
Preeclampsia most commonly appears after a woman has been pregnant for 37 weeks, although it may develop at any time in the second half of her pregnancy, to include during labor or even after delivery - usually in the first 48 hours.
It is possible for a woman to experience symptoms of preeclampsia before 20 weeks but only in rare instances, such as with a molar pregnancy. Preeclampsia may progress slowly or quickly from symptoms that are mild to ones that are severe and present life-threatening complications if not diagnosed and treated rapidly. A woman's doctor will screen them for the condition at each prenatal visit by taking their blood pressure and checking their urine sample for protein.
The more severe the condition and the earlier preeclampsia appears, the greater the risks for both a woman and her baby. The majority of women who get preeclampsia develop symptoms that are mild near to their due date and they and their babies do will with appropriate care. Yet when preeclampsia is severe it may affect a number of organs and cause serious or life-threatening issues. A woman may need to deliver early if their condition is severe or worsening. Preeclampsia causes a woman's blood vessels to constrict, resulting in high blood pressure and a reduction of blood flow that may affect organs in her body such as her kidneys, liver, or brain.
When less blood flows to a woman's uterus, it may mean issues for her baby such as too little amniotic fluid, poor growth and placental, 'abruption,' which is when the placenta separates from the uterine wall prior to delivery. Also, the baby might be born prematurely if the mother needs to deliver early in order to protect her health. Changes in a woman's blood vessels caused by preeclampsia might cause her capillaries to leak fluid into her tissues resulting in swelling or, 'edema.' When the tiny blood vessels in a woman's kidneys leak, protein from her bloodstream spills into her urine.
The symptoms of preeclampsia usually disappear shortly after childbirth. Women who have experienced preeclampsia have an increased risk of experiencing cardiovascular issues in the future to include stroke, hypertension and heart failure.
Some women with preeclampsia develop a condition called, 'HELLP syndrome.' HELLP stands for, 'Hemolysis,' which is the breakdown of red blood cells, 'Elevated Liver enzymes,' and, 'Low Platelets,' the blood cells that are needed for clotting. HELLP syndrome places a woman and her baby at an even greater risk for the same kinds of issues that may result from severe preeclampsia itself. After a woman develops preeclampsia, she will have her blood tested periodically for signs of HELLP syndrome.
Not as frequently, preeclampsia may lead to seizures - a condition referred to as, 'eclampsia.' Eclampsia may have very serious consequences for both a mother and her baby. The seizures might be preceded by symptoms such as:
On occasion, the seizures happen with warning. Due to this, every woman who experiences severe preeclampsia is given magnesium sulfate which is an anti-seizure medication.
Preeclampsia can appear quickly and it is important to be aware of the symptoms. It is important to call your doctor or midwife promptly if you notice puffiness around your eyes or swelling in your face, more than slight swelling of your hands, or sudden or excessive swelling of your ankles or feet. The swelling is caused by retention of water and may also lead to quick weight gain. Let your caregiver know if you gain more than 5 pounds in a week. Bear in mind that not all women with preeclampsia experience obvious swelling or dramatic weight gain. Not all women with swelling or rapid weight gain have preeclampsia. With severe preeclampsia a woman might experience additional symptoms and needs to call her caregiver if she experiences any of the following warning signs:
The symptoms may vary between women and preeclampsia can happen without any obvious symptoms at all, especially in the early stages. In addition, some symptoms of preeclampsia such as weight gain and swelling might seem like common pregnancy complaints. A woman may not know they have the condition until it is diagnosed at a routine prenatal checkup! Due to this it is extremely important not to miss these checkups.
A woman's caregiver will check her blood pressure. If her blood pressure is elevated and she has protein in her urine she will be diagnosed with preeclampsia. Even if she does not have protein in her urine, high blood pressure might prompt a caregiver to order blood tests to check her platelet count, as well as how her kidneys and liver are working. A woman's blood pressure is considered to be, 'high,' if she has a systolic reading of 140 or more or a diastolic reading of 90 or higher. Due to the fact that blood pressure may fluctuate during the day, more than one reading is taken to confirm that her blood pressure is consistently high.
A woman's caregiver will also check her urine. A test strip is dipped into a sample of her urine to look for protein. As with blood pressure, the amount of protein in a woman's urine may fluctuate during the day. If a caregiver suspects there is an issue, she might be asked to collect her urine over a 24 hour period of time for testing purposes. Vision changes or headaches also point to a potential diagnosis of preeclampsia.
Interestingly, while researchers have learned a great amount about preeclampsia, many aspects of the condition are still not known. Experts believe that many instances of preeclampsia actually start early in a woman's pregnancy, well before any symptoms appear, and that they are related to a reduction of blood flow to the placenta. The reduction of blood flow could happen if the placenta fails to implant properly in the lining of a woman's uterus and the arteries in that area do not dilate as they should, so less blood gets to the placenta. Conditions such as diabetes and chronic hypertension may also cause a reduction of blood flow to the placenta.
There is evidence that changes in blood flow to the placenta might trigger the release of high levels of certain placental proteins into a woman's bloodstream. The release may set off a complex set of reactions that includes constricted blood vessels leading to high blood pressure, reduced blood volume, damage to the vessel walls leading to swelling and protein in urine, as well as changes in blood clotting which may cause a number of other issues. Why this happens in some women and not others is not completely understood and there is most likely not single explanation. Nutrition, genetics, the way a woman's immune system reacts during pregnancy, certain underlying diseases and additional factors may all play parts.
If a woman experiences high blood pressure before they conceive, or during the first half of their pregnancy, they are considered to have chronic hypertension and their caregiver will need to monitor them closely during their pregnancy to make sure their blood pressure remains under control and that their baby is doing well. She will also have to watch for signs of preeclampsia and other complications. Women with chronic hypertension who develop preeclampsia are at greater risk for complications than women with either condition alone.
It is more common for a woman to get preeclampsia for the first time during her first pregnancy. Once a woman has had preeclampsia, they are more likely to develop it again in later pregnancies. The more severe the condition and the earlier it appears, the greater the risk is. If a woman experienced severe preeclampsia that began before 30 weeks of pregnancy, her likelihood of experiencing it again can be as high as 40%. Additional risk factors include the following:
Management of preeclampsia depends on how severe it is, how far along a woman is in her pregnancy, as well as how her baby is doing. She will most likely be hospitalized for an initial assessment and potentially for the remainder of her pregnancy. Along with blood pressure and urine testing, a health care provider will perform a number of blood tests to find out how serious the issue is. A sonogram will be performed to check the baby's growth, and possibly a biophysical profile and non-stress test to find out how the baby is doing.
If a woman has mild preeclampsia and is at 37 weeks or more she will most likely be induced, particularly if her cervix is beginning to thin out an dilate. If there are signs that she or her baby will not be able to tolerate labor, she will have a c-section. If a woman is not yet at 37 weeks, her condition is mild and seems to be stable and her baby is in good condition, she most likely will not need to deliver right away. Instead, she may be sent home and told to, 'take it easy.' She may be asked to monitor her blood pressure at home, or have a nurse check on her. The woman's health care provider may want her to stay in the hospital so she can rest in bed and be monitored.
While no studies have shown definitely that bed rest improves the outcomes for a woman or her baby when they have preeclampsia, her blood pressure will usually be lower when she is at rest. Most health care providers will recommend that a woman with preeclampsia restrict her activities, or go on modified bed rest. 'Complete bed rest,' means a woman with preeclampsia is to remain in bed for an extended period of time and would most likely not be helpful while increasing her risk of developing blood clots.
Whether a woman with preeclampsia is at home or in the hospital, she and her baby will be monitored closely for the remainder of her pregnancy. If she is at home, it means going to see her health care provider for frequent blood pressure checks and urine testing, and possibly blood tests, as well as periodic non-stress tests and sonograms. She will also do daily fetal kick counts. If at any time her symptoms indicate that her preeclampsia is worsening, or that her baby is not doing well, she will be admitted to the hospital and will most likely need to deliver.
If you are diagnosed with severe preeclampsia, you will definitely have to spend the remainder of your pregnancy in the hospital. You might be transferred to a hospital where a high-risk pregnancy specialist can provide care for you and your baby. You will be administered magnesium sulfate intravenously with the goal of preventing seizures, as well as medication to lower your blood pressure if it is very high.
If you are at 34 weeks or more you may be induced or - in some situations, delivered by c-section. If you are at less than 34 weeks, you might be administered corticosteroids to help your baby's lungs mature more quickly. If you do not deliver immediately, both you and your baby will be monitored very, very closely.
You will be induced or delivered by c-section at the first sign that the preeclampsia is worsening, including if you have HELLP or eclampsia, or if your baby is not doing well - despite where you are in your pregnancy. If you develop preeclampsia during labor, you will be monitored closely. Depending upon your situation, you might be administered magnesium sulfate to prevent seizures and medication to lower your blood pressure.
Once you have delivered you will remain under close supervision for a few days to watch your blood pressure and to watch for signs of additional complications. A number of instances of eclampsia and HELLP syndrome occur after delivery, usually within the first 48 hours. Your health care provider will closely monitor your blood pressure.
The majority of women, especially women with mild preeclampsia, find their blood pressure decreasing within a day or so. Women with more severe preeclampsia can experience elevated blood pressure for longer periods of time. Women whose blood pressure stays high are administered magnesium sulfate intravenously for at least 24 hours after they deliver to help prevent seizure activity. They might end up going home on blood pressure medication.
Medical science does not know for sure how to prevent preeclampsia, although there is a good amount of research being pursued in this area. Several studies have examined whether restricting salt intake, taking extra calcium, or boosting vitamins may help. The results have not been clear enough to make recommendations. If you are at high risk of preeclampsia your doctor may recommend taking low-dose aspirin. Do not take aspirin during pregnancy unless your doctor recommends doing so.
The best thing you can do is get good prenatal care and keep every one of your prenatal appointments. At every visit your health care provider will check your blood pressure and test your urine for protein. It is also important to be aware of the warning signs of preeclampsia so you can inform your health care provider and receive treatment as soon as possible.
UPDATE: (13 Nov, 2015 ) - New theory may help demystify pregnancy-related condition
Preeclampsia, a late-pregnancy disorder that is characterized by high blood pressure and organ damage, may be caused by problems related to meeting the oxygen demands of the growing fetus, experts say in a new Anaesthesia paper. The new theory challenges the current view that pre-eclampsia is caused by a problem with the placenta. "When the fetus is not getting enough oxygen and nutrients for its growth, due to conditions in the mother, conditions in the placenta or conditions in the baby, the mother makes changes in her own body to increase the supply of oxygen and nutrients to her baby, and in doing so damages her own body and gives her high blood pressure," said Associate Professor Alicia Dennis, lead author of the study.
UPDATE: (16 Dec, 2015 ) - Research offers recommendations for use of aspirin to prevent preeclampsia
To prevent preeclampsia, new research suggests that low-dose aspirin should be given prophylactically to all women at high risk (those with diabetes or chronic hypertension) and any woman with two or more moderate risk factors (including obesity, multiple gestation and advanced maternal age). The researchers concluded, "Both the U.S. Preventive Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower health care costs in the United States to a much greater degree than the approach currently recommended by ACOG."
MFM specialists at Women & Infants/Brown publish research in Obstetrics & Gynecology
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