What is Preeclampsia?

Diagnosing and Managing Preeclampsia

Pregnancy Ultrasound
Pregnancy Ultrasound. Stephen Morton / Stringer / Getty Images

Preeclampsia is a complication of pregnancy that affects blood pressure and other organ systems. Specifically, the condition preeclampsia is diagnosed when high blood pressure and proteinuria (protein in the urine) is found in a pregnant woman who is beyond 20 weeks gestation. This is an important distinction, since women who had high blood pressure before becoming pregnant may sometimes meet the clinical criteria for preeclampsia, but should be treated according to a different set of guidelines.

Signs and Symptoms of Preeclampsia

In most cases, a sudden increase in blood pressure is the first sign of preeclampsia. Less often, blood pressure will rise slowly but steadily. In either case, when blood pressure reaches or exceeds 140/90 mm Hg and a healthcare provider has documented this change on at least two occasions, spaced at least four hours apart, a diagnosis of preeclampsia is suspected. 

In addition, excess protein in the urine, found during a urine screening that is a routine part of prenatal care, can signal the kidney problems that often accompany high blood pressure in preeclampsia. 

Other signs and symptoms of preeclampsia include: 

  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
  • Upper abdominal pain
  • Nausea or vomiting
  • Decreased urine output
  • Decreased levels of platelets in the blood (thrombocytopenia)
  • Impaired liver function
  • Shortness of breath
  • Sudden weight gain and swelling (also common in normal pregnancies)

Who Is At Risk for Preeclampsia?

Aside from being pregnant, which is the biggest risk for for preeclampsia since it occurs exclusively in pregnant women, other factors may put you at greater risk for developing the condition.

These include: 

  • A previous history of preeclampsia (either you or a blood relative)
  • First pregnancy
  • Being age 40 or older
  • Being obese
  • Carrying a multiple pregnancy
  • Spacing pregnancies less than two years or more than 10 years apart
  • Having certain conditions before becoming pregnant, such as high blood pressure, migraine headaches, diabetes, kidney disease, or lupus

Treating Preeclampsia

If it goes untreated, preeclampsia can lead to very serious complications for both the mother and the baby. In some cases, it can even be fatal. The only cure for the condition is delivery of the baby, which represents a unique challenge to healthcare providers and women as they balance the benefits of an early delivery with the risks of prematurity

Women with preeclampsia face an increased risk of seizures, placental abruption and stroke. If it is too early in the pregnancy to safely induce delivery, close monitoring of the health of the mother and the baby may involve an increased frequency of prenatal exams, blood tests, ultrasounds and nonstress tests.

 

Other strategies may be used to help control blood pressure when it is too early to safely induce labor. These include: 

  • Antihypertensive medications to lower blood pressure. 
  • Corticosteroids to both improve liver and platelet function in the mother and help develop the baby's lungs to prepare for an early delivery. 
  • Anticonvulsant medications to prevent seizures. 
  • Bed rest 
  • Hospitalization

Sources:

Cunningham, FG., Lindheimer, MD. Hypertension in Pregnancy. New England Journal of Medicine, 326(14):927-32.

Working group report on high blood pressure in pregnancy. National Institutes of Health, Washington, DC 2000.

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