Pre-eclampsia

Also Known As: Toxemia, Pregnancy-induced Hypertension

Pre-eclampsia is one of the most serious conditions affecting pregnant women. It is diagnosed when a woman develops high blood pressure (hypertension), protein in her urine (proteinuria), and/or swelling of the hands, feet and/or face during pregnancy. In severe cases, there may be evidence of damage to the kidneys or liver, accumulation of fluid in the lungs, or disturbances of the central nervous system. About 5 to 7 percent of pregnant women develop pre-eclampsia, which can occur after week 20 of pregnancy.

Untreated pre-eclampsia is dangerous because it can harm the mother’s organs and lead to seizures. If these seizures, called eclampsia, aren’t treated right away, they are usually fatal for a woman and her baby. Pre-eclampsia or eclampsia can also lead to low birth weight in the baby, still birth, premature delivery, which can cause health problems in the baby, or placental abruption, in which the placenta comes loose from the uterus before the baby is born, causing bleeding.

Pre-eclampsia can also progress to HELLP syndrome, another life-threatening condition. It is called HELLP because it is defined by the breakdown of red blood cells (Hemolysis), Elevated Liver enzymes and Low Platelet count.

Two out of every 200 women with untreated pre-eclampsia progresses to eclampsia. Most cases of eclampsia occur in the third trimester of pregnancy or within 4 days after delivery. Rarely, it may develop up to 6 weeks after delivery.

Pre-eclampsia sometimes causes symptoms that are very similar to those of normal pregnancy. Some women with pre-eclampsia may have no symptoms at all. That is why it is important to regularly attend all prenatal checkups. During the checkup, the healthcare practitioner will do a physical exam and perform laboratory tests to look for the “silent” signs of pre-eclampsia, like high blood pressure and protein in the urine.

About Pre-eclampsia

Risk Factors
Researchers are still trying to establish the exact cause of pre-eclampsia. However, it is associated with certain risk factors. These include:
  • A past pregnancy with pre-eclampsia
  • A family history of pre-eclampsia
  • Being pregnant for the first time
  • Being older than age 35 at the time of pregnancy or younger than age 19
  • Obesity
  • Carrying multiple babies
  • A history of other conditions, including chronic high blood pressure, migraine headaches, type 1 or type 2 diabetes, kidney disease, a hypercoagulable state (increased tendency for blood to clot), antiphospholipid syndrome, or lupus
Signs and Symptoms

Pre-eclampsia is a serious complication of pregnancy that can develop with no obvious symptoms. If symptoms are present, they may seem similar to those experienced during normal pregnancy. For example, weight gain and swelling are pre-eclampsia symptoms that also occur during normal pregnancies. High blood pressure is a sign of pre-eclampsia that typically goes unnoticed until a healthcare practitioner detects it during a routine pre-natal visit. If you have symptoms associated with pre-eclampsia or notice sudden changes in your pregnancy, it is important that you let your healthcare provider know right away. He or she will look for other signs of pre-eclampsia and help monitor your symptoms. Untreated pre-eclampsia is a serious condition that can be fatal for you and your baby. Be sure to attend all pre-natal checkups and seek medical attention if symptoms arise.

Symptoms of pre-eclampsia may include:

  • Sudden weight gain of more than 2 pounds in a week
  • Sudden face and hand swelling (edema)
  • Persistent headaches
  • Vision changes: temporary loss, blurry vision, flashing light sensations, or light sensitivity
  • Bluish skin resulting from poor circulation
  • Nausea or vomiting, especially if it suddenly appears after mid-pregnancy
  • Decreased urine output
  • Shortness of breath caused by fluid in the lungs or increased blood pressure
  • Shoulder pain or stomach pain or pinching, especially in the upper right side of your abdomen or when laying on your right side—may indicate liver problems
Some signs of pre-eclampsia that may be detected during a physical exam include:
  • Elevated blood pressure 140/90 mmhg
  • Unusually strong leg reflexes (i.e., when a healthcare practitioner taps your knee with a rubber hammer)
Blurred vision, severe headaches, abdominal pain, and shortness of breath are all serious symptoms of pre-eclampsia. If you have any of these symptoms you should seek immediate medical care.
Complications

If left untreated, pre-eclampsia can lead to serious and life-threatening complications for a mother and her baby.

Possible complications include:

  • Seizure (eclampsia)
  • Liver rupture
  • Stroke
  • Low birth weight in the baby
  • Placental abruption (the placenta comes loose from the uterus before the baby is born and causes bleeding)
Women with a history of pre-eclampsia are more likely to develop:
  • Heart disease
  • Diabetes
  • Kidney disease
Tests

There is currently no one reliable test for pre-eclampsia early in pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare practitioners screen for pre-eclampsia in the first trimester by taking a detailed medical history and assessing women for risk factors.

During routine prenatal exams, a healthcare practitioner will look for signs and symptoms of preeclampsia, including high blood pressure,>140/90 mmhg, hand and face swelling, and unusual weight gain. In the second and third trimesters, urine is tested for high amounts of protein,using pr/cr ratio metric test a possible sign of pre-eclampsia.

If you have signs or symptoms of pre-eclampsia, your healthcare provider will do additional laboratory and imaging tests to diagnose pre-eclampsia and determine its severity.

Laboratory Tests

Healthcare practitioner will look for high blood pressure along with proteinuria, or high blood pressure plus one of a number of other signs and symptoms, including a low platelet count, poor kidney function, poor liver function, severe changes in vision, or edema.

The following tests will help to diagnose pre-eclampsia, determine its severity, and monitor its progression:

  • Urine protein and urine protein to creatinine ratio – used to look for elevated protein in the urine
  • BUN, serum creatinine, and uric acid – kidney function tests used to look for organ damage resulting from pre-eclampsia; serum creatinine will be measured frequently to monitor your condition.
  • Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) – elevated levels of these liver function tests may indicate organ damage from pre-eclampsia; ALT and AST will be measured frequently to monitor your condition.
  • Complete blood count (CBC) – ordered to look for changes in the blood associated with pre-eclampsia, such as low platelet counts
  • Partial thromboplastin time (PTT) – used to measure the time it takes for a person's blood to clot; PTT may be prolonged because pre-eclampsia can extend blood clotting times.
  • Antiphospholipid antibodies – Antiphospholipid syndrome is an autoimmune disorder associated with pre-eclampsia and other pregnancy complications. Tests for these antibodies can determine if an autoimmune disorder is underlying your pre-eclampsia.

HELLP syndrome is a life-threatening variant of pre-eclampsia that is defined by Hemolysis (the breakdown of red blood cells) Elevated Liver enzymes, and a Low Platelet count. If your healthcare practitioner suspects you may have HELLP syndrome, the following tests may be done:

  • Peripheral blood smear – red blood cells are examined with a microscope for damage or abnormalities.
  • Serum lactate dehydrogenase (LD) – elevated LD levels indicate tissue or cell damage, as occurs in the breakdown of red blood cells.
  • Total bilirubin – elevated levels of bilirubin are an indication of liver damage or red blood cell hemolysis.
Non-Laboratory Tests
  • Ultrasonography – used to assess the baby's health, make sure pre-eclampsia isn't restricting the baby's growth, and check for blood flow in the umbilical cord
  • Non-stress test – a non-invasive test used to monitor the baby’s health by checking the heart rate and oxygen supply
Treatment and Prevention

Treatment

Delivering your baby is a way to cure pre-eclampsia (though the condition can also develop after delivery). In deciding when to deliver, your healthcare provider will try to minimize your risk from pre-eclampsia while allowing your baby the maximum time to mature.

If your pregnancy is far enough along (usually at least 37 weeks), your healthcare provider may recommend delivery to reduce the risk of your condition progressing to eclampsia. You may need to undergo a Cesarean section (C-section) or medication to induce labor.

If it is too early to deliver your baby, you may be able to manage pre-eclampsia at home. In this case, your healthcare provider will recommend bed rest, staying well hydrated, and eating less salt. Sometimes you may be given medication to reduce your blood pressure.

If you are hospitalized for pre-eclampsia, you and your baby will be closely monitored. You may be given medicine to lower your blood pressure and prevent seizures. If your pregnancy is less than 34 weeks, you may be given steroid injections to help speed up your baby's lung development since an early delivery is more likely.

Untreated pre-eclampsia is a dangerous condition for you and your baby. It is important that you regularly attend your prenatal checkups and call your healthcare practitioner if you have symptoms of pre-eclampsia.

Prevention

While many risk factors for pre-eclampsia cannot be controlled, there are some things you can do to reduce your risk of high blood pressure:

  • Avoid additional salt in your meals
  • Drink 6 to 8 glasses of water per day
  • Avoid fried and processed foods
  • Exercise regularly

The U.S. Preventive Services Task Force recommends that pregnant women with risk factors for pre-eclampsia and no history of adverse reactions to aspirin take a low dose of aspirin (81 mg) each day after the 12th week of pregnancy.

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