Preeclampsia
What is Preeclampsia?
Preeclampsia is persistent high blood pressure that develops during pregnancy or the postpartum period and is often associated with high levels of protein in the urine OR the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.
Preeclampsia: Frequently Asked Questions
Preeclampsia (pre-e-CLAMP-si-a) is persistent high blood pressure that develops during pregnancy or the postpartum period. It is often associated with high levels of protein in the urine or the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances. It is diagnosed by the elevation of the expectant mother’s blood pressure usually after the 20th week of pregnancy and is unique to human pregnancy. According to guidelines released by the American College of Obstetricians and Gynecologists, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Evidence shows organ problems with the kidneys and liver can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress. Prior to these new guidelines, most healthcare providers traditionally adhered to a rigid diagnosis of preeclampsia based on blood pressure and protein in the urine.
Preeclampsia is now to be diagnosed by persistent high blood pressure that develops during pregnancy or the postpartum period that is associated with high levels of protein in the urine OR the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.
Important symptoms that may suggest preeclampsia are headaches, abdominal pain, shortness of breath or burning behind the sternum, nausea and vomiting, confusion, heightened state of anxiety, and/or visual disturbances such as oversensitivity to light, blurred vision, or seeing flashing spots or auras. Preeclampsia and related hypertensive disorders of pregnancy impact 5-8% of all births in the United States.
Most women with preeclampsia will deliver healthy babies and fully recover. However, some women will experience complications, several of which may be life-threatening to mother and/or baby. A woman’s condition can progress to severe preeclampsia very quickly. The rate of preeclampsia in the US has increased 25% in the last two decades and is a leading cause of maternal and infant illness and death.
Preeclampsia and other hypertensive disorders of pregnancy can be devastating diseases, made worse by delays in diagnosis or management, seriously impacting or even killing both women and their babies before, during or after birth.
There are two forms of preeclampsia:
- Preeclampsia-eclampsia
- Preeclampsia superimposed on chronic hypertension
You may encounter other names like toxemia, PET (pre-eclampsia/toxemia) and PIH (pregnancy induced hypertension) EPH gestosis (edema, proteinuria, hypertension), but these designations are all outdated terms and no longer used by medical experts.
The Preeclampsia Foundation also focuses on two other hypertensive disorders of pregnancy, which include:
- Chronic hypertension (hypertension when you are not pregnant) which may not have been diagnosed before pregnancy
- Gestational hypertension, blood pressure rising after the 20th week but not accompanied by proteinuria.
Many factors guide a healthcare provider’s decision about how to manage preeclampsia, including the gestational age and health of the baby, overall health and age of the mother, and a careful assessment of how the disease is progressing. This includes monitoring blood pressure and assessing the results of laboratory tests that indicate the condition of the mother’s kidneys, liver, or the ability of her blood to clot. Other tests monitor how well the unborn baby is growing and/or if he or she seems in danger. When the pregnancy is less than 37 weeks the caregiver usually tries to gain some time, but if 37 weeks or later, the provider will often opt to deliver the baby.
The healthcare provider will watch for signs of instability in the mother, including very high blood pressure that’s not responding to antihypertensive drugs, signs the kidneys and/or liver are failing, and a reduced number of red blood cells or platelets. Providers also watch closely for indications of an impending seizure or signs the brain is about stroke, and may treat the patient with magnesium sulfate (an anticonvulsant specifically used for preeclampsia). Antihypertensive drugs will be used if blood pressure rises to dangerously high levels, 160/110 or higher.
If the baby is growing insufficiently, not at all, or scores poorly on a “stress test,” he or she may not survive if left in the uterus. Even if the baby is very premature, delivery may be required if the disease can not be stabilized in order to protect the mother or ensure