Preeclampsia
Topic Overview
What is preeclampsia?
Preeclampsia is high blood pressure after 20 weeks of pregnancy. Protein in the urine is a common sign of the disease. Preeclampsia usually goes away after you give birth. But symptoms may last a few weeks or more and can get worse after delivery. Rarely, symptoms of preeclampsia don’t show up until days or even weeks after childbirth.
Not all high blood pressure is preeclampsia. In some women, blood pressure goes up very high in the second or third trimester. This is sometimes called gestational hypertension, and it can lead to preeclampsia. Women who have high blood pressure before 20 weeks of pregnancy or before they are pregnant can also get preeclampsia.
Preeclampsia can be dangerous for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother’s liver, kidneys, and brain. Women with very bad preeclampsia can have dangerous seizures. This is called eclampsia.
What causes preeclampsia?
Experts don’t know the exact cause.
Preeclampsia seems to start because the placenta doesn’t grow the usual network of blood vessels deep in the wall of the uterus. This leads to poor blood flow in the placenta.
If your mother had preeclampsia while she was pregnant with you, you have a higher chance of getting it during pregnancy. You also have a higher chance of getting it if the mother of your baby’s father had preeclampsia.
Already having high blood pressure when you get pregnant raises your chance of getting preeclampsia.
What are the symptoms?
Mild preeclampsia usually doesn’t cause symptoms.
But preeclampsia can cause rapid weight gain and sudden swelling of the hands and face.
Severe preeclampsia causes symptoms such as a very bad headache and trouble seeing and breathing. It also can cause belly pain and decreased urination.
How is preeclampsia diagnosed?
Preeclampsia is usually found during a prenatal visit.
This is one reason why it’s so important to go to all of your prenatal visits. You need to have your blood pressure checked often. During these visits, your blood pressure is measured. A sudden increase in blood pressure often is the first sign of a problem.
You also will have a urine test to look for protein, another sign of preeclampsia.
If you have high blood pressure, tell your doctor right away if you have a headache or belly pain. These signs of preeclampsia can occur before protein shows up in your urine.
How is it treated?
The only “cure” for preeclampsia is having the baby.
You may get medicines to lower your blood pressure and to prevent seizures.
You also may get medicine to help your baby’s lungs get ready for birth.
Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.
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Cause
Experts don’t know the exact cause of preeclampsia.
But it may start with a poorly developed placenta that doesn’t circulate blood normally. What causes this placenta problem isn’t yet clear. Experts also don’t know why the mother’s body then develops high blood pressure.
Immune system response
Preeclampsia occurs most often in women who are pregnant for the first time and in women who have been pregnant before but now have a first pregnancy with a different man.
Exposure to an antigen from the father (in the growing placenta or fetus, for example) may trigger an immune response in the woman’s body. This immune response—the body’s way of fighting infection—may result in narrowing of the blood vessels throughout the body, causing higher blood pressure and other problems.
Symptoms
Although you may have other symptoms, you will not be diagnosed with preeclampsia unless you also have one or both of the following:
- Your systolic blood pressure (the top number of your blood pressure reading) is over 140, or your diastolic blood pressure (the bottom number) is over 90, or both, for two measurements taken at least 4 hours apart.
- A urine test shows that you have too much protein in your urine.
Other symptoms of mild preeclampsia may include:
- Swelling of the hands and face that doesn’t go away during the day. (If you have no other symptoms of preeclampsia, this swelling is probably a sign of normal pregnancy.)
- Rapid weight gain—more than2 lb (0.9 kg) a week or6 lb (2.7 kg) a month.
- Bleeding from a cut or injury that lasts longer than usual.
Severe preeclampsia
In severe preeclampsia, systolic blood pressure is over 160, or diastolic blood pressure is over 110, or both.
As blood circulation to the organs decreases, more severe symptoms can develop, including:
- A severe headache that will not go away with medicine such as acetaminophen.
- Blurred or dimming vision, spots in the visual field, or periods of blindness.
- Decreased urination—less than 2 cups (500 mL) in 24 hours.
- Lasting belly pain or tenderness, especially on the upper right side.
- Problems breathing, especially when lying flat.
- HELLP syndrome. This is a life-threatening liver disorder. It is usually related to preeclampsia. Get emergency medical treatment if you have several symptoms of HELLP syndrome, such as headaches, vision problems, fatigue, or belly pain.
Eclampsia
When preeclampsia leads to seizures, it is called eclampsia.
Eclampsia is life-threatening for both a mother and her baby. During a seizure, the oxygen supply to the baby is drastically reduced.
Call 911 any time a pregnant woman has a seizure.
What Happens
Preeclampsia can be mild or severe. It may get worse gradually or rapidly. It affects your blood pressure, placenta, liver, blood, kidneys, and brain.
It’s very important to get treatment, because both you and your baby could suffer life-threatening problems involving your:
- Blood pressure. The blood vessels increase their resistance against blood flow, increasing blood pressure. Very high blood pressure keeps your baby from getting enough blood and oxygen. Also, blood volume doesn’t increase as much as it should during pregnancy. This can affect the baby’s growth and well-being.
- Placenta. The blood vessels of the placenta don’t grow deep into the uterus as they should. And they don’t widen as they normally would. This makes them unable to provide normal blood flow to the baby.
- Liver. Poor blood flow to the mother’s liver can cause liver damage. Liver impairment is related to the life-threatening HELLP syndrome, which requires emergency medical treatment.
- Kidneys. When affected by preeclampsia, the kidneys can’t work as well as they should to remove waste and extra water.
- Brain. Vision impairment, persistent headaches, and seizures (eclampsia) can develop. Eclampsia can lead to maternal coma and fetal and maternal death. This is why women with preeclampsia are often given medicine to prevent eclampsia.
- Blood. Low platelet levels in the blood are common with preeclampsia. In rare cases, a potentially life-threatening blood-clotting and bleeding problem develops along with severe preeclampsia.footnote 1 This condition is called disseminated intravascular coagulation (DIC). After delivery, DIC goes away. In the meantime, you may be given a medicine (clotting factor), blood transfusion, or platelet transfusion.
Delivery of the baby and placenta is the only “cure” for preeclampsia. If your condition becomes dangerous enough that delivery is necessary but you don’t go into labor, your doctor will induce labor or deliver the baby with surgery (cesarean section). Symptoms of preeclampsia may last a few weeks or more and can get worse after delivery. Rarely, symptoms of preeclampsia don’t show up until days or even weeks after childbirth.
Unless you have chronic high blood pressure, your blood pressure should return to normal in a few days or weeks. In severe cases, this can take 6 or more weeks.
After having preeclampsia, you have a higher-than-average risk of heart disease, stroke, and kidney disease. This may be because the same things that cause preeclampsia also cause heart and kidney disease. To protect your health, work with your doctor on living a heart-healthy lifestyle and getting the checkups you need.
The infant
The earlier in the pregnancy that preeclampsia begins and the more severe it becomes, the greater the risk of preterm birth, which can cause problems for the newborn.
An infant born before 37 weeks may have difficulty breathing because of immature lungs (respiratory distress syndrome).
A newborn affected by preeclampsia may also be smaller than normal. This is because of inadequate nutrition from poor blood flow through the placenta.
What Increases Your Risk
Risk factors (things that increase your risk) for preeclampsia include:
- Chronic (ongoing) high blood pressure, chronic kidney disease, or diabetes.
- High blood pressure in a past pregnancy, especially before week 34.
- Personal history of preeclampsia.
- Family history of preeclampsia.
- Being very overweight at the time of conception.
- Being pregnant with more than one baby (such as twins or triplets).
- First pregnancy ever or first-time pregnancy with current partner.
- Age younger than 21 or older than 35.
When should you call your doctor?
Someone must call 911 or other emergency services immediately if you are having a seizure (eclampsia). Eclampsia can lead to a coma. It is life-threatening to both you and your baby.
If you are pregnant and have preeclampsia, your family and friends should know how to help during a seizure.
Seek medical care immediately if you are pregnant and begin to have symptoms of preeclampsia, such as:
- Blurred vision or other vision problems.
- Frequent headaches that are becoming worse or a persistent headache that does not respond to nonprescription pain medicine.
- Pain or tenderness in your belly, especially in the upper right section.
- Weight gain of 2 lb (0.9 kg) or more over a 24-hour period.
- Shoulder, neck, and other upper body pain (this pain starts in the liver).
If you have mild high blood pressure or mild preeclampsia, you may not have any symptoms. It is important to see a health professional regularly throughout your pregnancy.
Symptoms such as heartburn or swelling in the legs and feet are normal during pregnancy. They usually aren’t symptoms of preeclampsia. You can discuss these symptoms with your doctor or nurse-midwife at your next scheduled prenatal visit. But if swelling occurs along with other symptoms of preeclampsia, contact your doctor right away.
Who to see
If you get preeclampsia during pregnancy, you can be treated by:
- An obstetrician.
- A family medicine doctor who is experienced in obstetric care.
- A perinatologist.
- A certified nurse-midwife supervised by an obstetrician or a perinatologist.
Exams and Tests
Preeclampsia is usually found during regular prenatal checkups.
Routine prenatal tests
Certain tests are given at each prenatal visit to check for preeclampsia. These include a:
- Blood pressure reading. Blood pressure is always monitored closely during pregnancy.
- Urine test to check for too much protein in the urine. This is a sign of kidney damage caused by preeclampsia.
- Weight measurement. Rapid weight gain can be a sign of preeclampsia.
Tests for women considered high-risk for preeclampsia
Other tests may also be used to check for signs of preeclampsia, including:
- Blood tests to check for problems such as HELLP syndrome and kidney damage. (Too much uric acid in the blood is often the earliest sign of preeclampsia.)
- Creatinine clearance test to check kidney function. This requires both a blood sample and a 24-hour urine collection.
- 24-hour urine collection test to check protein in the urine.
Tests for women who have preeclampsia
If results from one or more of the above tests suggest that you have preeclampsia, you and your baby will be closely monitored for the rest of your pregnancy.
Testing is more frequent and extensive when preeclampsia is severe and the pregnancy is less than 37 weeks.
You may have a physical exam to check for signs that preeclampsia is getting worse.
You may also have:
- Blood tests to check for blood abnormalities and kidney damage.
- A creatinine clearance test.
Tests for women who have eclampsia
If you have a seizure (eclampsia), one or more of the following tests may be done after delivery:
- A CT scan or MRI to check organs and internal body structures.
- An electroencephalogram (EEG) to measure the brain’s electrical activity.
Tests for the baby
If you get preeclampsia, the baby’s health also will be closely watched. The more severe your condition, the more often you’ll need testing, ranging from once a week to daily.
Tests commonly used include:
- Electronic fetal heart monitoring. It records the baby’s heart rate.
- Fetal ultrasound to check the baby, the placenta, and the amount of amniotic fluid.
- Doppler ultrasound. This test checks how well the placenta is working.
Treatment Overview
Mild preeclampsia
For mild preeclampsia that is not rapidly getting worse, you may only have to reduce your level of activity, monitor how you feel, and have frequent office visits and testing.
Moderate to severe preeclampsia
For moderate or severe preeclampsia, or for preeclampsia that is rapidly getting worse, you may need to go to the hospital for expectant management. This typically includes bed rest, medicine, and close monitoring of you and your baby.
Severe preeclampsia or an eclamptic seizure is treated with magnesium sulfate. This medicine can stop a seizure and can prevent seizures. If you are near delivery or have severe preeclampsia, your doctor will plan to deliver your baby as soon as possible.
Life-threatening preeclampsia
If your condition becomes life-threatening to you or your baby, the only treatment options are magnesium sulfate to prevent seizures and delivering the baby.
If you are less than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will likely be given antenatal corticosteroids to speed up the baby’s lung development before delivery.
Delivery
A vaginal delivery is usually safest for the mother. It is tried first if she and the baby are both stable.
If preeclampsia is rapidly getting worse or fetal monitoring suggests that the baby cannot safely handle labor contractions, a cesarean section (C-section) delivery is needed.
After childbirth
If you have moderate to severe preeclampsia, your risk of seizures (eclampsia) continues for the first 24 to 48 hours after childbirth. (In very rare cases, seizures are reported later in the postpartum period.) So you may continue magnesium sulfate for 24 hours after delivery.footnote 2
Unless you have chronic high blood pressure, your blood pressure is likely to return to normal a few days after delivery. In rare cases, it can take 6 weeks or more. Some women still have high blood pressure 6 weeks after childbirth yet return to normal levels over the long term.
If your blood pressure is still high after delivery, you may be given a blood pressure medicine. You will then have regular checkups with your doctor.
After having preeclampsia, you have a higher-than-average risk of heart disease, stroke, and kidney disease. This may be because the same things that cause preeclampsia also cause heart and kidney disease. To protect your health, work with your doctor on living a heart-healthy lifestyle and getting the checkups you need.
Prevention
Lowering your blood pressure helps to prevent preeclampsia. If you have chronic high blood pressure, you can lower your blood pressure before pregnancy by:
- Exercising.
- Eating a diet low in sodium and rich in fruits and vegetables.
- Staying at a healthy weight.
When you are pregnant, regular checkups are key to early detection and treatment. Prompt treatment is vital to preventing the development of severe and possibly life-threatening preeclampsia.
To reduce your risk for preeclampsia, your doctor may recommend that you take low-dose aspirin during the second and third trimesters of your pregnancy.
Home Treatment
Expectant management
If you develop signs of preeclampsia early in pregnancy, your doctor or nurse-midwife may prescribe something called expectant management at home, possibly for many weeks.
This may mean you are advised to stop working, reduce your activity level, or possibly spend a lot of time resting (partial bed rest). Although partial bed rest is considered reasonable treatment for preeclampsia, experts don’t know how well it works to treat mild preeclampsia or high blood pressure.footnote 3 It is known that strict bed rest may increase your risk of getting a blood clot in the legs or lungs.
Whether you are required to reduce your activity or have partial bed rest, expectant management limits your ability to work, remain active, take care of children, and fulfill other responsibilities. It may be helpful to follow some tips for dealing with bed rest.
Daily monitoring
You may be required to monitor your own condition on a daily basis. If so, you or another person (such as a trained family member or a visiting nurse) will:
- Monitor your blood pressure at home.
- Check your urine for protein.
- Check your weight. Before checking your weight, you should empty your bladder, take off your shoes, and wear about the same amount of clothing each time.
- Monitor fetal movements or kick counts.
Keep a written record of your results, including the dates and times you checked. Take this record with you when you visit your doctor or nurse-midwife.
Social support
Worry and reduced activity are difficult parts of having preeclampsia. It often helps to talk with women who are or have been in the same situation.
Medications
Medicine for preeclampsia may be used to:
- Control high blood pressure. Lowering high blood pressure doesn’t prevent preeclampsia from getting worse. That’s because high blood pressure is only a symptom of the condition, not a cause. Your doctor may recommend blood pressure medicine if your blood pressure reaches high levels.
- Prevent seizures. Magnesium sulfate is usually started before delivery and continued for 24 hours after delivery for women with pregnancy-related seizures (eclampsia) and those who have moderate to severe preeclampsia.
- Speed up fetal lung development. When possible, steroid medicine is given to the mother prior to a premature birth. This medicine matures the baby’s lungs over a 24-hour period, which lowers the risk of breathing problems after birth.
Blood pressure medicines
Medicines used to control chronic high blood pressure during pregnancy include:
- Labetalol.
- Methyldopa.
- Nifedipine.
Some high blood pressure medicines are dangerous during pregnancy.footnote 4 If you take high blood pressure medicines, talk to your doctor about the safety of your medicine. Discuss this before you become pregnant or as soon as you learn you are pregnant. Make sure that your doctor has a complete list of all medicines that you take.
Other blood pressure medicines that may be used include hydralazine. This is an intravenous medicine used to quickly lower severely high blood pressure during pregnancy.
Lowering blood pressure too much or too fast can reduce blood flow to the placenta, causing problems for the baby. So medicine is reserved for preventing severely high blood pressure levels that may be life-threatening to you or your baby.
Surgery
There is no surgical treatment for preeclampsia.
A cesarean section delivery is used when:
- A rapid delivery is medically needed for the mother’s or baby’s well-being or survival.
- Induction of labor has not been successful, usually after 24 hours.
- There are medical reasons, such as placenta previa, that make vaginal delivery dangerous.
References
Citations
- Roberts JM, Funai EF (2009). Pregnancy-related hypertension. In RK Creasy, R Resnik, eds., Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice, 6th ed., pp. 651–688. Philadelphia: Saunders.
- Roberts JM, Funai EF (2009). Pregnancy-related hypertension. In RK Creasy, R Resnik, eds., Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice, 6th ed., pp. 651–688. Philadelphia: Saunders.
- Sibai BM (2003). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1): 191–192.
- Cooper WO, et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23): 2443–2451.
Other Works Consulted
- U.S. Preventive Services Task Force (2014). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaspg.htm. Accessed September 16, 2014.
Current as of: May 29, 2019
Author: Healthwise Staff
Medical Review:Sarah Marshall MD – Family Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & William Gilbert MD – Maternal and Fetal Medicine
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