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Management of Preeclampsia During Delivery

What Is Preeclampsia?

Preeclampsia is a problem that arises during pregnancy and is characterized by high blood pressure and damage to other organs, such as the kidneys. Preeclampsia is considered a serious condition that can lead to dangerous complications for you and your baby. The exact cause, however, isn’t known. Researchers suspect that it may involve problems with the blood vessel development in the fetus, which in turn causes a dysfunctional reaction in the mother’s blood vessels.

What Are the Symptoms of Preeclampsia?

Symptoms

Preeclampsia usually begins after week 20 of pregnancy. The condition can occur in women who previously had normal blood pressure. The first sign of preeclampsia is an abnormal rise in blood pressure. This is defined as a rise in blood pressure to greater than 140/90 millimeters of mercury that persists for more than just a few hours. Your doctor will check your blood pressure at every pregnancy checkup, so that if preeclampsia is suspected, your doctor can run the proper tests to confirm and treat the diagnosis.

 Other symptoms of preeclampsia include:

  • severe headaches
  • excess protein in the urine, which is a sign of kidney problems
  • dizziness
  • nausea
  • vomiting
  • blurry vision
  • a temporary loss of vision
  • upper abdominal pain
  • decreased urine output
  • swelling of the face and hands

Preeclampsia occurs in about 2 to 8 percent of pregnancies, according to the National Institutes of Health (NIH). The only way to cure preeclampsia is to deliver your baby. Since preeclampsia can be life-threatening, your doctor will likely choose to deliver your baby early to prevent further complications.

What Complications Can Arise During Delivery?

Complications

If you are diagnosed with preeclampsia, your doctor may decide to induce your labor. You’ll likely deliver vaginally. If you’re less than 30 weeks into your pregnancy, you’ll have to deliver your baby by a cesarean section, or C-section, instead because the cervix will not be ready to dilate.

If the hypertension gets worse, it can lead to several life-threatening complications. Complications that could arise for the mother during a delivery include:

  • bleeding in the brain, or hemorrhagic stroke
  • seizures
  • coma
  • HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelets), which can cause permanent damage to your nervous system, lungs, and kidneys

When preeclampsia causes seizures, it’s called eclampsia.

About one in every 50 women who experience seizures, or eclampsia, will die from the condition, according to the United Kingdom’s National Health Services (NHS). Unborn babies can suffocate during the mother’s seizure, and about one in every 14 of these babies may die. Additionally, mothers who experience a stroke due to preeclampsia may have permanent brain damage.

Severe cases of preeclampsia can also affect your baby, especially during the stressful process of delivery. Complications that could arise for the baby during delivery include:

  • impairment of blood and oxygen flow
  • the placenta detaching from the uterus too early, or placental abruption
  • other complications associated with prematurity, such as breathing problems due to underdeveloped lungs
  • death

What Is the Outlook for People with Preeclampsia?

Outlook

Preeclampsia is the third leading cause of death for mothers during pregnancy, according to research in the International Journal of Women’s Health. The risk of death is lower in developed countries like the United States. The risk of death or brain damage is also lower the earlier the preeclampsia is diagnosed Being closely monitored in a hospital and given medications also lowers the risk of death or brain damage. Having early and regular prenatal care is the most important thing you can do to minimize the risk of complications for you and your baby.

Babies that were born prematurely due to preeclampsia may also experience numerous long-term health issues depending on how early they were born. These include:

  • learning disorders
  • physical disabilities
  • cerebral palsy
  • epilepsy
  • deafness
  • blindness

Delivery of the baby is the only available cure for preeclampsia. After delivery, your blood pressure should go back to normal within a few hours to a few days. Sometimes, it can take up to six weeks to reach a normal level.

How Can Complications Be Prevented?

Prevention

If your preeclampsia is severe, the first step to preventing complications is to deliver the baby as soon as possible. A drug known as oxytocin is typically used to start labor. It works by stimulating the uterus to contract. An epidural anesthesia or other types of analgesic drugs can be given to control pain. However, women with low platelet counts caused by the preeclampsia may not be able to have an epidural. Your doctor will help you decide which pain medication is best for you.

During labor, management of preeclampsia involves medications that help to stabilize your blood pressure and prevent seizures. Intravenous magnesium sulfate is given to prevent seizures. The hospital staff will continually monitor your knee reflexes after you receive magnesium sulfate. Loss of knee reflexes is the first sign of hypermagnesemia, or elevated magnesium levels in the blood, which can lead to respiratory paralysis and cardiac arrest if it’s not monitored. Anti-hypertension drugs such as hydralazine (Apresoline) and labetalol (Normodyne, Trandate) are given to lower blood pressure gradually. Oxygen is also given.

You and your baby’s condition will be monitored closely. If you begin to experience severe bleeding, anemia, or low platelet levels, you might need a blood transfusion. 

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