Preeclampsia is a condition that commonly presents in pregnancy, but may also rarely occur postpartum. It’s characterized by high blood pressure and damage to other organs, such as the kidneys. Preeclampsia is a serious condition that can lead to dangerous complications for pregnant women and their babies.
The exact cause, however, isn’t known. Researchers suspect that it may involve problems with the blood vessel development between the placenta and uterus, which in turn causes a reaction in a pregnant woman’s blood vessels.
Preeclampsia usually begins after week 20 of pregnancy. Rarely, it can present earlier in pregnancy or even postpartum. 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 or equal to 140/90 that persists for more than just a few hours.
Your doctor will check your blood pressure at every pregnancy checkup. If they suspect preeclampsia, 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
- blurry vision
- a temporary loss of vision
- upper abdominal pain
- decreased urine output
- swelling of the face and hands
Preeclampsia occurs in about 5 to 8 percent of pregnancies. Because preeclampsia is thought to result from problems developed by the pregnancy itself, delivery of the baby and placenta are the recommended treatment to stop progression and resolve the condition.
Your doctor will discuss the risks and benefits regarding timing of delivery, considering how far along you are in the pregnancy and how severe your preeclampsia has become. Since preeclampsia can be life-threatening, your doctor may choose to deliver your baby early to prevent further complications.
If you receive a preeclampsia diagnosis, your doctor may decide to induce your labor. You’ll likely deliver vaginally, though the earlier you are in the pregnancy, the higher the chance you may need a cesarean delivery instead because your cervix won’t be ready to dilate.
If your high blood pressure 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
- HELLP syndrome, causing elevated liver enzyme levels and low platelets, which may lead to permanent damage to your nervous system, lungs, and kidneys
When preeclampsia causes seizures, it’s called eclampsia. Unborn babies can suffocate during a 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 or even death.
According to a 2005 report from the World Health Organization, 12 percent of maternal deaths worldwide related to pregnancy or childbirth were due to hypertensive disorders such as preeclampsia and eclampsia.
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 across the placenta
- the placenta detaching from the uterus too early, or placental abruption
- complications associated with prematurity, such as breathing problems due to underdeveloped lungs
Hypertensive disorders are the third leading cause of death for mothers during pregnancy and childbirth, according to research in the . The risk of death is lower in countries such as the United States. The risk of death or brain damage is also lower the earlier preeclampsia is diagnosed and adequately managed.
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, as this helps your doctor to make a diagnosis sooner.
Babies born prematurely due to preeclampsia may also experience numerous long-term health issues depending on how early they were born. These include:
Delivery of the baby and placenta are the recommended treatment to stop progression of the disease and lead to resolution. Timing of delivery is based on severity of the disease and your baby’s gestational age.
After delivery, your blood pressure should go back to normal within days to weeks. Your doctor will recommend close follow up postpartum until resolution.
If your preeclampsia is severe, or has progressed to eclampsia or HELLP, the first step to preventing complications is to deliver the baby as soon as safely possible.
A drug known as oxytocin is typically used to start labor. It works by stimulating your uterus to contract. An epidural or other anesthetic can be given to control pain. However, women with low platelet counts 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. Magnesium sulfate may be injected 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 not monitored.
Your healthcare provider may give you anti-hypertension drugs such as hydralazine (Apresoline) and labetalol (Normodyne, Trandate) to lower blood pressure gradually. You may also be given oxygen.