What is Preeclampsia?
Preeclampsia occurs only during pregnancy. The only way to cure this disorder is to deliver your baby. If your baby is at or near term, your doctor may attempt to induce birth or deliver your baby by cesarean section.
If you are diagnosed with mild preeclampsia:
- at or after your 40th week of pregnancy, your doctor induces labor.
- between your 37th and 40th week, your doctor induces labor if your cervix is dilated sufficiently. If not, you are given medication to prepare your cervix.
- before your 37th week, your doctor may attempt to delay delivery.
Severe preeclampsia requires hospitalization. Induced delivery is initiated if:
- the pregnancy is at or over 32 to 34 weeks;
- the baby's lungs are fully developed; or
- the mother's or baby's condition declines.
The drugs hydralazine (for example, Apresoline), labetalol (Normodyne or Trandate), or nifedipine (Procardia) may be used to control your blood pressure.
Severe Preeclampsia at 0 to 28 Weeks
If you develop severe preeclampsia before the 28th week of pregnancy, you and your baby are at high risk of serious complications. Table 1 lists these potential risks and how often some of them occur.
Table 1. Complications Of Severe Preeclampsia Before The 28th Week Of Pregnancy
|Maternal Complications||• Seizures (eclampsia) 2-3% of cases|
• Pulmonary edema 3-5%
• Kidney failure 2-3%
• Stroke 0.5-1%
|Fetal Complications||• Death 10-20%|
• Pre-term delivery 100%
• Admission to neonatal intensive care 100%
• Growth retardation 30%
|Other Potential Fetal Complications:||• Bleeding in the brain|
• Injury to the bowel
• Chronic lung disease
Severe Preeclampsia at 21 to 27 Weeks
Severe preeclampsia rarely develops during the second trimester of pregnancy. When it does occur, it is usually in women who have a history of chronic hypertension, kidney disease, or type I insulin-dependent diabetes mellitus. It may be an outgrowth of the placenta developing abnormally-such as cloudy swelling (hydropic degeneration) of the placenta-or due to a molar pregnancy (growth of abnormal tissue in the uterus). Molar pregnancies and pregnancies complicated by hydropic degeneration are both associated with abnormal fetuses that never develop normally.
If you have preeclampsia at this stage of your pregnancy, you and your doctor must balance the risks of carrying your baby to term against the possible complications of extreme prematurity (fetal death, neonatal complications, neurologic deficits) and the increased risk of adverse maternal complications such as seizures, kidney failure, and stroke.
Severe Preeclampsia at 28 to 36 Weeks
If severe preeclampsia develops at 28 to 36 weeks of pregnancy, the risks are similar to those listed in Table 1 above, but the rates are substantially lower.
If you are 28 to 32 weeks pregnant and must deliver immediately, your baby is at high risk of complications and death. Moreover, some surviving infants suffer long-term disabilities. Therefore, your doctor may wait a few days before initiating delivery. During this time, you receive magnesium sulfate to prevent convulsions, other medications to lower your blood pressure (for example, hydralazine-sold under the brand name Apresoline), and steroids (for example, dexamethasone-sold as Decadron) to help your baby's lungs develop. This requires hospitalization until delivery.
For severe preeclampsia at or beyond 33 weeks, immediate delivery is usually recommended. However, between 33 to 34 weeks, your doctor may prescribe steroids to strengthen your baby's lungs 48 hours before inducing labor.
Severe Preeclampsia at 37 Weeks or Later
Though there are still risks for the mother if preeclampsia develops at or after the 37th week, the risks to the baby are small.
If you develop HELLP syndrome -a variant of severe preeclampsia-both you and your baby are at high risk for complications. Maternal risks include kidney failure and stroke, while fetal complications include respiratory failure and brain hemorrhage. Because these problems are so serious, your baby is delivered (preferable vaginally, but by cesarean section if necessary) within 48 hours of diagnosis. Therefore, your baby may be born prematurely.