After a pregnancy complicated by preeclampsia, eclampsia, or HELLP Syndrome, you should be aware of several special issues. First, although the signs and symptoms of preeclampsia usually disappear shortly after delivery, you may still be at risk for eclampsia (seizures). Second, your baby may require prolonged treatment in the neonatal intensive care unit. Third, you may now be susceptible to chronic hypertension. Finally, you are at increased risk of developing preeclampsia in future pregnancies.
Late Onset Eclampsia
Most cases of eclampsia develop either during pregnancy or within 48 hours after delivery. However, eclamptic seizures can also develop between three days and four weeks postpartum (after giving birth). This is known as late onset eclampsia. It is important to be aware of the symptoms that suggest the onset of seizures. These include:
- persistent, severe headaches;
- seeing flashes and spots;
- blurred vision;
- nausea and vomiting; and
- upper abdominal pain.
These symptoms can develop gradually or suddenly. If you notice any of these, call your doctor immediately. If you do not receive a response within 15 to 30 minutes, call an ambulance and go to the nearest hospital.
Late onset eclampsia can lead to significant complications similar to traditional eclampsia. Management of this condition is also similar, including hospitalization, magnesium sulfate treatment, and anti-hypertensive drugs as needed.
Follow-up for the Baby
Your baby may be born prematurely. Prematurity and low birth weight (a consequence of premature delivery) increase your baby's risk for complications and long-term health problems. Moreover, the effects of preeclampsia or eclampsia on the placenta can reduce the supply of oxygen and nutrition to the baby, which can further contribute to lower-than-expected birth weights. Some babies are born with low Apgar scores (indicative of poor physical status), with poor circulation, or fluid or tissues in their organs. Some have respiratory problems and require artificial ventilation. Injury to the bowel due to perforation and damaged blood vessels in the brain are other possible complications. If your baby has any of these problems, he may require a prolonged stay in a neonatal intensive care unit.
Some of these complications disappear on their own over time. However, the more premature your baby and the lower the birth weight, the higher the risk of residual damage to various organs. Therefore, it is important to make sure your baby receives pediatric check-ups at regular intervals.
Preeclampsia and Risk for Chronic Hypertension and Kidney Disease
Eclampsia alone is not a risk factor for developing chronic hypertension later in life. However, having preeclampsia may increase your susceptibility to chronic hypertension. Developing preeclampsia in only one of your pregnancies does not substantially increase your risk for developing chronic hypertension later in life. However, if you have preeclampsia in more than one pregnancy, you are at higher risk for developing chronic hypertension in the future. This link is strongest if you developed severe preeclampsia well before term. If you develop severe preeclampsia in your second trimester (21st to 27th week), your risk of developing chronic hypertension is about 35%.
In addition, the more pregnancies complicated by preeclampsia you have, the higher your risk of later hypertension. If you have recurrent, severe preeclampsia in your second trimester, your risk for developing hypertension within five years is almost 55%.
In one study, women who had severe preeclampsia during a first pregnancy and who were followed for 10 years, had an almost 50% likelihood of having chronic hypertension after age 40. In contrast, women of the same age who had normal blood pressure during pregnancy had only a 14% risk.
Therefore, if you developed preeclampsia in multiple pregnancies, particularly if it was severe and occurred in the second trimester, you should have your blood pressure checked every six months to one year. Early detection leads to timely treatment and prevention of serious medical complications of chronic hypertension-including heart disease, kidney disease, stroke, and premature death.
If you had a hypertensive disorder during your pregnancy, you are at higher risk for developing a similar complication in a future pregnancy. But, even if you develop chronic hypertension, this does not necessarily mean that you should not get pregnant again.
Women with mild to moderate hypertension usually do well in pregnancy. Only women with systolic blood pressures ranging from 140 to 160 or diastolic blood pressures above 95 to 100 require blood pressure medication. They are two to three times more likely to develop preeclampsia than pregnant women with normal blood pressures. However, a small percentage will develop severe preeclampsia and require prompt premature delivery.
On the other hand, if you have severe hypertension during your first trimester of a future pregnancy,, you are at 50% higher risk for early onset preeclampsia, 5 to 10% higher risk of placental abruption (premature separation of the placenta), 70% higher risk for delivery before your due date, and 40% higher rate of poor growth of your baby.. In addition, you may require more frequent prenatal visits and testing or even hospitalization before delivery to control your blood pressure.
If you had severe preeclampsia, you are at high risk of having preeclampsia in future pregnancies. Women who develop preeclampsia during multiple pregnancies have increased incidence of chronic hypertension late in life. If you have had severe preeclampsia or have chronic hypertension, you are also at increased risk for premature separation of the placenta in future pregnancies.
If you had eclampsia during your pregnancy, your have a low (2%) risk of developing eclampsia in a future pregnancy, and a 22% chance of developing preeclampsia. These risks are higher if the eclampsia occurred before your 30th week.
To improve the outcome of a second pregnancy, consider the following.
- Before becoming pregnant again, ask your doctor to perform a thorough evaluation of your blood pressure and kidney function.
- If you or a close relative have had vein or lung blood clots before, have your doctor test you for clotting abnormalities ( thrombophilias ). These genetic defects increase your risk for preeclampsia and clots in placental blood vessels.
- If you are obese, consider weight loss. . Weight reduction decreases your chance of developing preeclampsia again.
- If you have insulin-dependent diabetes mellitus, good control of your blood sugars before becoming pregnant and early in pregnancy reduces your risk of having preeclampsia again.
Currently, there are no medications or dietary supplements proven to prevent preeclampsia. The best way to improve the outcome of your pregnancy is to see your doctor regularly. Begin prenatal care at the onset of your pregnancy and keep all your scheduled prenatal visits. Likely, your doctor will obtain baseline blood and urine tests during one of your initial visits. Throughout your pregnancy, these tests may be repeated to aid in early detection of preeclampsia should you develop the condition again. The frequency of prenatal visits may need to be increased.
If you do develop preeclampsia during pregnancy, you and your baby are monitored regularly. Your treatment, which centers on detecting the onset of severe disease and prolonging the pregnancy until fetal maturity, may include frequent blood pressure monitoring and restricted activity. If there is any change in your condition, you will be hospitalized immediately.
Follow-Up for HELLP Syndrome After Delivery
if you developed HELLP syndrome during pregnancy, after delivering your baby, you are closely monitored for signs of eclampsia. Recent studies have shown that use of the steroid dexamethasone may be a helpful treatment for HELLP syndrome following delivery (although why this helps is not clear).
If some indicators of HELLP syndrome-such as abnormally low levels of blood platelets or elevated levels of liver enzymes-persist beyond the fourth day after delivery, you may be experiencing another condition entirely, such as thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acute fatty liver of pregnancy, viral or drug-induced hepatitis, or systemic lupus erythematosus. You should be evaluated for these illnesses.