Your Health - Pre-eclampsia

Pre-eclampsia

(Toxemia of Pregnancy; Pregnancy-induced Hypertension)

Pronounced: pre-ee-clamp'-see-ah

Definition

Pre-eclampsia is a problem that occurs in some women during pregnancy. Blood pressure increases and protein appears in the urine. This usually occurs during the second half of pregnancy and in 5%-8% of pregnancies.

Your doctor will look for the following signs:

High blood pressure
Swelling that does not go away (especially in legs and face)
Large amounts of protein in your urine

Cardiovascular System and Kidneys

Causes

The cause of pre-eclampsia is unknown. Possible causes may include:

Genetic factors
Dietary factors
Problems with blood vessel function
Autoimmune disorder (the immune system turns against the body)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

First pregnancy
Family history (eg, mother and sister also had the condition)
Multiple births
Inadequate prenatal care
Pre-eclampsia in a previous pregnancy
Obesity
Age: under 18 years old or older than 40 years old
Race: black
Chronic high blood pressure
Kidney disease
Overweight or obese

Symptoms

Women with pre-eclampsia may have symptoms or they may feel fine, especially if the pre-eclampsia is mild. It is very important to see your doctor regularly during pregnancy to detect problems early.

Symptoms may include:

Headaches
Bloating or water retention
Noticeably swollen ankles or feet (some mild swelling during pregnancy may be normal)
Swelling of the face and upper body when waking up
Blurred vision or sensitivity to light
Upper abdominal pain
Nausea or vomiting
Seizures or convulsions

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

Blood Pressure Measurement

A blood pressure reading of 140/90 or higher is considered high whether or not a woman is pregnant. During pregnancy, blood pressure in the third trimester is compared with blood pressure before pregnancy or during the beginning of the second trimester. Blood pressure is elevated during pregnancy if:

The first number in your blood pressure reading has risen 30 mmHg or more, or
The second number has risen 15 mmHg or more

Fluid Retention Assessment

Sometimes fluid retention is obvious during the physical exam. Fluid retention may cause weight gain of more than five pounds in one week. Sudden weight gain over one or two days is almost certainly due to fluid retention.

Urine Test

Under normal circumstances there is no or minimal measurable protein in urine. In pre-eclampsia, significant amounts of protein usually appears in the urine.

Blood Tests

Blood test include checking:

Complete blood count
Clotting factors
Electrolytes
Kidney and liver function

Treatment

Treating pre-eclampsia early can prevent its progression to eclampsia (seizures caused by severe pre-eclampsia). The only way to cure pre-eclampsia is to deliver the baby.

Treatment may include:

Early Delivery of the Baby

If the pregnancy has progressed 36 weeks or more, your doctor may recommend that labor be induced.

Supplements and Medication

Mild pre-eclampsia can often be managed until 36 weeks gestation with rest and medication. For example, your doctor may recommend that you take:

Aspirin to lower risk of pre-eclampsia
Medications to lower blood pressure, such as hydralazine (eg, Apo-Hydralazine), methyldopa
Magnesium sulfate to reduce risk of convulsions
Daily calcium supplement—may reduce the risk of eclampsia, particularly if your calcium intake was low to begin with

Home Treatment

If your home situation is stable, and you live close to the hospital, your doctor may treat you at home. Home treatment may include:

Taking frequent blood pressure readings
Getting plenty of rest (remaining mostly at bed rest)
Obtaining help for preparing meals, doing housework, and caring for family members

Admission to the Hospital

If pre-eclampsia is moderate, or your home situation is not restful, the doctor may admit you to the hospital. Treatment may include:

Lowering your blood pressure (medications)
Medications (usually magnesium sulphate) to prevent eclampsia
Monitoring your baby's condition
Making sure you get enough rest

Severe Pre-eclampsia

If the pre-eclampsia is severe, labor can be induced as early as 28 weeks. Early delivery poses a risk to the fetus, but allowing severe pre-eclampsia to continue is extremely risky for the mother and fetus.

Most women with pre-eclampsia still deliver healthy babies. A few develop a condition called eclampsia, in which seizures, caused by severe pre-eclampsia, occur. This condition is very serious for the mother and baby. Fortunately, pre-eclampsia is usually detected early in women who get regular prenatal care, and most problems can be prevented.

Prevention

There are no reliable guidelines for preventing this condition. However, the following actions may help prevent pre-eclampsia or other problems related to pregnancy:

Get early and regular prenatal care. Early treatment of pre-eclampsia may prevent eclampsia.
If you have chronic high blood pressure, keep it under control during pregnancy.
Get your doctor's approval before taking any prescription or over-the-counter medicines.
Do not smoke or drink alcohol during pregnancy.
Eat regular, healthful meals and take prenatal vitamins.
Also ask your doctor if you should take a daily calcium supplement. In women who have a low calcium intake, supplementation may reduce the risk of pre-eclampsia, eclampsia, and premature birth .

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org/

American College of Obstetricians and Gynecologists
http://www.acog.org/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm/

References:

ACOG practice bulletin on diagnosing and managing pre-eclampsia and eclampsia. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20020715/practice.html . Published July 15, 2002. Accessed June 6, 2009.

Duley L, Henderson-Smart D, Knight M, King J. Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. BMJ . 2001;322:329-333. Review.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ .

National Library of Medicine. Available at: http://www.nlm.nih.gov/ .

Pre-eclampsia and pregnancy-induced hypertension. EBSCO Natural and Alternative Treatment website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Accessed February 1, 2008.

¹9/30/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Samuels-Kalow ME, Funai EF, Buhimschi C, et al. Prepregnancy body mass index, hypertensive disorders of pregnancy, and long-term maternal mortality. Am J Obstet Gynecol. 2007;197:490.e1-6. Epub 2007 Aug 21.

²7/6/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Villar J, Abdel-Aleem H, Merialdi M, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gynecol . 2006;194:639-649.

³7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Kumar A, Devi SG, Batra S, Singh C, Shukla DK. Calcium supplementation for the prevention of pre-eclampsia. Int J Gynaecol Obstet. 2009;104:32-36.

Last reviewed October 2009 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.