Swelling During Pregnancy: When to Worry
Preeclampsia complicates 5 to 8 percent of all pregnancies, according to the Preeclampsia Foundation. The hypertensive disorder usually develops in the second half of pregnancy and can be life-threatening, if left untreated. Despite the seriousness of the condition, there?s good reason to expect a positive outcome if you have it. "Most women who develop preeclampsia will deliver a healthy baby and fully recover," according to the foundation. But prompt medical attention is a must. Consult our guide to learn more about the signs and symptoms of preeclampsia, as well as how it's treated.
What is preeclampsia?
Preeclampsia (also called toxemia) is a serious disorder that generally develops after 20 weeks of pregnancy and is marked by high blood pressure and high levels of protein in the urine. "In preeclampsia, a lot of small blood vessels clamp down in the liver, the kidneys, the brain, and other organs," says Virginia R. Lupo, M.D., chair of the department of obstetrics and gynecology at Hennepin County Medical Center in Minneapolis. "Women will have symptoms in the area where the vessels are clamping down." Preeclampsia can also cause the larger blood vessels to constrict, which results in high blood pressure.
What causes preeclampsia?
Doctors are not sure what causes preeclampsia. But one theory is that an imbalance in prostaglandins--substances that help relax and contract smooth muscles during pregnancy--causes the blood vessels to constrict, Dr. Lupo says.
What are the complications of preeclampsia?
Beyond dangerously high blood pressure and high levels of protein in the urine (a sign of kidney problems), preeclampsia is associated with several other complications if left untreated, including:
- A low birth weight baby (under 5.5 pounds)
- Placental abruption (the placenta separates from the uterus)
- Abnormal liver function tests
- Preterm delivery (delivering before 37 weeks)
- Kidney failure
- Transient (not permanent) loss of vision
- Rupture of the liver
- Maternal and/or fetal death (rare)
Who is at risk for preeclampsia?
Although there are risk factors for preeclampsia, it's possible for any pregnant woman to develop the condition. "You can have the healthiest, best pregnancy going, and out of the blue one day have terrible blood pressure and protein in the urine," Dr. Lupo says. But experts have identified several risk factors, including:
- A personal or family history of preeclampsia
- A first pregnancy
- Being in your teens or over the age of 40
- Being pregnant with multiples
- High blood pressure
- Obesity (a body mass index over 30)
What are the symptoms or signs of preeclampsia?
The most prominent signs of preeclampsia are high blood pressure, protein in the urine, excessive swelling (edema) of the hands and face, and rapid weight gain (more than two pounds in a week). Other symptoms that warrant an immediate call to your doctor include:
- Severe headache
- Visual disturbances such as flashing lights or blurred vision
- Pain in the upper right area of your abdomen and/or shoulder pain
- Pain or a burning sensation behind your sternum
- Nausea or vomiting
- Confusion or anxiety
- Shortness of breath
How is it diagnosed?
Your health-care provider will monitor you for preeclampsia by checking your blood pressure and testing your urine for protein at every visit. "Preeclampsia is a blood pressure of 140 over 90 on two occasions separated by at least six hours in the second half of pregnancy in a woman who has not previously had high blood pressure," says John Repke, M.D., chairman of the department of obstetrics and gynecology at Penn State Hershey College of Medicine in Hershey, PA. "The second component of it is 300 milligrams or more of protein in the urine in a 24-hour collected specimen." That means if your doctor finds a high level of protein when you pee in a cup at the office, he or she will send you home with a jug that you fill over a 24-hour period and bring back for testing.
How is preeclampsia treated?
The only cure for preeclampsia is to deliver the baby, but your doctor will develop a treatment plan that takes your specific case into account. For mild preeclampsia that begins before the baby is full-term (37 weeks) "the typical treatment is admission to the hospital, with modified bed rest, low stimulation, fetal monitoring, and blood and urine tests," says Chad Klauser, M.D., a perinatologist and clinical assistant professor at the Mt. Sinai School of Medicine in New York City. Steroid treatments can help your baby's lungs develop. If you remain stable, you may be able to wait to deliver until you're full-term. If your preeclampsia is severe, you'll probably be delivered within a few days--just long enough for the steroids to help your baby's lungs mature.
Is a C-section necessary for moms-to-be with preeclampsia?
Possibly. The C-section rate is higher among women who have preeclampsia because they tend to deliver earlier, and preterm inductions are difficult. "At 28 weeks, there is up to a 50 percent chance of a failed induction," Dr. Klauser says. "If you come in at 35 or 36 weeks and your cervix is soft," there is a better chance the induction will succeed and you'll be able to have a vaginal delivery. Another reason C-sections are more common if you have preeclampsia is that they're less strenuous than a vaginal delivery, which can be very stressful for an underdeveloped baby. Additionally, some patients opt for a C-section if they know they may end up with one after going through the most difficult part of labor, Dr. Klauser says.
Is there any way to prevent preeclampsia?
No. Because doctors are not sure why the condition develops, it's difficult to prevent it. Small research trials have shown limited success with low-dose aspirin or calcium supplements, but larger studies have not confirmed those findings and the practice is not standard. "The best you can do is get good prenatal care so that preeclampsia can be detected early if you develop it," Dr. Lupo says.
How long does it take for preeclampsia to go away?
"Most cases of preeclampsia are fully resolved within 24 hours of delivery," Dr. Repke says. Less commonly, it can take up to three weeks for all of your symptoms to subside. Generally, the prognosis for women who have preeclampsia "is excellent," Dr. Repke says, but some research indicates that they may be at a higher risk for developing high blood pressure or heart disease later in life. Annual checkups are especially important if you've had preeclampsia.
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