Preeclampsia

Overview

Preeclampsia is a complication of pregnancy characterized by high blood pressure, high levels of protein in urine indicating kidney damage (proteinuria), or other signs of organ damage. It usually occurs after 20 weeks of pregnancy in women with previously normal blood pressure. If left untreated, preeclampsia can lead to serious and potentially life-threatening complications for both the mother and baby. Early delivery of the baby is often recommended, and treatment involves careful monitoring and medications to manage blood pressure and other complications. Preeclampsia may also develop after delivery, known as postpartum preeclampsia.

Understanding the disease

Symptoms

The symptoms of preeclampsia may include high blood pressure, high levels of protein in urine indicating kidney damage (proteinuria), or other signs of damage to organs such as the liver, lung, or brain. Other symptoms may include severe headaches, blurred vision, sudden weight gain or swelling, severe abdominal pain, and shortness of breath. Preeclampsia may develop after delivery, known as postpartum preeclampsia. It's important to attend prenatal visits for blood pressure monitoring and seek immediate medical attention if experiencing severe symptoms like severe headaches, blurred vision, or sudden appearance of swelling.

Risk Factors

Risk factors for developing preeclampsia include:

1. Chronic high blood pressure (hypertension)
2. Type 1 or type 2 diabetes before pregnancy
3. Kidney disease
4. Autoimmune disorders
5. Use of in vitro fertilization
6. Family history of preeclampsia
7. Maternal age of 35 or older
8. Complications in a previous preeclampsia.
9. More than 10 years since previous pregnancy
10. Being pregnant with more than one baby
11. Black women and indigenous women in North America may have a greater risk of preeclampsia due to inequities in access to healthcare and social factors affecting health.
12. Lower income women also have a greater risk of preeclampsia, likely due to inadequate access to healthcare and social factors affecting health.

Development

Preeclampsia can develop in different ways:

1. Gestational preeclampsia: This is the most common form of preeclampsia, occurring after 20 weeks of pregnancy in women with previously normal blood pressure. It is typically characterized by high blood pressure and proteinuria.
2. Chronic hypertension: This type of preeclampsia develops in women with high blood pressure before pregnancy or who have hypertension that persists beyond the first 20 weeks of pregnancy. It may not be associated with proteinuria, but it still requires close monitoring and management.
3. Postpartum preeclampsia: This type of preeclampsia develops after delivery, typically within 48 hours, and is less common than gestational preeclampsia. Preeclampsia may be managed with careful monitoring, medications to control blood pressure, and early delivery of the baby if necessary. It is essential to seek medical attention if symptoms of preeclampsia develop, as the condition can have serious consequences for both the mother and the baby.

Assessment and Diagnosis

Triage

If you suspect preeclampsia, you should immediately contact your healthcare provider or go to an emergency room if you experience severe symptoms such as severe headaches, blurred vision or other visual disturbances, severe belly pain, or severe shortness of breath. It's important to attend your prenatal visits so that your healthcare provider can monitor your blood pressure regularly. If you're concerned about your symptoms or have any new symptoms, it's recommended to contact your doctor for guidance.

Diagnosis

To diagnose preeclampsia, a healthcare provider will check for the presence of high blood pressure after 20 weeks of pregnancy, along with at least one additional finding such as protein in the urine, low blood platelet count, elevated liver enzymes, fluid in the lungs, severe headaches, vision disturbances, or other signs of kidney or liver impairment. If you have preeclampsia that isn't severe, your healthcare provider may recommend preterm delivery after 37 weeks. If you have severe preeclampsia, delivery will likely be recommended before 37 weeks, depending on the severity of complications and the health and readiness of the baby. After delivery, you will be closely monitored for high blood pressure and other signs of preeclampsia.

Management and Treatment

Complications

Preeclampsia can lead to several potential complications for both the mother and the baby. Some of these complications include:

1. Fetal growth restriction: Inadequate blood and oxygen supply to the placenta can result in slower fetal growth.
2. Preterm birth: Preeclampsia may cause an unplanned preterm birth or may warrant planned preterm birth to manage the condition. Premature babies face a higher risk of health issues such as breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy.
3. Placental abruption: Preeclampsia increases the risk of placental abruption, which can lead to heavy bleeding and is potentially life-threatening for both mother and baby.
4. Eclampsia: This is the onset of seizures or coma with symptoms of preeclampsia. It can occur without prior symptoms, and signs like severe headaches, vision problems, and mental confusion may appear before seizures. Eclampsia can happen before, during, or after delivery.
5. Organ damage: Preeclampsia can cause damage to the kidneys, liver, lung, heart, or eyes, and may result in a stroke or other brain injuries. The severity of organ damage depends on the extent of preeclampsia.
6. Cardiovascular disease: Women who have had preeclampsia may have an increased risk of developing future heart and blood vessel (cardiovascular) disease. This risk is higher if a woman has had preeclampsia multiple times or experienced a preterm delivery. Risk factors for preeclampsia include being pregnant with multiple babies, chronic high blood pressure (hypertension), type 1 or type 2 diabetes before pregnancy, kidney disease, autoimmune disorders, and the use of in vitro fertilization. Factors associated with a moderate risk of developing preeclampsia include a first pregnancy with the current partner, obesity, family history of preeclampsia, maternal age of 35 or older, complications in a previous pregnancy, and more than 10 years since the last pregnancy.

Prevention

Preeclampsia cannot be completely prevented as it is a complex pregnancy complication that involves both genetic and environmental factors. However, certain measures can help reduce the risk. The best clinical evidence for prevention is the use of low-dose aspirin, as recommended by your primary care provider if you have one high-risk factor or more than one moderate-risk factor for preeclampsia. It is essential to consult with your healthcare provider before taking any medications, vitamins, or supplements to ensure their safety. Additionally, maintaining a healthy lifestyle and managing any conditions that increase the risk of preeclampsia before pregnancy can be beneficial.

Treatment

The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your primary care provider may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor. The timing of delivery is often recommended for preeclampsia treatment, and it depends on how severe the preeclampsia is and how many weeks pregnant you are. Preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications. In addition to medical interventions, early healthy lifestyle and healthy choices before pregnancy, especially if you've had preeclampsia before, can help reduce the risk of developing preeclampsia. Manage any conditions that increase the risk of preeclampsia by talking to your provider. It's important to consult your healthcare provider to determine the best course of action for your specific situation.

Preparing for medical consultation

Preparing for an appointment regarding preeclampsia involves gathering information about your symptoms, medical history, and any concerns you may have. Here are some steps to help you prepare:

1. Make a list of your symptoms: Write down any symptoms you're experiencing, such as high blood pressure, swelling in the face and hands, headaches, or sudden weight gain.
2. Gather your medical history: Prepare a list of your past pregnancies, if any, and any existing medical conditions or concerns.
3. List your medications: Create a list of all the medications, vitamins, supplements, or herbal products you're taking, including the dosages and how often you take them.
4. Bring a support person: Consider bringing a family member or friend along to the appointment to help you remember the information discussed during the visit and provide emotional support.
5. Prepare questions for your healthcare provider: Write down any questions or concerns you have about preeclampsia, such as:

• What are the signs and symptoms of preeclampsia that I should be aware of?
• What tests will be performed to diagnose preeclampsia?
• What are the treatment options for preeclampsia?
• Are there any lifestyle changes I should make to manage preeclampsia?
• What is the outlook for preeclampsia, and are there any potential complications? By being well-prepared for your appointment, you can ensure that you and your healthcare provider have a productive conversation and that you receive the information and care you need.