Preeclampsia

Preeclampsia is a condition in pregnant and immediate postpartum women characterized by new onset high blood pressure during pregnancy with end-organ damages such as cerebral, hepatic, and renal diseases found after the 20th week of gestation. Hypertension is blood pressure higher than 140/90 mmHg for an extended period. One single instance of elevated blood pressure is not considered hypertension.

Risk Factors

Preeclampsia can occur in any pregnant women. You may be at risks of developing preeclampsia if:

• It is your first pregnancy, not including previous abortions or miscarriages.
• You are under 20 years old or older than 35.
• You have a history of preeclampsia or family history of preeclampsia.
• You have gestational diabetes or obesity.
• You are pregnant with twins or more.

Causes

When the placenta does not grow deep enough into the uterine wall, both the placenta and fetus may not be able to receive adequate oxygen and nutrient supply during pregnancy which can cause problems after 20 weeks of pregnancy when fetal development is rapid. Blood vessels throughout the mother’s body including the brain, liver, and kidneys, may be damaged by ensuing processes from inadequate oxygen and nutrient supply to the placenta and fetus, leading to clinical symptoms of preeclampsia. It is not yet clearly known why some women develop preeclampsia.

There are 4 types of high blood pressure during pregnancies, including

• Preeclampsia: when high blood pressure is developed after 20 weeks of pregnancy for the first time associated with organs such as the brain, liver, and kidneys damages. You may have headaches, blurry vision, occasional seizures, and proteinuria. Sometimes, you can develop preeclampsia after delivery in the immediate postpartum period. The organ damage can usually resolve on its own within a couple of days or weeks after childbirth.
• Gestational hypertension or transient hypertension found in women who are pregnant for more than 20 weeks and develop a new onset of high blood pressure but have no signs or symptoms of end-organ damage of preeclampsia. The condition can progress into preeclampsia over time, or the high blood pressure could be preexisting chronic hypertension if the high blood pressure persists longer than 3 months after childbirth.
• Chronic hypertension is a condition of pre-pregnancy high blood pressure. It should be considered in women with high blood pressure before the 20th week of gestation, and the high blood pressure is confirmed after the delivery if it persists for more than 3 months.
• Preeclampsia superimposed upon chronic hypertension occurs in women with chronic high blood pressure who develop preeclampsia after 20 weeks of pregnancy.

Symptoms

Preeclampsia is often asymptomatic if it is not severe. You may have slightly high blood pressure and protein in your urine. A regular prenatal checkup is necessary to monitor your blood pressure, particularly after the 20th week of pregnancy.

You may develop severe preeclampsia if you have one of the following signs or symptoms pregnancy.

You may develop severe preeclampsia if you have one of the following signs or symptoms below.
Signs of severe preeclampsia

• Your blood pressure is ≥160/110 mmHg more than once. This level of high blood pressure leads to increased risk of developing stroke.
• You have platelet count <100,000/mL
• Kidney and liver abnormalities detectable through additional tests.
• You are diagnosed with pulmonary edema.
• You have a seizure.

Symptoms of severe preeclampsia

• You have a persistent severe headache.
• You have mid or right upper abdominal pain, similar to heartburn.
• You have blurry or double vision, see squiggly lines or flashes of lights, and develop blind spots or vision loss.

Whenever you develop any signs or symptoms of preeclampsia, always discuss it with your doctors to confirm the diagnosis and prevent the progression.

Treatment

The definitive treatment for preeclampsia during pregnancy is to deliver the baby. Your doctor will discuss with you when it is best to do so, taking into consideration your estimated due date and the severity of your preeclampsia. The fetus should have time to grow and develop as much as possible.

• Your doctor will advise you to wait if your pregnancy is less than 34
• Your doctor will discuss possible options if your pregnancy is between 34 and 37
• Your doctor may suggest delivering the baby if your pregnancy is more than 37

If you agree to wait, you may have to see your doctor often or stay in the hospital until the delivery date. Both vaginal birth and cesarean birth (c-section) are possible for women with preeclampsia.

You will need to have a baby delivered as soon as possible if your condition is severe. If your blood pressure is extremely high, your doctor will prescribe a medication to lower your blood pressure, preventing you from a stroke. You may receive drugs to prevent seizures during labor, but this is rare.

Prevention

At present, there is nothing that can help prevent preeclampsia. It is best to attend all your prenatal doctor appointments for regular blood pressure and urine protein level checking. If you feel the baby is not moving as much as usual or have symptoms of preeclampsia, seek immediate medical care.

You are at higher risk of developing preeclampsia if you have had a history of premature birth or preeclampsia, you have preexisting high blood pressure, or you have multiple pregnancies. Your doctor may prescribe low-dose aspirin during the 2nd and 3rd trimesters of pregnancy. Never take any medications without consulting your doctor first.