Pre-eclampsia (Toxemia)
Pre-eclampsia
What is preeclampsia? — Preeclampsia is a dangerous condition that some women get when they are pregnant. It usually happens during the second half of pregnancy (after 20 weeks). It can also happen during labor or after the baby is born.
Women with preeclampsia have high blood pressure. They might also have too much protein in their urine, or problems with organs like the liver, kidneys, brain, eyes, or placenta. (The placenta is the organ that brings the baby nutrients and oxygen and carries away waste.) Plus, the baby might not grow well and be smaller than normal.
What are the symptoms of preeclampsia? — Most women with preeclampsia do not feel any different than usual. Preeclampsia usually does not cause symptoms unless it is severe. Signs and symptoms of severe preeclampsia include:
A bad headache
Changes in vision: blurry vision, flashes of light, spots
Belly pain, especially in the upper belly
If you have any of these symptoms, tell your doctor or nurse. You might not have preeclampsia, because these symptoms can also occur in normal pregnancies. But it's important that your doctor knows about them.
You should also call your doctor or nurse if you have bleeding from the vagina.
How might preeclampsia affect my baby? — Preeclampsia can:
Slow the growth of the baby
Decrease the amount of amniotic fluid around the baby (amniotic fluid is the liquid that surrounds and protects the baby in the uterus) (figure 1)
You should call your doctor or nurse if your baby is not moving as much as usual. Your doctor or nurse will do tests to check for any problems with the baby.
Is there a test for preeclampsia? — Yes. To test for preeclampsia, your doctor or nurse will take your blood pressure and check your urine for protein during pregnancy. He or she might also do blood tests to make sure your organs are working as they should.
When your doctor or nurse tells you your blood pressure, he or she will say 2 numbers. For instance, your doctor or nurse might say that your blood pressure is "140 over 90." To be diagnosed with preeclampsia, your top number (called "systolic pressure") must be 140 or higher, or your bottom number (called "diastolic pressure") must be 90 or higher. Plus, you must have too much protein in your urine or problems with 1 or more of your organs.
It is possible to have high blood pressure (above 140/90) during pregnancy without having high protein in the urine or other problems. That is not preeclampsia. Still, if you develop high blood pressure, your doctor will watch you closely. You could develop preeclampsia or other problems related to high blood pressure.
How is preeclampsia treated? — For preeclampsia that develops during pregnancy, the only cure is to deliver the baby. Your doctor or nurse will talk with you about whether it is better for you to have your baby right away, or to wait. The best decision will depend on how severe your preeclampsia is and how many weeks pregnant you are. While delivering the baby will cure your preeclampsia, it's also important to give the baby as much time as possible to grow and develop.
If your preeclampsia is mild:
If you are less than 34 weeks pregnant, your doctor will probably suggest waiting.
If you are between 34 and 37 weeks pregnant, your doctor will talk to you about your options and help you decide what to do.
If you are more than 37 weeks pregnant, your doctor will probably suggest delivering your baby.
If the decision is to wait, the doctor will check you and your baby often for any problems. You might need to stay in the hospital until it is time to give birth.
When it is time to deliver your baby, you will probably get medicine to start contractions. This is called "inducing labor." Most women are able to give birth the usual way, through the vagina. But in some cases the doctor will need to do a C-section. A C-section, or "cesarean delivery," is a type of surgery used to get the baby out of the uterus.
If your preeclampsia is severe, you will probably need to deliver your baby as soon as possible. You might also get medicine to lower your blood pressure, if it is very high. This is to keep you from having a stroke.
Women with preeclampsia can sometimes have seizures. Your doctor or nurse will probably give you medicine during labor to prevent this.
What can I do to prevent preeclampsia? — You can't do anything to keep from getting preeclampsia. The most important thing you can do is to keep all the appointments you have with your doctor, nurse, or midwife. That way, they can find out as soon as possible if your blood pressure goes up, or if you have too much protein in your urine or any other problems. Also, call someone on your health care team right away if you have symptoms of preeclampsia or the baby isn't moving as much as usual. Your doctor or nurse can do things to keep you from having worse problems from preeclampsia.
If you are at high risk for preeclampsia, your doctor might tell you to take low-dose aspirin during your second and third trimesters of pregnancy (after 12 weeks). You might be at high risk if you have had preeclampsia before and your baby was born early, if you are pregnant with twins, or if you have high blood pressure even when you are not pregnant. Your doctor can tell you if you are at high risk.
Do not take aspirin or other medicines unless your doctor or nurse tells you it's safe.
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This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15598 Version 10.0
Release: 28.2.2 - C28.105
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