Preeclampsia: The Silent Killer

Even with all of the efforts to improve maternal health care, ten million women a year are diagnosed with preeclampsia during their pregnancies or post natally. Seventy six thousand of these women will die as a result of this “silent killer” annually. Half a million babies die each year as a result of preeclampsia related complications.

The Preeclampsia Foundation reports that those numbers are higher than reported due to the thousands of deaths that go uninvestigated or unreported in instances where maternal care is lacking or nonexistant.

Preeclampsia occurs in 5% - 8% of all pregnancies in America. Preeclampsia is characterized by high blood pressure and protein in the urine. A diagnosis of preeclampsia is usually made after twenty weeks of gestation, although rare, an earlier diagnosis is possible. Postpartum preeclampsia can surface up to six weeks postpartum.

The disorder can usually be controlled to avoid serious complications, such as eclampsia and even death, if it is recognized soon enough.The problem is that many women and health care providers brush off the symptoms of the disorder as “normal pregnancy issues”. This lack of information, on both parts, puts both mothers and babies at risk. 

7 What Are the Signs and Symptoms of Preeclampsia?

Because your body is going through so many changes during pregnancy and postpartum, the symptoms of preeclampsia can be hard to discern. Here are a few of the common symptoms of preeclampsia:

High blood pressure (hypertension) - Hypertension is defined as having a reading of 140/90 or higher. Your physician may take immediate action to lower your blood pressure, or monitor your condition before taking action.

You may be asked to come on for blood pressure checks frequently to keep tabs on your readings. hypertension is not always a sign of preeclampsia, but it is an indicator that there is an underlying issue.

Protein in the urine (Proteinuria)- Preeclampsia affects the way the kidneys filter the blood, and as a result, proteins spill over into the urine.

At every prenatal visit, you will be screened for protein in your urine, using a dipstick test. Trace levels of protein are perfectly normal. But a reading of +1 or higher is a cause for concern.

To accurately determine the levels of protein in your urine, your doctor will have you do a 24 hour urine test. Most people find this inconvenient, but the results are more accurate than a dipstick test.

Swelling - Some swelling during pregnancy is normal.But if the swelling is in your face or hands, you should call your healthcare professional, just to be safe.

Nausea or vomiting - Morning sickness generally subsides after the first trimester. Nausea and vomiting, especially that occurs suddenly after 20 weeks gestation, can be a cause for concern.

Headaches- Severe headaches accompanied by visual disturbances that don’t respond to over the counter medicine, warrant a call to your healthcare provider.

Many women who have preeclampsia have no symptoms at all. Because they don’t feel like there is anything wrong, they question the severity of the disorder. It is extremely important for your health and the health of your baby that you receive good prenatal care and follow your healthcare provider’s advice.

6 The Risk Factors

A risk factor is something that makes someone prone to developing a disease or condition.

Some of the risk factors for developing preeclampsia are:

  • If you have a history of hypertension, diabetes, lupus, or kidney disease you are at increased risk for developing preeclampsia.
  • Mothers carrying multiple pregnancies have a higher risk of developing preeclampsia.
  • If your grandmother, mother, or sister had preeclampsia this raises your risk of developing preeclampsia.
  • The chances of developing preeclampsia are significantly higher if you are obese.
  • Mothers who are 40 years old and older are more likely to have preeclampsia. Some doctors even go so far as to say that anyone over the age of 35 is at an increased risk for developing preeclampsia.
  • If it is your first pregnancy, or your first pregnancy with a new partner, you are at a higher risk of developing preeclampsia.

Addressing these risk factors with your healthcare provider before you conceive can reduce your risks of developing preeclampsia.

For instance, if obesity is a factor, your doctor can help you implement a weight loss plan that will reduce your risks of developing preeclampsia.

If you have conditions that make you prone to developing preeclampsia,such as hypertension, diabetes, or lupus it is important to see your healthcare provider before conceiving. You may be taking prescription or over the counter medicine that is not safe to use during pregnancy.

In some cases, your healthcare provider will refer you to a doctor that specializes in high risk pregnancies.

5 What Causes Preeclampsia?

Healthcare professionals and researchers could only speculate as to the cause of preeclampsia until about ten years ago. Finding probable causes of preeclampsia has brought researchers closer to being able to cure the disorder and save thousands of women and babies each year.

Both of the prominent theories involve the placenta.

The Preeclampsia Foundation has this to say in regards to the first theory, which they have broken down into two stages, “ In the first, the initiating cause results in the placenta producing factors (eg., specific proteins, placental “debris”) that enter the maternal circulation and are believed responsible for producing the next stage.

This is the second stage , which results in the overt maternal “ disease” (high blood pressure, kidney, liver and coagulation abnormalities). The overt disease depends not only on the action of the circulating factors from the placenta, but also the health of the mother,including diseases that may affect the vasculature ( such as preexisting cardiovascular, renal, and genetic factors; and obesity).”

Aiwu Zhou, a researcher at the Cambridge Institute for Medical Research, used x rays to study a protein that has been associated with high blood pressure.Researchers had determined that hormonal changes caused a release of these proteins, but had been unable to find a causal relationship between this release and a rise in blood pressure.

Zhou’s team was able to determine that the release of hormones called “angiotensinogen” caused blood vessels to constrict and that resulted in raised blood pressure.

During pregnancy, the placenta changes to alter the amount of oxygen the growing baby receives, this change releases free radicals that oxidize the angiotensinogen and cause the blood pressure to rise.

By analyzing the blood for the presence of these oxidized angiotensinogen, researchers found that women with preeclampsia had higher than normal levels of oxidized angiotensinogen in their blood. 

4 How is Preeclampsia Diagnosed?

For a diagnosis of preeclampsia to be made, a patient has to have a blood pressure reading, on more than one occasion, of 140/90 or higher, as well as at least one of these complications of the disorder:

  • visual disturbances
  • compromised liver function
  • severe headache that doesn’t respond to over the counter medicine
  • symptoms of kidney distress
  • low platelet count
  • pulmonary edema ( fluid on the lungs)
  • proteinuria ( protein in the urine)

It has recently been discovered that a patient can have preeclampsia without these symptoms. If you have one or more of these symptoms, your healthcare provider will want to monitor your condition closely.

Your healthcare provider will run some of the following tests:

  • If your healthcare provider suspects that you may have preeclampsia, you will be given a 24 hour urine test. The dipstick tests that you receive each visit detect the presence of protein in your urine. A 24 hour test measures the exact levels of protein in your urine so your healthcare provider can evaluate the severity of your condition.
  • You will have blood tested to check liver and kidney function, as well as platelet levels to make sure that your blood is clotting properly.

The results of these two tests will help your healthcare provider determine the best treatment for you and your baby.

The following tests will be performed to determine the effects of preeclampsia on your baby:

  • Your healthcare provider will order an ultrasound to check baby’s growth and measure amniotic fluid levels.
  • You will also get a nonstress test to see how the baby’s heart rate reacts to his or her movements. Your doctor will combine the results of both of these tests to form a biophysical profile to determine baby’s tone, breathing, size, and the overall condition of the pregnancy.

3 How is Preeclampsia Treated?

The only "cure" for preeclampsia is to deliver the baby. If you are 37 weeks along, chances are that your healthcare provider will recommend doing just that.

If you are less than 37 weeks along, your healthcare provider will have to determine the severity of your condition, the condition of your baby, and the risks of each treatment option.

Here are a few common methods used to treat preeclampsia in a pregnancy that is less than 37 weeks along:

  • In mild cases of preeclampsia, your healthcare provider may recommend modified or strict bedrest until the baby reaches 37 weeks gestation. Going on bed rest can help to lower blood pressure and give baby more oxygen. It is important to follow your healthcare provider’s instructions to have the best outcome for you and your baby.
  • You can expect frequent visits to your healthcare provider to assess your condition. Protein levels in your urine will be closely monitored, as well as liver and kidney function. To ensure that baby is doing well, you will have frequent ultrasounds and nonstress tests.
  • If your healthcare provider feels that more aggressive treatment is necessary, you will be admitted to the hospital for close observation. Magnesium sulfate will be administered intravenously to prevent seizures, as well as medicine to lower blood pressure readings. Steroids will also be administered to help baby’s lungs mature.
  • In severe cases, baby is often delivered if the pregnancy is 34 weeks or more. If the threat to the health and life of the mother and/or baby is in jeopardy, delivery is recommended before 34 weeks, after the administration of steroids to mature baby’s lungs quickly.

Severe preeclampsia usually involves being transported to a hospital with a neonatal intensive care unit, and specialists who are familiar with treating severe preeclampsia.

2 What is Eclampsia?

Eclampsia is an often deadly complication of pregnancy that causes seizures or coma, generally in women who have been diagnosed with preeclampsia. In rare cases, seizure and coma are the first indications that something is wrong.

Early diagnosis is key to preventing eclampsia. Most of the signs and symptoms of preeclampsia are chalked up to normal pregnancy issues. This is why it is important for women seeking to become pregnant, and women who are already pregnant to educate themselves in regards to the symptoms of preeclampsia.

Like preeclampsia, the only “cure” for eclampsia is to deliver the baby. In the case of eclampsia, the mother must first be stabilized before baby can be delivered. This is done using magnesium sulfate, to prevent further convulsions and blood pressure medications to lower blood pressure readings.

Eclampsia is indicative of multiple organ failure or distress, the kidneys, liver, lungs, and cardiovascular system are often involved. Delivery is generally made by cesarean section, unless labor is already well under way.

The complications that can occur with eclampsia can be serious or even fatal. The main complications are:

  • Organ failure is the main concern that comes with an eclampsia diagnosis.
  • Pulmonary edema (excess water on the lungs) is also a possibility due to the administration of excessive IV fluids.
  • Maternal morbidity, due to complications of multiple organ failure, stroke, or cardiac event.
  • Perinatal morbidity, as a result of reduced oxygen levels, intrauterine growth retardation, or stress.

In spite of the possible complications of eclampsia, most mothers and babies do well.

The main concern for mothers is whether or not organ damage was extensive. If organs were only mildly affected, her prognosis is good, more extensive damage may require further medical treatment.

If baby was delivered at 37 weeks or beyond, chances are that there will be no ill effects from the experience. If baby was delivered prematurely, there will be the usual concerns that go along with a premature delivery.

1 Can Preeclampsia and Eclampsia Occur Postpartum?

For the most part, preeclampsia and eclampsia occur between 20 weeks gestation and delivery. Most of the symptoms of preeclampsia are completely gone within 48 hours of delivery, longer in more severe cases.

Postpartum preeclampsia and eclampsia can occur up to six weeks postpartum. Eighty percent of women who die from preeclampsia or eclampsia do so post partum. The symptoms of postpartum preeclampsia or eclampsia are the same as while pregnant, but new mothers recovering from birth may fail to recognize the symptoms.

It is extremely important to seek medical attention immediately if you notice any of the signs of preeclampsia or eclampsia post partum.

Diagnosis and treatment of postpartum preeclampsia or eclampsia is similar to preeclampsia or eclampsia that occurs while pregnant. Your healthcare provider will run tests to determine how severe your condition is.

The main concern with postpartum preeclampsia or eclampsia is the risk of seizures, so you will more than likely receive magnesium sulfate via IV. Measures will be taken to stabilize blood pressures and address any other complications as well.

With prompt medical care, the prognosis for a mother diagnosed with postpartum preeclampsia or eclampsia is good.

Making sure that mothers to be are well informed about the signs and symptoms of preeclampsia and eclampsia, along with early prenatal care, are the keys to preventing preeclampsia from progressing to a life threatening condition.

If you notice any of the signs or symptoms of preeclampsia, or your intuition tells you something just isn’t right, please call your healthcare provider or seek medical attention immediately. It’s much better to be safe than sorry.

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