Preeclampsia, also called toxemia, or pregnancy-induced-hypertension is a condition most frequently seen during the third trimester.
Preeclampsia only occurs during pregnancy, and most cases are mild. Doctors will carefully monitor any signs of preeclampsia to prevent the onset of eclampsia, a serious condition that is treated as a medical emergency.
Symptoms of preeclampsia are much like those of many other diseases, making it difficult to detect. Your doctor will monitor several factors during your prenatal visits after week twenty. These include high blood pressure (hypertension), rapid weight gain and swelling, and protein in the urine (proteinuria).
High blood pressure: 140 over 90 is considered hypertension, and 160 over 110 is severe hypertension. Chronic hypertension can mask the onset of preeclampsia in early pregnancy, and twenty percent (1 in 5) women with high blood pressure before pregnancy will develop the condition.
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Weight gain through water retension, a common complaint especially during late pregnancy pregnancy, will also be carefully monitored. While not considered a reliable symptom of preeclampsia, rapid weight gain greater than 2lbs (1 kg) per week will be closely watched.
Proteinuria, or protein in the urine is caused by the kidneys' failure during pregnancy to filter protein from the urine. While it cures itself after pregnancy it is often considered an important part of confirming a diagnosis of preeclampsia. But this symptom does not usually appear until the condition has progressed to a later stage.
Preeclampsia occurs in about five percent (1 in 20) of all pregnancies. The causes of preeclampsia are still unknown.
About 65% of cases occur in primigravidaA term used to describe a mother who is pregnant for the first time. Sometimes called gravida I.
Visit our comprehensive glossary for more pregnancy terms and definitions. patients. The incidence is three times higher in a multiple pregnancy.
Several risk factors for preeclampsia have been identified. About 65% of cases occur during a first time pregnancy. Because of this, it is very important that you attend your routine prenatal visits. You are at risk of pregnancy induced hypertension if you are:
Recurrence of preeclampsia in subsequent pregnancies is rare. If you have experienced preeclampsia in a previous pregnancy your doctor will recommend the use of baby aspirin to minimize the risk of recurrence.
If you fall into one of the categories that are at higher risk for preeclampsia your doctor may prescribe a daily dose of baby aspirin starting at about week twenty four. But don't forget that good prenatal care beginning early in your pregnancy and a well balanced diet are at least as important in preventing the onset of preeclampsia.
In most cases toxemia develops at the beginning of the third trimester. While the pregnancy cannot be restored to normal once preeclampsia has been detected, careful monitoring while in hospital will extend the pregnancy and prolong the development of the fetus in utero. Your blood pressure, kidney and liver function and the ability of your blood to clot will be carefully monitored during your hospital stay.
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The treatment includes bed rest and a diet that is high in protein and low in sodium. You will be advised to drink lots of water. Your doctor will perform a nonstress test and nipple stimulation test at least once each week. If the toxemia is developing quickly your doctor may also try magnesium sulfate or an antiseizure medication such as phenobarbital to control the preeclampsia.
Once the cervix has ripened sufficiently to permit delivery, labor will be induced. If the severity of the toxemia increases then a cesarean section may be required.
If your pregnancy is already near term and the cervix is ripening, your doctor will recommend delivery of the baby. Labor may be induced by artificially rupturing the membranes.
After delivery the condition usually subsides. Blood pressure will return to normal and signs of water retention will begin to disappear within 48 hours. You may experience seizures for five or more days postpartum.
There are a number of warning signs that the toxemia is increasing in severity. Your doctor will ask you to look for the following symptoms: headache, spots or blurry vision or other changes in your eyesight, pain under the right side of your rib cage and swelling in your hands and face. If you notice any of these symptoms you should contact your doctor immediately.
If eclampsia does develop there are major complications that require immediate hospitalization and treatment. The word eclampsia comes from the Greek meaning 'to strike like lightning' and the onset of eclampsia is indeed sudden. Symptoms include seizures and if left untreated is a life threatening condition for both mother and baby. Fortunately eclampsia is now very rare and the condition is most often diagnosed at its earliest stages: preeclampsia. Should eclampsia develop doctors are prepared to deal with it quickly.
With the onset of eclampsia the blood vessels in the uterus enter into spasm (vasospasm) resulting in reduced blood flow to the fetus. This will prevent proper development of the fetus due to hypoxia.
If the vasospasm is allowed to continue kidney failure is threatened, and the level of oxygen travelling to the brain is reduced which is manifested as seizures. Water retention and hemorrhages may damage fragile tissues such as the liver.
Treatment of eclampsia begins by increasing the flow of blood to the brain. Just as with preeclampsia, treatment involves delivery of the baby, usually by cesarean section. Your doctor will introduce an I.V.The delivery of fluid, often glucose, directly into the vein using a plastic catheter, and bag of fluid.
Visit our comprehensive glossary for more pregnancy terms and definitions. to administer magnesium sulfate, a drug that will limit convulsions. Internal fetal monitoring will be used to measure fetal distressA condition, usually discovered in labor, in which the fetal heartbeat follows an abnormal pattern. The fetal heartbeat is recorded using electronic fetal monitoring.
The acid balance of the fetal blood is measured, and labor is allowed to continue if it falls within prescribed ranges, and the abnormal heartbeat does not recur or persist.
If nescessary, attempts will be made to stabilize the fetus by administering oxygen to the mother, increasing her fluid intake or prescribing an agent to help the uterus relax. In some cases a cesarean section may be required.
Visit our comprehensive glossary for more pregnancy terms and definitions. throughout labor and delivery.
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