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Preeclampsia
Preeclampsia


Definition:

Preeclampsia is high blood pressure and protein in the urine that develops after the 20th week of pregnancy.



Alternative Names:

Toxemia; Pregnancy-induced hypertension



Causes, incidence, and risk factors:

The exact cause of preeclampsia is not known. Possible causes include:

Preeclampsia occurs in a small percentage of pregnancies. Risk factors include:



Symptoms:

Symptoms of preeclampsia can include:

  • Headaches
  • Swelling of the hands and face (edema )
  • Weight gain
    • More than 2 pounds per week
    • Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with pregnancy.

Other symptoms that can occur with this disease:

  • Abdominal pain
  • Agitation
  • Decreased urine output
  • Nausea and vomiting
  • Vision changes


Signs and tests:
  • Increase in blood pressure
  • Higher than normal liver enzymes
  • Platelet count less than 100,000 (thrombocytopenia )
  • Protein in the urine (proteinuria )
  • Swelling in the upper body
  • Weight gain


Treatment:

The only way to cure preeclampsia is to deliver the baby. However, if that delivery would be very early (premature), the disease can be managed by bed rest, close monitoring, and delivery as soon as the fetus has a good chance of surviving outside the womb. Sometimes, medicines are prescribed to lower the mother's blood pressure.

The pregnant mother is usually admitted to the hospital, but some women may be allowed to stay at home with careful monitoring of their blood pressure, urine, and weight, and the baby.

Ideally, the condition is managed until the baby can be delivered after the 37th week of pregnancy.

Labor may be induced if any of the following occur:

Delivery is the treatment of choice for women with severe preeclampsia who are between 34 - 40 weeks pregnant.

For those who are less than 24 weeks pregnant, inducing labor is recommended, although the chance that the fetus will survive is very small.

Pregnancies between weeks 24 and 34 are considered a "gray zone." Prolonging a pregnancy has been shown to lead to problems for the mother in most cases. Infant death also can occur. The medical team and parents may decide to delay delivery to allow the fetus to develop.

Treatment during 24 - 34 weeks includes giving the mother steroid injections to help tspeed up the development of the baby's organs (including the lungs). The mother and baby are closely monitored for complications.

When labor and delivery are induced, the mother will be given medication to prevent seizures and to keep blood pressure under control. The decision to have a vaginal delivery versus cesarean section is based on the health of the mother, the baby's ability to tolerate labor, and other factors.



Support Groups:



Expectations (prognosis):

Death of the mother from preeclampsia is rare in the U.S. The infant's risk of death generally decreases as the pregnancy continues.

A woman with a history of preeclampsia is at risk for the condition again during future pregnancies.

Women who have high blood pressure problems during more than one pregnancy have an increased risk for high blood pressure when they get older.



Complications:

Preeclampsia can develop into eclampsia if the mother has seizures. Complications can occur if the baby is delivered prematurely .

Severe preeclampsia may lead to HELLP syndrome .



Calling your health care provider:

Call your health care provider if you have symptoms of preeclampsia during your pregnancy.



Prevention:

Although there is no known way to prevent preeclampsia, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as preeclampsia early.



References:

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.

Cunnigham FG, Leveno KL, Bloom SL, et al . Hypertensive disorders in pregnancy. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 34.




Review Date: 7/21/2009
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine (10/28/2008).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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