Imagine a condition that can happen suddenly and without warning during your pregnancy. Imagine if the only cure was to deliver your baby, regardless of how far along you were.
And one more thing – signs that you may have this condition are similar to normal symptoms of pregnancy. Pretty scary, right?
This is a real condition called preeclampsia. It actually is one of the more common pregnancy complications, affecting about 5 to 8 percent of all pregnancies in the United States.
If you’ve been pregnant before, you may remember having your blood pressure and urine checked during every prenatal appointment. One of the main reasons we do this is to screen for preeclampsia.
Although preeclampsia is scary to think about, we have a long history of caring for women with this and other high-risk complications.
What is preeclampsia?
Preeclampsia is a condition that only happens to women when they are pregnant or in the early postpartum period. Women who are diagnosed with preeclampsia have:
- High blood pressure (hypertension), and
- At least one of the following:
- Protein in the urine
- Kidney or liver dysfunction
- Low platelet counts
- Fluid in the lungs
- Neurologic changes
Most of the time, preeclampsia affects women in the third trimester pregnancy. We’ve had patients who developed preeclampsia as early as the second trimester, but this usually occurs in women at increased risk due to underlying medical problems.
Preeclampsia can affect any organ system in the body. The kidney and liver are the most at-risk for damage from preeclampsia. Bleeding also is a risk because preeclampsia can affect cells called platelets, which are needed for your blood to clot. Additionally, many women experience headaches and vision abnormalities due to changes in the brain.
Once preeclampsia has been diagnosed, it can be “cured” only by delivery of the baby. You’ll notice that preeclampsia starts with “pre” – that’s because if it’s left untreated, the condition can develop into eclampsia: pregnancy-related seizures.
We don’t know for sure what causes preeclampsia. But the general belief is that it happens when the placenta does not interface with the uterus appropriately.
Preeclampsia risk factors and symptoms
There are several risk factors for preeclampsia. The most obvious is if you’ve experienced it before. If you’ve had preeclampsia with an earlier pregnancy, you are much more likely to develop it again, so we will be watching trends in your blood pressure closely during your prenatal appointments.
In addition, preeclampsia most often affects women who:
- Are younger than 25 years old or older than 35 years old
- Are obese
- Have pre-existing high blood pressure, diabetes, lupus, or other autoimmune conditions
The signs that you may be developing preeclampsia are very easy to miss or ignore. If you are pregnant, you should see a doctor if you develop any of these symptoms:
- Severe headache
- Vision changes
- Swelling of the hands and feet (some swelling in the feet and legs is expected during pregnancy)
- Upper abdominal pain (sometimes mistaken for heartburn)
Of the patients I’ve treated, there is usually a split. Some women feel nothing strange at all, even though their blood pressure has spiked or there’s protein in the urine. Other women mention they “just don’t feel good” or have a headache.
‘Things were going well, until they weren’t’
With my first pregnancy, things were going well, until they weren’t. All of a sudden, at 31 weeks and three days, I started “not feeling good.” I continued to work, thinking I would feel better in a couple of days. Two days later, I checked my blood pressure, and it was 163/94. I was admitted to the hospital, and I started having double vision. I was diagnosed with severe pre-eclampsia, and I had my baby at 31 weeks and six days.
Two years later I was pregnant again, and this time I knew I was at increased risk for developing pre-eclampsia. At 29 weeks it happened again, the exact same way. I started “not feeling good,” and my blood pressure was elevated – I had mild pre-eclampsia. This time I was able to stay pregnant on bedrest, but at 34 weeks I developed severe pre-eclampsia and had to deliver my baby.
How we help women with preeclampsia
The first thing we do is classify the patient’s condition as mild or severe. Women with severe features have blood pressure levels higher than 160/110, low platelet counts, fluid in the lungs, or problems with their kidney or liver function.
Based on the severity of the condition, we develop a game plan for each patient. Of course, the more time we can buy for the patient and her baby, the better. But there’s a balance. Waiting to improve the chances the baby will do well means risking the possibility that the mother may get sicker herself. If there are no severe features, we aim for at least 37 weeks for delivery.
When a woman is diagnosed with preeclampsia, she will likely remain in the hospital until delivery. Even if severe features are not present, preeclampsia can worsen suddenly, so we monitor these women closely. No medications can treat preeclampsia.
We recently had three patients who developed preeclampsia at 22 weeks. These patients all had pre-existing risk factors. Babies are unlikely to survive if they are born before 23 weeks, so there was a lot at stake.
In two of the cases, we were able to delay delivery until 26 weeks, and the babies survived. In the third case, the mother was so sick her life was at risk. She delivered at 23 weeks, and unfortunately, the baby did not survive.
These are very difficult conversations to have and decisions to make. Our overall goal is the health and safety of both the mother and the baby.
After delivery, the patient’s blood pressure usually returns to safer levels within 24 to 48 hours. For some women, it can take longer, up to 12 weeks – we prescribe medication to treat these patients.
The story isn’t over when pregnancy ends. Research has shown that developing preeclampsia or other pregnancy complications can predict a woman’s future heart disease risk.
There is no way to prevent preeclampsia. Studies have been done where women used aspirin, calcium, or other blood thinners, but nothing has been shown to work. The best thing you can do is be aware of your risk and report any concerning symptoms to your doctor.
If you are taking medication for high blood pressure, and you’re planning to get pregnant soon, request an appointment with us. Depending on your situation, it may be appropriate to change your medication. The best time to change medications is before you are pregnant.
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