Preeclampsia is a pregnancy complication characterized by consistent high blood pressure and protein in the urine. Your blood pressure and urine will be checked at every prenatal visit - blood pressure that is consistently more than 140/90 mmHg is considered high. Preeclampsia affects approximately 5% of all pregnancies greater than 20 weeks gestation and is most commonly seen in the third trimester.
Signs
Women with preeclampsia may experience swelling of the hands and face, sudden weight gain, abdominal pain, headaches, or changes in vision. Not all women with these symptoms have preeclampsia but you should report them to your health care provider. Often, women with preeclampsia do not feel sick, which is why attending all prenatal appointments is of the upmost importance.
Treatment
Preeclampsia is taken very seriously; in severe cases, the condition progresses to eclampsia, which can lead to a coma or potentially fatal seizure. Cerebral hemorrhage, ruptured liver, HELLP syndrome (damage to the liver and increased risk of haemorrhage) or retinal detachment, are also risks of preeclampsia. There is no way to prevent preeclampsia – the only cure is to deliver the baby. It can, however, be managed. Depending on the severity of your condition your health care provider may recommend certain medications to lower your blood pressure or to prevent seizures. If you have experienced preeclampsia it is important that after delivery you closely monitor your blood pressure to ensure that it returns to a safe level.
Risk Factors
There is no one known, specific cause for preeclampsia, but there are certain conditions that may make you more susceptible, such as:
- First time pregnancy, or if you are under age 20 or over age 40
- Previous history of preeclampsia
- Family history (mother/sister) of preeclampsia
- Family history of high blood pressure
- Carrying multiple foetuses
- Pre-pregnancy obesity
- Pre-existing condition such as diabetes
- African or black descent
- A new partner for each conception
Commonly asked questions
Q. Is there anything I can take to decrease my chance of developing preeclampsia?
A. Unfortunately not. Many large clinical trials have looked at the benefits of taking extra calcium or vitamin C and E, or taking low dose aspirin but nothing has shown to be really effective; in fact the vitamin C and E studies suggest a worsening of effect! There is currently an international trial studying extra Folic Acid supplements in the second half of pregnancy for women at high risk of developing preeclampsia. If you’re interested in participating, ask your health care provider if they are a participating centre.
Q. I had preeclampsia in my first pregnancy and delivered prematurely. What’s my chance of getting it again?
A. The data suggests that women who develop severe or early onset (before term) preeclampsia have up to a 30 to 50% chance of developing some form of hypertensive disorder in a subsequent pregnancy. It does tend to develop later and in a less severe form after the first time.
Q. If I develop preeclampsia, when will the doctor make the decision to deliver my baby?
A. Delivery is always good for the mother as it’s the only way of treating preeclampsia, but it’s not always good for the baby depending on the gestational age. We know that preeclampsia is one of the leading causes world-wide of maternal death during pregnancy. Most of these deaths occur in the developing world because of the inability to treat mothers with medications that can prevent seizures or deliver the baby when needed. The decision to deliver will be based on how sick you and/or your baby are, which is based on your clinical assessment, blood tests and ultrasound results.
Q. If I need to deliver is it automatic that I will have a caesarean section?
A. No…but there is an increased risk of that happening. If you have severe preeclampsia and/or your physician is really worried about your baby, the recommendation may be to proceed immediately to a caesarean section - recognizing that you will start to get better relatively quickly after the baby is born. However, if it is felt there is time, your physician may recommend inducing you, which includes medications to ripen your cervix (get it to open up) so doctors can break your water and start medications to get you into labour. Induction, especially prematurely, is also associated with an increased chance of caesarean section as some people just don’t respond and their cervix doesn’t change despite having uterine contractions. So, while it isn’t automatic you will have a caesarean section, there is a greater chance that one might be necessary for you and/or your baby.
Gestational Hypertension
Women who experience consistent high blood pressure during pregnancy (after 20 weeks gestation) without protein in their urine or any other signs of preeclampsia suffer from gestational hypertension. The risk factors for gestational hypertension are the same as for preeclampsia, but women who have no history of high blood pressure may develop gestational hypertension purely as a result of being pregnant. Like preeclampsia, it is important to maintain a normal blood pressure level; consistent high blood pressure puts the mother at risk for severe and life threatening complications. Your health care provider may suggest certain medications to lower your blood pressure. Your pressure should return to normal shortly after delivery or certainly within 6 weeks of delivery.