Preeclampsia and Eclampsia

Pregnancy-Induced Hypertension (PIH), Toxemia of Pregnancy

What is Preeclampsia and Eclampsia?

Preeclampsia is a serious condition in which a pregnant woman develops high blood pressure (hypertension), fluid retention (edema), and protein or albumin in her urine (proteinuria) during the second half of pregnancy. Preeclampsia can be mild or severe, but if it is not controlled, it can lead to eclampsia. Eclampsia, which is characterized by seizures, can result in death of the mother and/or baby. Eclampsia occurs during late pregnancy, labor, or the period following delivery.

Affecting about six percent of pregnancies, preeclampsia is more common in first pregnancies and in mothers under 25 or over 35. Underlying conditions such as diabetes, hypertension, or kidney disease also increase the risk of preeclampsia. Eclampsia occurs more commonly in women who have had little or no prenatal care. The reason for this is that if preeclampsia does occur, it is not detected early enough, and so goes untreated. About half of all cases of eclampsia develop in late pregnancy, one third during labor, and the rest after delivery.

Although the exact cause is not known, both preeclampsia and eclampsia are thought to be caused by immunological dysfunction of the placenta (the organ in the womb that sustains the unborn child).

How is it diagnosed?

History: Symptoms may include swelling of the hands and face upon arising in the morning, weight gain in excess of two pounds per week, or particularly sudden weight gain over one to two days. Eclampsia includes the symptoms of preeclampsia, plus seizures. Before the onset of the seizure, there may be a severe headache, confusion, blurred vision, or upper abdominal pain. The seizures consist of violent, rhythmic, jerking movements of the limbs. Breathing may be difficult due to the constriction of the muscles of the "voice box" (larynx). Coma may follow.

Physical exam: Hypertension (high blood pressure) is the most important standard for judging preeclampsia. Mild preeclampsia involves borderline hypertension. Any significant increase during the second trimester could be a warning signal. Blood pressure can be quite unstable, but it usually falls during sleep. In severe preeclampsia, the blood pressure may increase during sleep, reaching its highest point at 2:00 a. m.

Edema (fluid retention) is not relieved even with bedrest. However, edema is not always present in preeclampsia or eclampsia. The abdominal pain in severe eclampsia is caused by an enlarged liver, which can be detected by palpation (an exam done by pressing on the abdomen with the hand). Ophthalmic exam (examination of the eyes) may show the arteries of the eyes to be in spasm, causing the blurred vision.

Tests: A urinalysis may reveal proteinuria (protein in the urine). This is usually the last sign to appear, and may be an indication that the baby is in danger. In severe preeclampsia, blood tests may reveal elevated levels of hemoglobin and hematocrit, elevated uric acid and serum creatinine. Alkaline phosphatase may be increased two to three times the normal level due to liver injury.

How is Preeclampsia and Eclampsia treated?

The treatment of mild preeclampsia is bedrest. The individual is usually hospitalized upon diagnosis to diminish the possibility of convulsions and to protect the fetus. Antihypertensive drugs or magnesium sulfate injections may be used to reduce blood pressure. In mild preeclampsia, individuals who can be relied on to follow physician instructions can be treated at home with bedrest, close monitoring of blood pressure, and daily urine tests (dipsticks) to monitor for protein.

The goal of treatment is to preserve the life and health of mother and infant. The only cure for preeclampsia and eclampsia is delivery. Therefore, the condition must be stabilized so that this may be accomplished. If the woman is close to term (at or beyond 36 weeks of pregnancy), or if eclampsia is imminent, labor may be induced (artificially started). The baby's condition is monitored by kick counts, non-stress tests, and ultrasound assessment of amniotic fluid volume.

Corticosteroids may be used to accelerate fetal lung development when it is thought that delivery may occur in two to seven days. In cases of eclampsia, the treatment is to control seizures and reduce high blood pressure. Anticonvulsants and antihypertensive drugs (used sparingly) are given by intravenous infusion. When the condition is stabilized, the baby is delivered (often by emergency cesarean section).

Once the baby is born, the mother's condition often resolves. However, because eclampsia may still occur in the two to four day period after delivery, continued observation (and prolonged hospitalization) may still be needed.

Medications

Valium (Diazepam), Normodyne (Labetalol)

What might complicate it?

Preeclampsia may require early delivery, which may create complications for the baby due to premature birth. One-third to one-half of babies fail to survive eclampsia. This is usually due to lack of oxygen in the uterus (uteroplacental insufficiency). Complications to the mother may include bleeding in the brain (cerebral hemorrhage), brain damage due to lack of oxygen (hypoxic encephalopathy), pneumonia caused by inhaling foreign matter into the lungs (aspiration pneumonia), generalized failure of blood clotting mechanism, rupture of the liver, or kidney (renal) failure.

Predicted outcome

After delivery, the mother's blood pressure usually returns to normal within a week, and the urine is cleared of protein within six weeks. Preeclampsia does not cause permanent damage or adversely affect the long-term health of the mother. Maternal deaths due to preeclampsia are rare. The prognosis is worse for the mother and fetus if the mother has a history of chronic high blood pressure.

Alternatives

Chronic hypertension can mimic preeclampsia.

Appropriate specialists

Obstetrician or gynecologist and perinatologist.

Notify your physician if

  • You or a family member has symptoms of preeclampsia at any stage of pregnancy.
  • The following occur during treatment:
    • Severe headache or vision disturbance.
    • Weight gain of 3 or more pounds in 24 hours.

Last updated 7 August 2011


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