Pregnancy-Induced Hypertension (PIH) – Preeclampsia
Preeclampsia is high blood pressure that develops or increases during pregnancy. The condition usually occurs after the 20th week of pregnancy.
What is going on in the body?
The placenta is the spongy material in the mother’s uterus that nourishes the fetus. Some experts believe that a problem with the placenta causes preeclampsia. The mother has spasms of the blood vessels, which increase her blood pressure. The blood flow to the placenta is impaired. If the blood pressure is not controlled, it can damage the placenta and cause death of the fetus.
Preeclampsia develops in 5% of pregnant women. It usually occurs after the 20th week of pregnancy. It may be mild or severe. The high blood pressure can affect the brain, kidneys, liver, and lungs. If the woman develops seizures or coma, the condition is known as eclampsia.
What are the causes and risks of the condition?
Following are factors that increase a woman’s risk of preeclampsia:
African American ethnicity
age younger than 20 or older than 35
low socioeconomic status
molar pregnancy, an abnormal condition that mimics a normal pregnancy but is actually a tumor
multiple gestation such as twins or triplets
Additional factors that increase the risk of preeclampsia are as follows:
if the mother had preeclampsia or eclampsia in previous pregnancies
if the mother has diabetes
if the mother has high blood pressure before pregnancy
if the mother has underlying kidney disease
if the mother or the baby’s father was born of a pregnancy with preeclampsia or eclampsia
Symptoms & Signs
What are the signs and symptoms of the condition?
The symptoms of preeclampsia may include:
agitation and confusion
changes in mental status
decreased urine output
nausea and vomiting
pain in the right upper part of the abdomen
shortness of breath
sudden weight gain over 1 to 2 days
swelling of the face or hands
weight gain of more than 2 pounds per week
Diagnosis & Tests
How is the condition diagnosed?
Diagnosis of preeclampsia begins with a medical history and physical exam. The woman’s blood pressure will be measured. The healthcare provider may order the following tests:
blood tests to check clotting and liver function
complete blood count, or CBC, to look for abnormal blood cell counts
cranial CT scan to check for bleeding or stroke
pregnancy ultrasound to check the age and condition of the fetus
urinalysis to look for protein in the urine
Prevention & Expectations
What can be done to prevent the condition?
There are no known ways to prevent preeclampsia. All pregnant women should have early prenatal care. Blood pressure changes should be watched closely.
What are the long-term effects of the condition?
Preeclampsia may cause pregnancy complications, including the following:
increased risk for cesarean section
intrauterine growth retardation, a lack of normal growth of the baby within the womb
placenta abruptio, or separation of the placenta from the uterine wall
suffocation at birth, or asphyxia
Preeclampsia can also cause the following health problems that affect both mother and baby:
acute renal failure, or kidney failure
disseminated intravascular coagulation, or DIC, a clotting problem that causes widespread bleeding
eclampsia, with high blood pressure, coma, and seizures
HELLP syndrome, which includes liver and blood disorders
intracerebral hemorrhage and stroke
What are the risks to others?
Preeclampsia is not contagious. Both mother and baby are at risk for complications of preeclampsia.
Treatment & Monitoring
What are the treatments for the condition?
Giving birth is the only cure for preeclampsia. Preeclampsia limits blood flow to the placenta and the fetus. If a woman has symptoms, flow may already be reduced by 50%. The healthcare provider may decide to induce labor or to wait for labor to occur naturally. The following factors will determine the decision:
condition of the mother and fetus
dilation of the cervix
failure of fetal growth as measured by pregnancy ultrasounds
fluid in the lungs
presence of labor
severity of the condition
the wishes of the mother
If the symptoms are mild, outpatient treatment is common. This includes bed rest at home and biweekly exams in the provider’s office. If symptoms do not improve, hospitalization may be needed. Fetal testing will be done to decide if early delivery is possible.
In severe cases, the provider may decide to induce labor with medications. Delivery may be induced if any of the following conditions occur:
destruction of red blood cells, known as hemolysis
elevated liver function tests
falling platelet count
pain in the right upper abdomen
persistent and severe headache
signs of kidney failure
very high blood pressure for more than 24 hours
Treating severe preeclampsia means controlling the woman’s blood pressure. A C-section may be needed. Medications to prevent eclampsia include magnesium sulfate and hydralazine. Anticonvulsants may be used to prevent seizures.
What are the side effects of the treatments?
Magnesium sulfate may cause nausea, vomiting, and breathing problems. These can often be avoided with careful monitoring of serum magnesium levels. Other medications may cause allergic reactions and stomach upset.
What happens after treatment for the condition?
A woman may be at risk for developing eclampsia up to 6 weeks after delivery. She will have regular visits to the healthcare provider, as well as regular blood and urine tests.
How is the condition monitored?
Any new or worsening symptoms should be reported to the healthcare provider.