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Understanding Preeclampsia
At each prenatal visit, your doctor will weigh you, check your blood pressure and measure the amount of protein in your urine. These three procedures are the simplest means of screening for preeclampsia, also known as toxemia of pregnancy, which affects 6 - 8% of all pregnancies.

Preeclampsia typically manifests in the second half of pregnancy. The hallmark signs of this condition are elevated blood pressure, protein excretion in the urine and diffuse swelling from retaining fluids. The increase in blood pressure results from vasospasm (constriction of blood vessels), which results in less blood flow to the uterus, kidneys, liver, and brain. Decreased uterine blood flow can compromise blood flow to the baby, and that can lead to restricted growth for baby and a decrease in the amount of amniotic fluid. Women with preeclampsia may notice sudden weight gain due to extensive fluid retention with swelling in their legs, hands and face. If preeclampsia becomes severe, symptoms can include headaches, visual disturbances, decreased urinary flow, and upper abdominal pain. All pregnant women should familiarize themselves with the warning signs of preeclampsia. Preeclampsia can sometimes progress quickly and have perilous consequences. Untreated preeclampsia can occasionally progress to eclampsia, which is the occurrence of seizures during pregnancy. If mild preeclampsia is managed appropriately, a healthy outcome for mother and baby is likely.

Preeclampsia is uniquely related to pregnancy. It is likely that the placenta plays a role in causing this disease because delivery results in a reversal and “cure” of this condition.

If you develop warning signs for preeclampsia, contact your doctor immediately or head to a hospital. With mild preeclampsia, your doctor will order specific urine and blood tests and monitor your pregnancy more closely. You will be restricted to bed rest and told to lie on your side: this improves circulation, lowers blood pressure and helps reduce swelling. Your baby’s heart rate and movement may be monitored and an ultrasound may be performed to measure your baby’s growth and your quantity of amniotic fluid.

If severe preeclampsia develops, hospitalization is necessary. A medication called magnesium sulfate may be given to prevent seizures, and other medications may be used to treat severe hypertension (high blood pressure). We know that delivery will “cure” this condition. Therefore, the desire to protect mum’s health must be balanced against the risks to the baby of premature delivery. If a baby is close to term, immediate delivery is often advised. If a baby is very premature, physicians will try to use conservative management to delay delivery as long as possible.

Women at higher risk for preeclampsia include those carrying twins, women over 40, and women with poor nutrition. Preeclampsia is also more likely in women with a history of high blood pressure and diabetes. Preventive measures include eating a healthy diet with adequate calcium, magnesium, vitamin C, vitamin E and protein. Some women at high risk are advised to take baby aspirin throughout pregnancy. Know the warning signs of preeclampsia: rapid weight gain, swelling throughout the body, severe headache, visual disturbances, and abdominal pain, and inform your doctor if any of these occur. Fortunately, obtaining regular prenatal care is an excellent way to detect early signs of preeclampsia and to receive the best possible treatment to prevent its progression.

Laura E. Stachel M.D. Obstetrician & Gynecologist