Preeclampsia is a condition that occurs only during pregnancy, after the 20th week. A woman with preeclampsia develops high blood pressure and protein in the urine, and she often has swelling (edema) of the legs, hands, face or entire body. When preeclampsia becomes severe, it can cause dangerous complications for the mother and the fetus. One of these complications is eclampsia, the name for seizures or coma that are caused by severe preeclampsia.

Experts are still researching the details of how preeclampsia is caused, but recent research has provided a basic understanding of the disease. Preeclampsia occurs when the placenta does not anchor itself as deeply as expected within the wall of the uterus. This happens if the placenta does not form a normal system of arteries. Many things can lead to an incomplete artery system in the placenta, including illnesses that can interfere with normal circulation (diabetes or high blood pressure), genetic (inherited) factors and the way the mother's immune system reacts to the growing placenta.

As the pregnancy progresses, a placenta that does not have a normal artery system creates an abnormal balance of enzymes (proteins) called growth factors that have effects on arteries in the body. This abnormal balance of enzymes changes the way that arteries in the mother and the placenta function. Arteries throughout the body can tighten (become narrower), raising blood pressure. They can also become "leaky," allowing protein or fluid to seep through their walls, which causes tissues to swell. Arteries can also react to the abnormal growth factor balance by forming clots.

In preeclampsia, changes in arteries decrease the blood supply to the fetus and placenta, the woman's kidneys, liver, eyes, brain and other organs.

Preeclampsia and eclampsia are leading causes of illness and death for mothers and newborns. Preeclampsia occurs in approximately 5% to 8% of pregnant women in the United States. Eclampsia occurs in 1 of every 200 women with preeclampsia, and it is often fatal if not treated.

The following conditions increase the chance that a woman will develop preeclampsia and eclampsia:

• Chronic (long-lasting) high blood pressure
• Obesity
• Diabetes
• Kidney disease
• Being under 15 or over 35 years old
• First pregnancy
• Having preeclampsia in a previous pregnancy
• Multiple gestations (twins, triplets or greater)
• Certain autoimmune conditions, including antiphospholipid antibody syndrome and some autoimmune arthritis conditions
• African-American or Hispanic ethnicity
• Having a sister, mother or daughter who has had preeclampsia or high blood pressure in pregnancy
• Having a male partner whose previous partner had preeclampsia (this suggests that the father's genetic material, passed to the fetus and its placenta, may play a role)
• Having a male partner with whom you were sexually active for only a short length of time prior to becoming pregnant (this may be due to a change in the way a woman's immune system reacts to genes from the father, after repeated exposure to his semen)

Mild preeclampsia. A woman with mild preeclampsia may not notice any symptoms, or she may have only mild swelling of the hands or feet. However, most pregnant women have some degree of swelling, so not all swelling indicates preeclampsia.

Severe preeclampsia. Symptoms can include:

• Headache
• Visual changes
• Nausea and abdominal pain, usually in the upper abdomen
• Difficulty breathing
• Pelvic pain
• Bleeding, such as from the gums or the vagina, or blood in the urine

Eclampsia. Eclampsia causes seizures, which cause loss of consciousness with jerking movements of the arms and legs and may cause loss of control of bladder or bowels.

Because preeclampsia doesn't always cause noticeable symptoms, it is crucial that all pregnant women see a health care professional regularly during pregnancy for prenatal care. This gives you the best chance of having preeclampsia diagnosed and treated before it becomes severe. Your doctor or midwife will measure your blood pressure and test your urine for protein at each prenatal visit because abnormal results are the earliest, most common signs of preeclampsia.

Preeclampsia can be especially difficult to detect in women who have a history of high blood pressure (hypertension) before pregnancy. One in four women with high blood pressure develop preeclampsia during pregnancy, so it is essential that these women be monitored closely for changes in blood pressure and for protein in the urine.

Your doctor or midwife will diagnose preeclampsia or eclampsia depending on your symptoms and the results of tests. Tests that measure the level of several proteins related to preeclampsia have been developed and are being studied; these tests may be available within the next several years and could allow doctors to predict preeclampsia or diagnose preeclampsia. Currently, since a simple blood test is not available, here is how the diagnosis is determined:

• Mild preeclampsia. Characterized by the following:
  • Blood pressure of 140/90 or above, or a 30-point rise in the systolic value (upper number) or 15-point rise is the diastolic (lower number) over your usual blood pressure, even if the values are not above 140/90
  • Swelling that occurs even when lying down, weight gain of more than 2 pounds in a week or a sudden weight gain. (Swelling in the ankle area is considered normal during pregnancy.)
  • Protein in the urine



• Severe preeclampsia. Characterized by:
  • Blood pressure of 160/110 or higher while on bed rest and in more than one reading separated by at least six hours
  • Protein in the urine of more than 5 grams in a 24-hour period
  • Symptoms such as severe headache, changes in vision, reduced urine output, abdominal pain, fluid in the lungs, pelvic pain and vaginal bleeding
  • Signs of the "HELLP" syndrome, which means the liver and blood-clotting systems are not functioning properly. HELLP stands for Hemolysis (damaged red blood cells), Elevated Liver enzymes (from liver swelling and bleeding) and Low Platelets (cells that help the blood to clot). It occurs in about 10% of patients with severe preeclampsia.



• Eclampsia. Eclampsia is diagnosed when a woman with preeclampsia has seizures or goes into a coma. These seizures usually happen in women who have severe preeclampsia. However, they can occur with mild preeclampsia. Eclampsia can happen soon after a woman gives birth. Approximately 30% to 50% of patients with eclampsia also have the HELLP syndrome.

Preeclampsia can begin as early as the 20th week of pregnancy, but it is more likely to develop during the last three months of pregnancy. It usually can be managed with treatment through the rest of pregnancy. If the condition worsens and threatens the health of the mother by causing eclampsia or other complications, the baby has to be delivered along with the placenta. Preeclampsia goes away after delivery.

Two studies published in October 2007 showed that careful management of the weight that you gain during pregnancy can lower your risk for preeclampsia. When researchers compared women who gained small, medium and large amounts of weight, the women who gained less than 15 pounds had fewer cases of preeclampsia. Women who gained more than 35 pounds had significantly higher rates of preeclampsia. These findings were true for women with a normal body mass index prior to their pregnancies as well as for women who were overweight or obese.

Calcium and low-dose aspirin, two treatments that were once thought to prevent preeclampsia, have been shown not to help prevent preeclampsia in large studies of healthy women. Some experts suspect that low-dose aspirin may provide slight protection to women who are at especially high risk of preeclampsia, even though the treatment have not been shown to work for women at average risk.

The complications of preeclampsia and eclampsia can be prevented. The U.S. Centers for Disease Control and Prevention found that women who receive prenatal care are seven times less likely to die of preeclampsia and eclampsia than women who do not get any care during pregnancy. Prenatal care is a crucial and lifesaving step in preventing complications and deaths of both the mother and the fetus.

The only cure for preeclampsia and eclampsia is to deliver the baby. If your symptoms are mild, your doctor or midwife may try to delay delivery to make sure the baby has developed enough to do well outside the womb.

• Mild preeclampsia. The goal of treating mild preeclampsia is to delay delivery until the fetus is mature enough to live outside the womb. You most likely will be put on bed rest and your doctor or midwife will monitor your blood pressure, weight, urine protein, liver enzymes, kidney function and the clotting factors in your blood. Your provider also will monitor the well-being and growth of your fetus. Some women need to be hospitalized for adequate treatment and monitoring, while others can remain in bed at home. If you are not hospitalized, you will need to be seen by your health care professional frequently.



• Severe preeclampsia. The overall goal is to prevent eclampsia (seizures), prevent other complications and deliver your baby as soon as your physical health allows. Your physical health and well-being will begin returning to normal after the baby is delivered from your womb. Women with severe preeclampsia are hospitalized and usually are treated with magnesium sulfate, a medication to lower the risk of seizures. Magnesium sulfate is usually given intravenously (into a vein) or by injection into a muscle. Medications to lower blood pressure may be needed before delivery.



• Eclampsia. Seizures generally are treated with intravenous magnesium sulfate. Other antiseizure medications such as lorazepam (Ativan) or phenytoin (Dilantin) may be used, but they don't work as well to control eclampsia. Once seizures are controlled and the mother's blood pressure is stabilized, the baby is delivered.

You should schedule your first prenatal care visit with a health care professional as soon as you become aware you are pregnant. If you have swelling, severe headache, changes in vision, abdominal or pelvic pain, or other symptoms of preeclampsia, see your doctor or midwife immediately.

The outlook for full recovery from preeclampsia is very good. Most women begin to improve within one to two days after delivery, and blood pressure returns to the normal pre-pregnancy range within the next 6 to 12 weeks. Prenatal care can dramatically reduce the complications and deaths of preeclampsia, because women who are diagnosed while preeclampsia is mild can receive treatment without any delay. Between 5% and 8% of pregnant women in the United States develop preeclampsia. Progress in treating eclampsia has saved the lives of both mothers and their newborns. In the United States and Britain, between 1% and 2% of women who developed eclampsia die and 3% of their babies die during or shortly after birth. The maternal death rate from eclampsia in locations where health care is not easily available can exceed 13%.

About one of every five women with preeclampsia during a first pregnancy will have preeclampsia during a second pregnancy.

American Academy of Family Physicians (AAFP)
P.O. Box 11210
Shawnee Mission, KS 66207-1210
Phone: 913-906-6000
Toll-Free: 1-800-274-2237
Email: email@familydoctor.org
http://www.familydoctor.org/

American College of Obstetricians and Gynecologists
P.O. Box 96920
Washington, DC 20090-6920
Phone: 202-638-5577
http://www.acog.org/