May is Preeclampsia Awareness Month. Preeclampsia is a multi-factor hypertensive disorder that can occur during pregnancy and in the immediate postpartum period. It was previously known as Toxemia of Pregnancy. Around the world it is a leading cause of death for women and their babies. The likelihood of developing preeclampsia is about 5%.
- First pregnancy
- Advanced maternal age >40 years old
- Previous history of preeclampsia or family history
- Chronic hypertension
- Socioeconomic factors
- Kidney disease
- Blood clotting disorders
- Twins or higher order multiples
Categories of Hypertensive Disorders in Pregnancy :
Chronic Hypertension : blood pressure > 140 /90* prior to 20 weeks of pregnancy or persists 12 weeks after birth.
Gestational Hypertension: blood pressure >140/90* that presents after 20 weeks of pregnancy. Previously called pregnancy induced hypertension or PIH.
Preeclampsia: Persistently elevated blood pressure BP >140/90* after 20 weeks of pregnancy associated with changes in kidney, liver function, and/ or decreased platelet count (blood component that helps with clotting) . Possible symptoms include headache, blurred vision, epigastric pain, and/or swelling.
Preeclampsia with severe features: Persistently elevated bp >160/110*, impaired liver and/or kidney function, and/or decreased platelet count. Possible symptoms include severe headache, blurred vision, epigastric pain, swelling, and /or shortness of breath.
Eclampsia: Preeclampsia diagnosis with seizure occurrence. Severe form of preeclampsia
HELLP Syndrome: Hemolysis (destruction of red blood cells), Elevated liver enzymes, and low platelets . Severe form of preeclampsia.
Preeclampsia Warning Signs :
- Headaches that does not resolve with rest or Tylenol
- Blurred vision, changes in vision, or floaters
- Pain on right side under breast or epigastric pain
- New onset nausea/vomiting after 20 weeks
- Increased swelling especially in face or hands
*It is important to let your OB or midwife know if you have any of the following symptoms * Your practitioner may order the following: a blood pressure reading, blood work, urine for protein or 24hr urine collection, a non-stress test (NST), and/or an ultrasound. The treatment plan will depend on clinical assessment, lab results, and fetal assessments.
Complications From Preeclampsia
- Eclampsia (seizure)
- Placenta abruption
- Increased risk of hemorrhage
- Increased risk of cesarean birth
- Delayed onset of mature milk production
- Impact on future cardio-vascular health
- Liver or kidney damage
- Traumatic birth experience
- Preterm birth & associated risk factors
- Low birth weight
- NICU admission
- Respiratory disease from prematurity
The exact cause of preeclampsia is unknown; making prevention difficult. The most proactive thing that women can do is to eat a nutrient dense diet full of lots of fruits, vegetables, healthy fats, and proteins. Limit processed foods and sugar. Maintain physical activity throughout pregnancy unless directed otherwise by your practitioner. Drink lots of water. Manage stress: consider journaling, meditation, prenatal yoga, or seeing a therapist if stress management is a challenge. Take your prenatal vitamin and regularly see your OB doctor or midwife. If you are high risk for preeclampsia your doctor may recommend taking low dose aspirin during pregnancy. Preconception, improve modifiable risk factors through dietary and lifestyle adjustments.
Treatment For Preeclampsia
The only cure for preeclampsia is birth. Timing of birth relates to severity of the condition and gestational age. Depending on severity may be managed on an outpatient basis, or admitted to hospital for close antepartum monitoring, or unscheduled induction of labor, or cesarean birth may be indicated. Symptoms do not immediately resolve after birth and risk for seizure is still present.
Management Of Preeclampsia May Include:
- Magnesium Sulfate (anticonvulsant) via IV infusion
- IV push antihypertensive medications such as Labetolol or Hydralazine
- Po antihypertensive medications such as Labetalol or Procardia
- Frequent fetal monitoring, blood pressure assessments, ultrasounds, and blood work
- Steroid injection to help with baby’s lung development if preterm
- Induction of labor or cesarean birth
Awareness of the signs and symptoms of preeclampsia is key to aid in early detection. Regular access to prenatal and postpartum visits with prompt management to help minimize complications is essential. For more information check out the CDC or ACOG resources.
Being diagnosed with preeclampsia can be scary and overwhelming. Mama Coaches are Registered Nurses who can help provide education and support as you adjust to the expected changes. Many Mama Coaches offer virtual or private customizable prenatal classes if you are unable to attend a group class and postpartum-newborn visits with phone & email support to help you navigate the 4th trimester.
See here, to find a Mama Coach near you.