Articles from http://www.preeclampsia.org
Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.
Typically, preeclampsia occurs after 20 weeks gestation (in the late 2nd or 3rd trimesters or middle to late pregnancy), though it can occur earlier. Proper prenatal care is essential to diagnose and manage preeclampsia. Preeclampsia, Pregnancy Induced Hypertension (PIH) and toxemia are closely related conditions. HELLP Syndrome and eclampsia are other manifestations of the same syndrome. It is important to note that research shows that more women die from preeclampsia than eclampsia and one is not necessarily more serious than the other.
Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.
Signs and Symptoms
None
High blood pressure is a silent killer. Oftentimes, women diagnosed with preeclampsia do not feel sick. Many signs and symptoms of preeclampsia mirror other “normal” effects of pregnancy on your body. Women diagnosed with preeclampsia may feel frustrated when prescribed bedrest because they feel fine. If you feel fine, it may be hard for you or your partner to appreciate that preeclampsia is a serious condition.
What you can do…
Proper prenatal care is essential. Tests taken at these check-ups: weighing in, checking your blood pressure, dipping your urine are all done to screen for preeclampsia. Particularly after 20 weeks–do not miss your prenatal appointments. As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals and the basic food groups is important; cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol and any medication not prescribed by a physician is essential. It is also advisable to speak with your health care professional before taking any supplement, herbal or otherwise.
Hypertension (High blood pressure)
High blood pressure is defined as blood pressure of 140/90 or greater as measured on two separate occasions within six hours. However, a woman who normally has a low baseline blood pressure, such as 90/60, could be considered hypertensive at a blood pressure of less than that - especially if she has other symptoms. A rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more is cause for concern.
In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:
In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.
It should also be noted that 4 members of the Preeclampsia Foundation Medical Board and our Executive Director participated in this working group. There was significant debate over removing baseline BP as diagnostic which is why the final sentence was included. The Preeclampsia Foundation continues to encourage its women, particularly those with low baseline BPs, to know their baseline and to be aware of significant changes and to make any concerns about those changes known to their health care provider.
What you can do…
Know your baseline blood pressure (your blood pressure prior to pregnancy), learn what it means, and ask, “What are my numbers” at each visit. If you are told “It’s fine,” repeat, “What are my numbers?” If you have had preeclampsia before or if you have chronic high blood pressure, consult a specialist, a high risk OB, or a perinatologist, about your pregnancy. You can find a perinatologist near you who specializes in hypertensive diseases of pregnancy by going to the North American Society for the Study of Hypertension in Pregnancy (www.nasshp.com). Women who have had preeclampsia in a previous pregnancy should request a full screening by a perinatologist to rule out any underlying disease or problems, such as chronic hypertension, autoimmune disorders, thrombophilias, renal disease, etc. Women with a previous history of preeclampsia should have subsequent pregnancies supervised by an obstetrician or a perinatologist. The single large risk factor for getting preeclampsia is a history of having had it before.
If you are inactive or have a higher-than-average body mass index (BMI), make sure to exercise moderately and get yourself in the best shape you can. (You can calculate your BMI). Women with a BMI of 30 or higher are at an increased risk of preeclampsia and should make efforts to reduce this risk by following the advice of their doctor.
Finally, you can buy your own blood pressure monitor at most pharmacies. Some pharmacies have a monitor available for your use. Keep a log of your blood pressure, taken at the same time each day, if possible, and in the same position. Share it with your care provider. If you own your own monitor, you can take it with you to your appointment and have it calibrated to match those in the office. You might also ask your doctor when they last had their monitor calibrated.
It should be noted that home monitors are not always as accurate as those in one’s clinic or hospital. Home readings should not replace prenatal visits, nor should a “normal” reading mean ignoring symptoms that may be markers of preeclampsia. Home readings should only be used to help the mother be more proactive in her care.
If you are diagnosed with preeclampsia, many physicians will recommend bedrest, and in late pregnancy, lying on your left side. While health care providers don’t always agree that lying on your left side will help, there is no evidence of harm. The thinking is that lying flat on your back might cause the pregnant uterus (and the weight of the baby) to restrict the vein that supplies the heart.
Swelling or Edema (particularly of the hands or face)
A certain amount of swelling during pregnancy is normal. Edema is the accumulation of excess fluid. It is particularly concerning when it accumulates in the face (eyes) or hands. It is normal to have trouble wearing rings throughout pregnancy.
What you can do…
Find a picture of yourself just before pregnancy. Share it with your provider if you feel your face is getting excessively puffy. If the swelling in your extremities becomes severe, you may notice pitting edema (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs. If this happens, notify your provider, put your feet up every day (but avoid sitting for extended periods) and drink water to keep hydrated.
Proteinuria (Protein in your urine)
Proteinuria is the result of proteins, normally confined to the blood, spilling into your urine because the small blood vessels in the kidneys become damaged. A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria.
What you can do…
At each prenatal visit ask for the results of the urine test. Usually the nurse dips a reagent strip into your urine sample and then waits a minute for the results. The strips have the markings for “trace”, 1+, 2+, etc. A reading of trace protein is relatively common and is usually not a cause for concern. If the strip shows a reading of 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is less than 140/90. If you have a reading of 2+, call your health care provider immediately. If you are concerned, or have had preeclampsia before, you can buy reagent strips at some pharmacies or online. They are not cheap and insurance might not cover them.
Sometimes health care providers will have the mother take a 24-hour urine collection for a formal lab assessment. This is not a particularly pleasant task, but if you have been asked to do this, follow the directions of your health care provider carefully, and make every effort to be accurate.
Dark yellow urine is usually the result of inadequate fluid intake and dehydration. However, urine that is quite dark, reddish or the color of cola may indicate a problem. If you have any of these symptoms, inform your care provider.
Sudden Weight Gain
A gain of more than 2 pounds in a week or 6 pounds in a month could be cause for concern.
What you can do…
In general, eat normally and make every effort to include fresh raw fruit and vegetables, your prenatal vitamin, and a folic acid supplement in your diet. Do not diet or try to lose weight. It is important that you eat a healthy, balanced diet. Avoid excessive salt. And as always, avoid alcohol, caffeine, smoking and recreational drugs. Consult with your provider regarding non-prescription drugs and any herbal medications you might take. The Preeclampsia Foundation recognizes the importance of a good diet but does not endorse any particular diet nor juice product. Given that preeclampsia is a complex disease, women will develop it for different reasons. We encourage all women to share with their doctors any diets or product they are trying. For some women–a good diet may make a significant difference, however we urge caution when trying diets, particularly those that encourage large amounts of protein. For women with underlying kidney disease–excessive protein can be unsafe. Similarly, while some women might benefit from low-dose aspirin–studies show that it has been linked with increased placental abruption and miscarriage and so should not be taken routinely by pregnant women unless they have been advised to do so by their physician.
Be sure to drink plenty of water and get regular moderate exercise. At your prenatal visits do not attempt to disguise any weight gain by skipping breakfast, using diet pills or fasting for the day. An accurate weight is vital for a proper diagnosis.
Headaches
Dull, throbbing headaches, often described as migraine-like that just won’t go away.
What you can do…
Call your care provider. If you have tried taking over-the-counter medication without relief, or if the headache is very painful or you have light sensitivity, call immediately and ask to see the doctor that day.
Nausea or Vomiting
Nausea or vomiting is particularly significant when the onset is sudden and in the second or third trimesters.
What you can do…
Call your care provider. Nausea or vomiting can be confused with the flu, so be sure to get your blood pressure checked and ask to have your urine checked for proteinuria. Insist on both.
Changes in Vision
Vision changes include temporary loss of vision, sensations of flashing lights, auras, light sensitivity, and blurry vision or spots. For some women who are farsighted, vision may actually improve.
What you can do…
If you have any of these symptoms, you may be developing preeclampsia. Symptoms such as these may be associated with irritation of the central nervous system and should be taken seriously. They may be indicative of cerebral edema (swelling of the brain). It is very important that you consult with your provider as soon as possible. If he or she is not available, you should go directly to the hospital. We regard these symptoms as potentially very serious and they should not be left until the morning, tomorrow and particularly not until the end of the weekend. With preeclampsia, it is better to have the health professionals tell you it was nothing, than to take a chance that might risk your or the baby’s life. No doctor ever died from seeing a woman too many times.
Racing pulse, mental confusion, heightened sense of anxiety, trouble catching your breath
If these symptoms are new to you, they could indicate an elevated blood pressure.
What you can do…
Contact your health care provider if these symptoms are new. If they are not, be sure to mention them at your next visit.
Stomach and/or Right Shoulder Pain
This type of stomach pain, called epigastric pain by the medical profession, is usually under the right-side ribs. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Shoulder pain is often called referral pain because it radiates from the liver under the right ribs. Lower back pain is different from muscle strain common to pregnancy. It is usually more acute and specific. All may be a sign of HELLP Syndrome or a related problem in the liver. Shoulder pain can feel like someone is deeply pinching you along the bra strap, or it can be painful to lie on your right side.
What you can do…
Pain in this area should be taken very seriously; do not dismiss it and go to bed. Call your health professional immediately.
Lower Back Pain
Lower back pain is a very common complaint of pregnancy. However, sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms or preeclampsia.
What you can do…
Read also Stomach and Right Shoulder Pain (above) and mention this symptom to your health care provider. If this pain accompanies one or more of the other symptoms, you should call your health care provider immediately.
Hyperreflexia
Hyperreflexia is when your reflexes are so strong that when they are checked, your leg bounces back hard.
What you can do…
This is not usually something you will notice yourself, but if you are bumped and you notice an abnormally strong reflexive response, it might merit a call to your health care provider
