Preeclampsia is a complication of pregnancy after 20 weeks' gestation associated with high blood pressure (140/90 or greater) and protein in the urine that may cause symptoms like headache, dizziness, and sudden onset of swelling.
Preeclampsia appears to be caused by problems with the development of blood vessels in the placenta, and is more common in pregnant people with a history of preeclampsia in a previous pregnancy or high blood pressure prior to pregnancy. The risk is also higher in pregnant people under the age of 17 and over the age of 35.
It is important to seek urgent medical attention if you suspect you might have preeclampsia. Treatment with medications to help lower blood pressure or induce labor may be necessary in order to prevent serious and potentially life-threatening complications for the pregnant person and the fetus.
Common symptoms
Symptoms of preeclampsia can vary based on the severity of the diagnosis:
1. Preeclampsia without severe features ("mild" preeclampsia)
Signs and symptoms of "mild" preeclampsia include:
- Blood pressure between 140/90 and 160/110;
- Protein in the urine;
- Generalized swelling and rapid weight gain.
The presence of at least one of these symptoms should prompt the pregnant person to be seen immediately for a blood pressure check as well as additional exams to help confirm or rule out a diagnosis.
2. Preeclampsia with severe features ("severe" preeclampsia)
Signs and symptoms of "severe" preeclampsia include:
- Blood pressure of 160/110 or higher;
- Persistent bilateral or frontal headache;
- Right-sided abdominal pain;
- Decreased urine output and urge to urinate;
- Vision changes like blurred vision or seeing flashing lights;
- Burning sensation in the stomach (epigastric pain).
A pregnant person experiencing any of these symptoms needs to be seen immediately in the emergency department.
Confirming a diagnosis
The diagnosis of preeclampsia is made by your OBGYN or midwife based on symptoms, medical history, and a physical exam, which includes a blood pressure of 140/90 or higher.
Blood pressure and lab results
The workup for preeclampsia typically involves the following tests:
- Blood pressure checks, done two times at least 4 hours apart;
- Urine test to check for protein in the urine;
- Complete blood count (CBC);
- Creatinine and uric acid levels in the blood;
- Hepatic (liver) and renal (kidney) function tests.
In addition, your OB provider may order other exams like an ultrasound with doppler studies to evaluate fetal well being, amniotic fluid levels, and placental blood flow.
Possible causes
While the exact cause is unknown, preeclampsia appears to be caused by a problem with the development of blood vessels in the placenta, resulting in a narrowing of the blood vessels that can interfere with adequate blood flow and normal blood clotting.
Risk factors
The following factors are associated with an increased risk for developing preeclampsia:
- Personal or family history of preeclampsia;
- First pregnancy;
- Multiple pregnancy (twins or higher) and pregnancy after age 35;
- Assisted reproductive technology (ART) including in vitro fertilization (IVF);
- History of placenta abruption;
- Blood clotting disorders.
The risk for preeclampsia also tends to be higher in people with diabetes, kidney disease, hypertension (high blood pressure), obesity, and lupus.
Can blood pressure be normal with preeclampsia?
Blood pressure is typically elevated with preeclampsia, though not always.
People with gestational hypertension (high blood pressure during pregnancy without other signs or symptoms of preeclampsia) may go on to develop preeclampsia despite appropriate treatment.
Treatment guidelines
Treatment of preeclampsia is done under the supervision of an OBGYN and focuses on controlling blood pressure and preventing complications.
Treatment of preeclampsia may involve the following:
1. Close supervision
Preeclampsia without severe features ("mild" preeclampsia) may be able to be managed outpatient, with regular visits to the hospital or clinic every 2 days to monitor blood pressure and check blood and urine tests.
Ultrasounds are also indicated to monitor fetal growth and placental blood flow.
Medication may also be prescribed to help control blood pressure.
2. Rest
Modified bedrest may be indicated in cases of "mild" preeclampsia (preeclampsia without severe features) to help lower blood pressure. This includes lying on the left side to help promote blood flow to the uterus and kidneys and avoiding any strenuous activities.
Guidelines for modified bedrest will be determined by your doctor, as complete bedrest can increase the risk for blood clots and deep vein thrombosis (DVT).
3. Diet changes
Outpatient management of preeclampsia may involve decreasing salt intake and increasing fluids to around 2 to 3 liters of water per day.
This may help lower blood pressure and prevent worsening complications of preeclampsia.
4. Medication
Medications used to help manage preeclampsia include oral antihypertensives (blood pressure medications) like nifedipine, clonidine, and hydralazine in the case of "mild" preeclampsia. IV antihypertensives will be required in the case of "severe" preeclampsia.
5. Admission to the hospital
Preeclampsia with severe features ("severe" preeclampsia) requires admission to the hospital for monitoring and treatment with IV medications to help lower blood pressure.
Your OBGYN will also order magnesium sulfate to be given IV in order to prevent seizures.
In the case of preeclampsia presenting with seizures (eclampsia), medications like lorazepam, diazepam, or phenytoin may be given through an IV to help control the seizures.
If it looks like the baby will have to be born early, your doctor may also prescribe betamethasone (steroids) to help speed up development of the fetal lungs prior to delivery.
6. Induction of labor
The only definitive treatment for preeclampsia is delivery, which may be done at term in the case of "mild" preeclampsia or preterm in cases of "severe" preeclampsia. This often involves an induction of labor.
A cesarean birth (c-section) may be indicated in certain situations depending on gestational age and other fetal conditions.
Postpartum preeclampsia
Some people may develop preeclampsia for the first time in the postpartum period, most commonly in the first 6 weeks following the birth.
The risk of developing postpartum preeclampsia is higher in people who already had blood pressure problems during pregnancy as well as people over 35 and those with obesity or who had a cesarean birth.
Fetal risks
Preeclampsia can cause fetal growth restriction in addition to an increased risk for stillbirth, premature birth, newborn respiratory distress, and sepsis.
Preeclampsia can also increase the risk of developmental problems in childhood.
Possible complications
Complications of preeclampsia can include:
- Eclampsia and HELLP syndrome;
- Placental abruption;
- Bleeding;
- Acute pulmonary edema;
- Acute kidney injury and liver damage;
- Premature birth.
Other possible complications include severe acute respiratory syndrome, heart attack, and stroke.
These complications can be prevented through routine prenatal care, allowing for early recognition of the disease and prompt initiation of treatment.
People with a history of preeclampsia require close follow up in future pregnancies, and should see their OBGYN or midwife as soon as possible to establish a plan for prenatal care.
Preeclampsia vs eclampsia
Eclampsia is typically considered to be a complication of preeclampsia, involving seizures with no apparent cause.
The risk of eclampsia tends to be higher in twin pregnancies, first pregnancies, and in pregnant people over the age of 35.