Pre-eclampsia and Eclampsia
What is pre-eclampsia and eclampsia?
Pre-eclampsia (pre-e-KLAMP-se-ah) and eclampsia (e-KLAMP-se-ah) are conditions of hypertension (high blood pressure) and proteinuria (protein in urine) during pregnancy. Pre-eclampsia usually occurs after the 20th week of pregnancy. Pre-eclampsia may be mild or severe, or in addition to an already present hypertension. Eclampsia is the presence of seizures (convulsions) in addition to the other problems of pre-eclampsia. It is a more severe condition that may happen if pre-eclampsia is not controlled. Both of these conditions may affect many organs in the body, including the liver, brain, lungs, and kidneys.
What causes pre-eclampsia and eclampsia?
Caregivers do not exactly know what causes pre-eclampsia and eclampsia. They think pre-eclampsia may be caused by factors that lead to blood vessel damage and decreased blood flow. This may happen if the placenta does not form a normal system of arteries (blood vessels). The placenta is the tissue connecting you and your baby in the womb. Some chemicals in the mother's body may also cause changes in the mother's arteries that supply the placenta. Some caregivers also believe that pre-eclampsia has something to do with the mother's immune system. The immune system is the body system that fights infection. This immune system is thought to cause a rejection reaction to the fetus (baby). Still others believe that genetics may make a woman more likely to have pre-eclampsia.
Who is at risk of having pre-eclampsia or eclampsia?
Any of the following factors may increase your risk of having pre-eclampsia or eclampsia:
Age younger than 20 years or older than 40 years during the pregnancy.
Being pregnant for the first time, or having 10 or more years pass since your last pregnancy. You may also be at risk if you are pregnant with a new partner. Your new partner may have already fathered a pre-eclamptic first pregnancy in another woman.
Having a close family member who had pre-eclampsia or eclampsia, such as a mother or sister.
Having a history of increased blood pressure, pre-eclampsia, or eclampsia in a previous pregnancy.
Having a weight more than what your caregiver advised before and during pregnancy.
Having a multiple pregnancy, such as twins and triplets.
Having other health problems, such as chronic hypertension, diabetes (high blood sugar), or kidney disease.
What are the signs and symptoms of pre-eclampsia and eclampsia?
Aside from high blood pressure, proteinuria, or seizures, you may also have any of the following:
Bad headache that does not go away, nausea (upset stomach), or vomiting (throwing up).
Blurred or double vision (eyesight), seeing flashes of light or floating spots, or being easily bothered by a bright light.
Confusion (cannot think clearly), anxiety, or behaving, acting, or talking differently than normal.
Sudden pain in the abdomen (stomach) or on your right side just below the ribs.
Sudden swelling of the face, hands, or feet.
Passing only a little amount of urine, such as less than 500 mL (milliliters) per day.
Weight gain of more than two pounds in one week, or more than your caregiver has suggested during your pregnancy.
How are pre-eclampsia and eclampsia diagnosed?
You may need different tests to help caregivers diagnose pre-eclampsia or eclampsia. If seizures happen, tests may be done to rule out other possible causes. You may have any of the following tests:
Blood pressure measurement:
This is done while you are seated, with your arm at the level of the heart. Caregivers measure your blood pressure (BP) by wrapping an inflatable cuff snugly around your arm. The cuff is attached to a BP device that tells you your blood pressure reading. At least two blood pressure readings of 140/90 mmHg (millimeters of mercury) or above are needed to diagnose hypertension. These two readings should be measured at least 4 to 6 hours apart.
Blood tests:
Blood tests are needed to look for bleeding and liver problems.
Urine tests:
Your urine may need to be checked to see how much protein is in your urine. It can give your caregivers more information about your health condition. Two urine samples, at least 4 to 6 hours apart, may be taken to make sure of the result. All of the urine that you pass for one day may also be collected.
Other tests:
These tests may be used to rule out other diseases that may cause seizures. They may also be done to monitor the condition of both the mother and the baby.
Brain imaging tests:
A computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be done to take pictures of your brain. An electroencephalogram (EEG) may show tracing of brain wave activity from different parts of your brain.
Fetal biophysical profile:
A fetal biophysical profile is a test that combines the nonstress test and a special ultrasound of your unborn baby. The nonstress test measures changes in your baby's heartbeat during movement. The ultrasound will show your baby's movement, how his muscles are working, and the amount of fluid around him. It will also show if your baby's breathing muscles are working.
Lumbar puncture:
This procedure may also be called a spinal tap. During a lumbar puncture, you will need to lie very still. Caregivers may give you medicine to make you lose feeling in a small area of your back. Caregivers will clean this area of your back. A needle will be put in, and fluid removed from around your spinal cord. The fluid will be sent to a lab for tests. The tests check for infection, bleeding around your brain and spinal cord, or other problems. Sometimes medicine may be put into your back to treat your illness.
Nonstress test (NST):
This test is a simple way for your caregiver to check how your baby is doing. It uses a fetal heart monitor to watch your baby's heart rate. A baby's heart rate usually increases when he moves around or when your uterus has a contraction. A contraction is when the muscles of your uterus tighten and loosen. You may sit in a reclining chair or with the head of your bed raised during this test. Your caregiver may ask you to stand up or move around during the test. You may need this test more than once.
Ultrasound:
This test uses sound waves to show pictures inside your uterus. An ultrasound test may help caregivers check for problems in your pregnancy. If the fetus can already be seen, caregivers can learn the age of your baby and see how he is doing. The movement, heart rate, and position of your baby can be seen. Caregivers can see your placenta and if you have more than one baby.
How are pre-eclampsia and eclampsia treated?
Treatment often depends on the severity of your condition and the well-being of your baby. It also depends on how far along your pregnancy is. You may have any of the following:
Bedrest:
Caregivers may want you to limit your activity and may put you on bedrest. This is often advised in mild pre-eclampsia.
Delivery:
Early delivery of the baby may be needed to prevent further problems. Delivery of the baby may be induced if your pregnancy has reached 37 to 40 weeks. You may also be induced if your health is at risk or the baby is not doing well. Vaginal (birth canal) delivery is more preferred than a cesarean section (delivery through a cut in the abdomen). Delivery of the baby is the only cure for pre-eclampsia or eclampsia.
Medicines:
Anticonvulsant medicine:
Anticonvulsants are given to control seizures.
Blood pressure medicine:
This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
Steroids:
Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
With proper treatment, such as rest and medicine, you may have a pregnancy without further problems and deliver a healthy baby.
How can pre-eclampsia or eclampsia affect you and your baby?
You may have any of the following effects:
Bleeding disorders, such as disseminated intravascular coagulation (DIC) or HELLP syndrome. DIC is a disease that causes heavy bleeding because all the clotting factors in the blood have been used up. HELLP syndrome can cause liver failure. HELLP stands for hemolysis (red blood cells burst), elevated liver enzymes (chemicals), and low platelet count.
Development of hypertension later in life, or pre-eclampsia or eclampsia in future pregnancies.
Early separation of the placenta, which may cause bleeding or decreased blood supply to the fetus.
Lung problems.
Kidney failure.
Stroke or blindness.
Your baby may have any of the following effects:
Brain injury caused by a low oxygen supply.
Death.
Limited fetal growth, which may lead to low birth weight.
Preterm delivery (early birth).
How can pre-eclampsia and eclampsia be prevented?
At this time, there are no definite measures to prevent pre-eclampsia or eclampsia. Rest, exercise, diet, and calcium supplements may help. Some medicines may help decrease pre-eclampsia, eclampsia, or other associated problems. It is best to always have regular prenatal check-ups. Ask your caregiver for more information on how to prevent pre-eclampsia or eclampsia.
Where can I find support and more information?
Having pre-eclampsia or eclampsia may be life-changing for you and your family. Accepting that you have pre-eclampsia or eclampsia may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:
The American College of Obstetricians and Gynecologists
409 12th Street, SW
P.O. Box 96920Washington, DC 20090
202-638-5577
http://www.acog.org
