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) and up to six weeks postpartum (after delivery), though in rare cases it can occur earlier than 20 weeks. Proper prenatal care is essential to diagnose and manage preeclampsia. Pregnancy Induced Hypertension (PIH) and toxemia are outdated terms for preeclampsia. HELLP syndrome and eclampsia (seizures) are other variants of preeclampsia.
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.
INDICATORS OF PRE-ECLAMPSIA
- High blood pressure (Hypertension)
High blood pressure during pregnancy is one of the biggest red flags that preeclampsia may be developing. And even if it’s not a symptom of preeclampsia, it can still be a sign of a problem.
High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for.
- Protein in your urine (Proteinuria)
Proteinuria, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into your urine. This is because preeclampsia temporarily damages this “filter.” A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria, though more sophisticated equipment that can be set up in clinics and medical offices may be used in the future.
Dark yellow urine is usually the result of low fluid intake and may be associated with dehydration. However, urine that looks dark, reddish or the color of cola may indicate a problem. If you observe this, contact your health care provider.
- Swelling (Oedema)
A certain amount of swelling is normal during pregnancy. Unless you’re one of a lucky few, you may notice a little extra puffiness in your feet . Oedema, on the other hand, is the accumulation of excess fluid, and can be a concern when it occurs in your face, around your eyes, or in your hands. If you think your face is getting excessively puffy, find a picture of yourself from just before pregnancy to share with your healthcare provider. If the swelling in your hands and feet becomes severe, you may notice “pitting oedema” (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs. If you suspect this kind of oedema, notify your healthcare provider. You should also put your feet up every day, but avoid sitting for extended periods of time.
Dull or severe, throbbing headaches, often described as migraine-like that just won’t go away are cause for concern.
- Nausea or Vomiting
Nausea or vomiting is particularly significant when the onset is sudden and after mid-pregnancy. “Morning sickness” should disappear after the first trimester and the sudden appearance of nausea and vomiting after mid pregnancy may be linked to preeclampsia. Call your care provider. Nausea or vomiting can be confused with the flu or gallbladder problems, so insist on getting your blood pressure checked and checking your urine for proteinuria.
- Abdominal (stomach area) and/or Shoulder Pain
This type of abdominal pain, often called epigastric pain or upper right quadrant (URQ) pain, is usually under the ribs on the right side. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Shoulder pain is often called “referred pain” because it radiates from the liver under the right ribs. Lower back pain is different from muscle strain common to pregnancy, because it is usually more acute and specific. Shoulder pain can feel like someone is deeply pinching you along the bra strap or on your neck, or it can be painful to lie on your right side. All of these pain symptoms may be a sign of HELLP Syndrome or a related problem in the liver. 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 of preeclampsia. 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.
- Sudden Weight Gain
Weight gain of more than 2 pounds in a week may be an indicator of preeclampsia. Damaged blood vessels allow more water to leak into and stay in your body’s tissue and not to pass through the kidneys to be excreted.
Do not try to lose weight during pregnancy by restricting your diet. Eating a healthy, balanced diet, including fresh raw fruit and vegetables, your prenatal vitamin, and a folic acid supplement is important for all pregnancies. Avoid excessive salt. Prior to getting pregnant, achieve a healthy weight (a BMI of 30 or less) since obesity has been shown to increase the chances of getting preeclampsia.
- Changes in Vision
Vision changes are one of the most serious symptoms of preeclampsia. They may be associated with central nervous system irritation or be an indication of swelling of the brain (cerebral oedema).
Common vision changes include sensations of flashing lights, auras, light sensitivity, or blurry vision or spots.
If you experience any of these changes in vision, you should contact your healthcare provider immediately or go directly to the hospital. These symptoms are very serious and should not be left unattended, even until the next morning.
Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber “hammer”, your leg bounces back hard. This sign is generally measured by a health care provider and otherwise difficult for you to observe yourself.
- Shortness of breath, anxiety
Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema).
Contact your healthcare provider immediately if these symptoms are new. If you’ve experienced these conditions before pregnancy, be sure to mention them to your care provider during your next visit so they can be monitored throughout your pregnancy.
During pregnancy, it’s important to listen to your gut. If something doesn’t feel right, trust your instincts and call your healthcare provider. Never be afraid to call and discuss anything unusual. A good healthcare provider will never be too busy to address your concerns.
Please find below link to additional resources available at HealthTalk.org website, a vignette that a couple of INHA families have participated in http://healthtalk.org/pre-eclampsia