Preeclampsia: diagnosis and treatment

KEY POINTS

  • Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. 

  • Your health care provider can diagnose you with preeclampsia by measuring your blood pressure and testing your urine at prenatal visits.  

  • The treatments for preeclampsia depend on how far along you are in pregnancy and how severe it may be.  Treatments can include more regular checkups, stays at the hospital, or having your baby sooner. 

  • Most pregnant women with preeclampsia have healthy babies. But if not treated, it can cause serious problems, like premature birth and even death. 

How is preeclampsia diagnosed?

To diagnose preeclampsia, your health care provider measures your blood pressure and tests your urine for protein at every prenatal visit.

Your provider may check your baby’s health with:

  • Ultrasound.
  • Nonstress test. This test checks your baby’s heart rate.
  • Biophysical profile. This test combines the nonstress test with an ultrasound.

Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

How is mild preeclampsia treated?

Most women with mild preeclampsia after 37 weeks of pregnancy don’t have serious health problems. If you have mild preeclampsia before 37 weeks:

  • Your provider checks your blood pressure and urine regularly. She may want you to stay in the hospital to monitor you closely. If you’re not in the hospital, your provider may want you to have checkups once or twice a week. She also may ask you to take your blood pressure at home.
  • Your provider may ask you to do kick counts to track how often your baby moves. There are two ways to do kick counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell your provider.
  • If you’re at least 37 weeks pregnant and your condition is stable, your provider may recommend that you have your baby early. This may be safer for you and your baby than staying pregnant. Your provider may give you medicine or break your water (amniotic sac) to make labor start. This is called inducing labor.

How is severe preeclampsia treated?

If you have severe preeclampsia, you most likely stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids (also called ACS). These medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure and medicine to prevent seizures (called magnesium sulfate).

If your condition gets worse, it may be safer for you and your baby to give birth early. Most babies of moms with severe preeclampsia before 34 weeks of pregnancy do better in the hospital than by staying in the womb. If you’re at least 34 weeks pregnant, your provider may recommend that you have your baby as soon as your condition is stable. Your provider may induce your labor, or you may have a cesarean birth (also called c-section). If you’re not yet 34 weeks pregnant but you and your baby are stable, you may be able to wait to have your baby.

If you have severe preeclampsia and HELLP syndrome, you almost always need to give birth early. HELLP syndrome is a rare but life-threatening liver disorder. About 2 in 10 women (20 percent) with severe preeclampsia develop HELLP syndrome. You may need medicine to control your blood pressure and prevent seizures. Some women may need blood transfusions.

If you have preeclampsia, can you have a vaginal birth?

Yes. If you have preeclampsia, a vaginal birth may be better than a c-section. With vaginal birth, there's no stress from surgery. For most women with preeclampsia, it’s safe have an epidural to manage labor pain as long as your blood clots normally.  

How can preeclampsia affect you and your baby?

Without treatment, preeclampsia can cause serious health problems for you and your baby, even death. You may have preeclampsia and not know it, so be sure to go to all your prenatal care checkups, even if you’re feeling fine. If you have any sign or symptom of preeclampsia, tell your provider.

Health problems for women who have preeclampsia include:

  • Kidney, liver and brain damage
  • Problems with how your blood clots. Your body normally makes blood clots to stop bleeding after a scrape or cut. Problems with blood clots can cause serious bleeding problems.
  • Eclampsia. This is a rare and life-threatening condition. It’s when a pregnant woman has seizures or a coma after preeclampsia.
  • Stroke. This is when the blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open.

Pregnancy complications from preeclampsia include:

  • Premature birth
  • Placental abruption. This is when the placenta separates from the wall of the uterus (womb) before birth. It can separate partially or completely. If you have placental abruption, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy.  
  • Intrauterine growth restriction (also called IUGR). This is when a baby has poor growth in the womb. It can happen when mom has high blood pressure that narrows the blood vessels in the uterus and placenta. The placenta grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby doesn’t get enough oxygen and nutrients in the womb, he may have IUGR.
  • Low birthweight

Having preeclampsia increases your risk for postpartum hemorrhage (also called PPH). PPH is heavy bleeding after giving birth. It’s a rare condition, but if not treated, it can lead to shock and death. Having preeclampsia increases your risk for heart disease, diabetes and kidney disease later in life.

 

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