Pregnancy Induced Hypertension or Metabolic Toxemia

Preeclampsia Signs


- Sudden Weight Gain
- Edema or Fluid Retention
- Hypertension
- Nausea in Third Trimester



What Is Preeclampsia?
When Does It Occur During Pregnancy?
When Does It Occur After Delivery?
What Are The Symptoms?
What Is The Treatment?
Severe Preeclampsia
What Causes It?
What Are The Risk Factors?
Can It Be Prevented?

What Else Can Go Wrong
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List Of Pregnancy Complications

What Is Preeclampsia? - Definition

Also called metabolic toxemia of late pregnancy, pregnancy induced hypertension and PIH. Preeclampsia is a set of conditions which can develop in the third trimester of pregnancy, and if not treated can lead to eclampsia and possibly maternal death. Where a combination of hypertension (high blood pressure), edema (fluid retention) and proteinuria (protein in the urine) suddenly appear together, this is known as preeclampsia. This condition should be reported instantly, as the progression from preeclampsia to eclampsia can happen within hours. According to the American Preeclampsia Foundation thousands of women and babies die or become very sick with the disorder, which only occurs during pregnancy and in the postpartum period after delivery and childbirth. Additionally recent research seems to indicate that more women actually die from preeclampsia than eclampsia, so one is not necessarily more dangerous than the other.

When Does It Occur During Pregnancy?

Preeclampsia can occur at any time during pregnancy, and up to 6 weeks after delivery. Typically preeclampsia is more likely to appear in the third trimester and suddenly clears within 48 hours of childbirth. Preeclampsia can gradually develop, or appear suddenly out of the blue (probably because symptoms have gone undetected for weeks or months). To read about the link to high blood pressure, see our article on hypertension during pregnancy. Also, see our prenatal care guide, for the do's and don'ts, and tips on staying well.

When Does It Occur After Delivery?

In some cases preeclampsia does not occur until the final stages of labor, or in the 48 hour period after delivery. However, it has also been known to occur in the 6 week postpartum period after childbirth. In fact 80 percent of maternal deaths attributed to preeclampsia happen in the postpartum period. Reasons for this may be symptoms being attributed to other causes such as postpartum depression, sleep deprivation, or simply just unfamiliarity with how the body should react after childbirth. If you experience any of the symptoms of preeclampsia, contact your doctor immediately.

What Are The Symptoms?

Since some symptoms of preeclampsia are also just regular side effects of normal pregnancy, such as nausea, headache and weight gain, specific standards have been established. In true preeclampsia, hypertension must be present, in addition to either (or both) edema and proteinuria. Unfortunately, key elements of the diagnosis (hypertension & proteinuria) are not always apparent to the patient. For this reason, pregnant women should familiarize themselves with the group of symptoms and watch for signs, as well as discuss it with their pregnancy healthcare team.

Hypertension: defined 2 or more blood pressure readings of 140/90 mm Hg. High blood pressure is called a 'silent killer' for good reason. Women who suffer from hypertension may not notice any symptoms, which is why it is important to have your blood pressure checked regularly during your prenatal visits, particularly in the third trimester prenatal visit. Occasionally symptoms do manifest themselves in headaches, shortness of breath, dizziness, confusion and blurred vision. See also, will pregnancy raise my blood pressure?

Proteinuria: excess protein in the urine. A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria. Traces of protein are not usually a concern, but an increase of 1+ or greater may indicate a problem. If you are concerned for any reason between prenatal visits, you can always buy reagent strips online or in most pharmacies (Hemastix and Multistix are popular brands) and monitor your levels at home. Visually, urine that looks dark or reddish like Coca Cola may indicate a problem. Dark yellow urine is normally just an indication of dehydration, so you should drink more fluids.

Edema (Swelling): Defined as general fluid accumulation in the tissues, not just swelling of the feet or ankles which is regular part of pregnancy. Edema is often accompanied by sudden weight gain (at least 2.2 pounds/1 kilo per week), swelling of the face, eyes or hands.

Nausea/Vomiting: Morning sickness is one of the most common pregnancy symptoms, and usually subsides by the second trimester. If there is a sudden appearance of nausea or vomiting in the late second or third trimester, this could be an indication of preeclampsia.

Abdominal and/or Shoulder Pain: Also called upper right quadrant (URQ) pain or epigastric pain. It feels like it is radiating from the liver to the ribs on the right side of the body, and the shoulder pain can feel like someone is pinching you along the neck or bra strap line. It can also be painful to lie on the right side. If you experience either of these pains, contact your doctor immediately, they should be taken very seriously.

Lower Back Pain: Back pain while pregnant, particularly towards the last trimester is very common and quite harmless, if just uncomfortable. If it occurs with any of the above symptoms however, there is cause for concern.

Headaches: Again, another common complaint of pregnancy. This headache however may feel like a constant dull ache, similar to a migraine.

What Is The Treatment?

Preeclampsia is a cluster of conditions, which scientists are not completely clear on how to treat. Once symptoms appear complete bed rest at home or hospital (in severe cases) is advised, with the patient lying on her left side. Blood pressure, urine and weight will be monitored continuously. A protein rich diet is followed. If hypertension remains, small amounts of drugs will be used to reduce blood pressure. If this does not work, anticonvulsant drugs and strong sedation medications will be prescribed, the principle medication being magnesium sulfate. Many doctors will also treat preeclamptic patients with magnesium sulfate during labor. Ultimately the best 'cure' for preeclampsia is childbirth - as symptoms usually disappear within 48 hours of the baby’s birth. If high blood pressure persists, beta blockers may be prescribed until pressure finally returns to normal.

What Is Severe Preeclampsia?

Severe preeclampsia is as it sounds - the symptoms are more severe than in first stage preeclampsia. Blood pressure is higher, there is more protein in the urine, and it may be combined with pulmonary edema or cerebral/visual blurring. The only treatment for severe preeclampsia is termination of pregnancy. Usually it means the baby will be premature, and there may be a temptation to delay things until the baby’s chance of survival in the outside world is stronger. Doing this will put the mother's own life at risk.

What Causes Preeclampsia?

The true cause of preeclampsia is still not known, nor why is should occur in 5 to 8 percent of all pregnancies. There are numerous theories, but it is generally agreed that the placenta plays a key role, and that there are certain maternal risk factors such as a history of chronic high blood pressure and diabetes. Research shows that women who do develop preeclampsia are more likely to develop cardiovascular problems later in life. It is not clear whether preeclampsia predisposes women to cardiovascular problems, or whether those at risk of cardiovascular problems are more predisposed to preeclampsia. See Heart disease in women.

What Are The Risk Factors?

Although a certain percentage of women who develop preeclampsia may not fall into any risk category, the following is a list of conditions which increases a woman’s risk of developing preeclampsia:

1. The most obvious, a history of preeclampsia in previous pregnancies.
2. Multiple pregnancy, expecting more than one baby.
3. A history of chronic high blood pressure, kidney disease, diabetes or organ transplant.
4. Obesity, particularly in women with a Body Mass Index (BMI) over 30.
5. Women with a history of Polycystic Ovary Syndrome, Lupus, Rheumatoid Arthritis, or Sickle Cell Disease.
6. Women with a family history of preeclampsia or placental abruption.
7. Women who have undergone In Vitro Fertilization treatment (IVF).

Can It Be Prevented?

Preeclampsia probably cannot be wholly prevented but early detection can prevent it from developing into severe preeclampsia or eclampsia. For this reason, prenatal checkups are very important, particularly in the last trimester. Ensure that your blood pressure, weight and urine are frequently monitored. Preparing for pregnancy, at least 3 months before conception may also help.

2011 Research: Probiotics Reduce The Risk of Preeclampsia

According to a study carried out by the Institute of Public Health in Norway, pregnant women who drink milk and eat yogurt regularly are less likely to suffer pregnancy complications like preeclampsia. The study examined 33,000 women over a 6 year period and discovered that women who consumed probiotic products had a 20 percent lower incidence of preeclampsia. Researchers are not sure why this should be the case, they speculate that it may be because probiotics improve digestion and have an effect on the immune system preventing wide-spread inflammation. More research is still required. As doctors still do not know how to prevent preeclampsia, researchers say, the best thing a pregnant woman can still do is to have regular prenatal visits.

Other Complications

Bleeding During Pregnancy
HELLP Syndrome
Intrauterine Growth Restriction
Premature Labor

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