Preeclampsia and eclampsia are two pregnancy complications that require the help of a maternal fetal medicine specialist. Both require specialized care to ensure you have a healthy and successful pregnancy. Preeclampsia and eclampsia can be dangerous or even fatal, but the vast majority of cases in the United States are effectively managed and most patients do not have serious consequences. Still, you can experience illness and symptoms during pregnancy with preeclampsia and eclampsia, so here’s what to know about them.
What is Preeclampsia?
Preeclampsia is a condition that is specific to pregnancy and is diagnosed when a pregnant woman has high blood pressure and other clinical signs after 20 weeks of gestation. Although high blood pressure before pregnancy is one risk factor for preeclampsia, most women who develop preeclampsia never had high blood pressure and may have had low blood pressure before pregnancy. Other symptoms of preeclampsia include kidney problems, liver problems, headaches, changes in vision, shortness of breath, nausea and vomiting, or pain in the upper belly, often on the right side.
How is Preeclampsia Diagnosed?
New guidelines set forth by the American College of Obstetricians and Gynecologists recommend that high levels of protein in urine or “proteinuria” are not required to diagnose preeclampsia. Maternal fetal medicine specialists routinely screen for preeclampsia through blood pressure tests and urine tests that are done in the office. However, preeclampsia can also be diagnosed if a woman has high blood pressure with laboratory abnormalities such as decreased blood platelets, or abnormalities in liver or kidney tests. Preeclampsia can also be diagnosed when there are complications with the liver or kidneys, fluid in the lungs, headaches, seizures, or visual disturbances.
Who’s at Risk for Preeclampsia and Eclampsia?
There’s no known definite cause of preeclampsia and eclampsia, but there are risk factors that identify women who are more likely to experience these complications. These include high blood pressure before pregnancy, obesity, diabetes, multiple gestations (twins), previous pregnancies with preeclampsia, certain autoimmune conditions, kidney disease, heredity, ethnicity, being older than 35 or younger than 20, first pregnancies, and IVF pregnancies.
Although the rate of death from preeclampsia and eclampsia is very low, it’s one of the leading causes of illness for mothers and newborns, meaning it’s important to partner with a maternal fetal medicine specialist who can discuss your best care options. Patients who have or who are at risk for developing preeclampsia require frequent blood pressure monitoring to monitor any progression of this disorder.
Prevention of Preeclampsia and Eclampsia
A maternal fetal medicine specialist may recommend low-dose aspirin or other treatments to decrease the chance of a woman with risk factors for preeclampsia developing this condition. Before you become pregnant, you should also try to take steps to become as healthy as possible. Speak with your doctor regarding the management of any conditions that may increase your risk of preeclampsia. These treatments are most effective if started earlier in pregnancy before there are any signs of preeclampsia.
Preeclampsia Symptoms & Outcomes
The symptoms associated with preeclampsia are upper abdominal pain, headaches, swelling, trouble breathing, nausea, confusion, visual disturbances, and increased anxiety. Many patients will not have any symptoms, and not everyone who has these symptoms has preeclampsia. Preeclampsia impacts 5% to 8% of all births in the U.S. every year. Fortunately, most women who suffer from preeclampsia deliver healthy babies and fully recover from this condition. However, there are some cases where women experience complications that may be life-threatening to both the mother and baby.
Anyone who experiences headaches during pregnancy should contact their doctor or maternal fetal medicine specialist right away, as this is a common symptom of preeclampsia.
How Can Preeclampsia Affect a Mother and Her Baby?
Even if you don’t feel any symptoms, preeclampsia can cause serious health problems for both a mother and her child. This is part of why prenatal care, regular checkups, and an expert team of obstetricians is key to delivering a healthy, happy baby, and ensuring the health of the mother is protected throughout pregnancy and after birth. Complications that can arise in a pregnant woman due to preeclampsia include:
- Kidney or liver damage
- Excessive bleeding, including during delivery
People who have preeclampsia may have trouble with blood clotting, which can lead to a few different outcomes. If your blood clots too easily, you are at a higher risk for stroke, heart attack, and other conditions. On the other hand, if your blood loses some of its ability to clot, it can be especially dangerous during childbirth. The body relies on blood clotting to stop excess bleeding during childbirth, and if that ability is weakened, the pregnancy becomes higher risk.
Complications of preeclampsia that affect the development and birth of the baby include:
- Premature birth (15% of US premature births are due to preeclampsia)
- Placental abruption, when the placenta separates from the wall of the uterus (this can lead to stillbirth)
- Fetal growth restriction
- Low birthweight
All of these complications can lead to further health concerns and risks both during and after pregnancy. However, it’s important to remember that close follow up with an MFM can assure the best pregnancy outcome
How is Preeclampsia Treated?
Gestational age, the health of the baby, and overall health and age of the mother determine how a maternal fetal medicine specialist manages preeclampsia. Precise and continued assessment is necessary to evaluate if the disease is progressing. Patients with preeclampsia require more doctor’s visits and ultrasounds to ensure that the mother and baby are safe. Because preeclampsia is a disease of the placenta, continued ultrasouund monitoring is essential to track the growth of the fetus and the function of the placenta. It’s not uncommon for patients to also need evaluation at the hospital, or be admitted for around-the-clock care. Although some treatment measures include medications to help control the mother’s blood pressure, this does not prevent the progression of preeclampsia.
Ultimately, the treatment for preeclampsia is delivering the baby. In most cases, doctors will deliver the baby at around 37 weeks or at the time of diagnosis if after 37 weeks. However, sometimes babies need to be delivered earlier.
Serious Variants of Preeclampsia
If left untreated and unmonitored, preeclampsia can progress into more serious conditions that put the mother and baby at risk for serious complications or even death. These include HELLP syndrome and Eclampsia.
HELLP stands for Hemolysis Elevated Liver Enzymes and Low Platelet Count. It’s a three-part condition that includes the breakdown of red blood cells, high liver enzymes that signal damage to the liver, and low platelet levels, which prevents the blood from clotting like usual. Most cases occur in the third trimester, but HELLP can occur earlier in pregnancy or after giving birth.
Common symptoms of HELLP syndrome are similar to preeclampsia, and include:
- Abdominal or chest pain
- Nausea, vomiting, or indigestion
- Shoulder pain or pain when breathing deeply
- Headache that will not go away
- Swelling of the face or hands
- Changes in vision
- Shortness of breath
In addition to blood clotting problems, HELLP can cause kidney damage or failure, liver hemorrhage or failure, and fluid buildup in the lungs. This condition is treated with magnesium to prevent seizures and usually requires giving birth as soon as possible, even prematurely. If this syndrome is diagnosed early and the baby is delivered, the mother will generally have better outcomes.
What is Eclampsia?
Eclampsia is a serious complication of preeclampsia, characterized by seizures during or shortly after pregnancy. Eclampsia is a rare condition, affecting 1 in every 300 women, but it is also treatable with proper medical intervention. If left untreated, eclamptic seizures could brain damage or the death of the either the mother, baby, or both.
Preeclampsia, by original definition, was the disorder preceding eclampsia. However, eclamptic seizures are only one of many potential complications of preeclampsia.
How is Eclampsia Diagnosed?
Eclampsia is diagnosed when a woman who has preeclampsia has a seizure, or when a patient has a seizure and is then noted to have evidence of preeclampsia such as high blood pressure. This means that many of the same factors that contribute to a preeclampsia diagnosis also contribute to eclampsia.
Who is at Risk for Eclampsia?
Patients who have or have had preeclampsia may be at risk for eclampsia. There are also other risk factors for developing eclampsia including gestational or chronic hypertension, being older than 35 years old or younger than 20 years old, first-time pregnancy or a pregnancy with twins or triplets, kidney disease, diabetes, or other conditions that affect the blood vessels.
Eclampsia Symptoms & Outcomes
Because preeclampsia can lead to eclampsia, women may experience both conditions. Seizures that occur with eclampsia are usually generalized seizures, meaning the woman loses consciousness and experiences jerking movements and incontinence.
How is Eclampsia Diagnosed?
For women with a seizure who already have been diagnosed with preeclampsia or have a history of it, management includes checking blood pressure frequently. Your doctor will order tests of your liver and kidneys. For patients who do not have signs of preeclampsia, your doctor will consult with a neurologist and will order other tests including an MRI to find other reasons for seizures.
How is Eclampsia Treated?
To prevent eclampsia, magnesium sulfate is given intravenously to patients with severe preeclampsia. Magnesium is also given to patients with eclampsia to prevent more seizures. This treatment should only be performed in the hospital under close supervision of a general obstetrician since overdoses can occur.
Delivering your baby and placenta are also recommended to treat preeclampsia and eclampsia. Your doctor will consider many factors including the severity of the disease and the maturation of your baby before recommending a time for delivery.
It can be easy to worry that you may experience eclampsia if you’ve experienced symptoms of preeclampsia. However, if you find yourself with preeclampsia, you can rest assured that you and your baby will be monitored as carefully as possible for a positive pregnancy outcome.
Can I Get Preeclampsia After Giving Birth?
It is a rare but documented fact that people who have given birth can develop preeclampsia up to six weeks after delivery. The signs and symptoms for post-partum preeclampsia are the same after birth as they are during pregnancy, including nausea, dizziness, trouble breathing, headache, and altered vision. People who experience headache after giving birth should notify their doctor, as headache is a common symptom of post-partum preeclampsia.
There are certain risk factors that can raise a patient’s changes of developing post-partum preeclampsia, including high blood pressure during pregnancy, obesity, a family history of postpartum preeclampsia, age under 20 or over 40, and having twins or multiple babies.
Post-partum preeclampsia is just as serious a condition as preeclampsia during pregnancy, which means it’s vital to contact your medical team whenever you feel abnormal after birth. You may need to be admitted to the hospital, but the prognosis for full recovery is good. If you need medications to treat your blood pressure, you can talk to your doctor about choosing medications safe for breastfeeding.
I Had Preeclampsia in My Pregnancy. What Now?
Having preeclampsia in one pregnancy increases your risk of preeclampsia in future pregnancies. It may also increase your risk of high blood pressure or other medical conditions in the future. It is important to follow up with your doctor postpartum to check your blood pressure and examine your health to ensure that the disease is resolving.
Meet with a maternal fetal medicine doctor to discuss what happened in your pregnancy. They can help you plan for future pregnancies and provide guidance on being your healthiest self.
How to Treat Post-Partum Preeclampsia
Our maternal fetal medicine specialists diagnose post-partum preeclampsia through blood pressure, blood tests, and urine tests. Treatments include magnesium sulfate to help prevent seizures in women with severe signs and symptoms, and medications that lower blood pressure. It is generally considered safe to breastfeed while taking these medications. However, if you have any questions be sure to ask your provider.
By being open and honest with your prenatal care team, you can help ensure that your doctors are aware of and can accurately diagnose any conditions that could cause harm to you or your baby during or after pregnancy.
Schedule an Appointment
The best way to reduce your chances of complications from preeclampsia and eclampsia is by partnering with an award-winning maternal fetal medicine specialist. To schedule a consultation at our New York City office, we invite you to contact us by calling or filling out our online form. For more information regarding preeclampsia and eclampsia or any other service, read our frequently asked questions or visit our blog.
Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!