Deal With Pre Eclampsia

Pre-eclampsia is a serious condition in which a pregnant woman develops high blood pressure and signs of damage occurring to other organs. It can be fatal to both the mother and the baby. It usually develops after at least 20 weeks. The only way to stop it is to deliver the baby. If you have signs of pre-eclampsia, get medical help immediately. Your doctor will help you evaluate your options for how to address it.

Steps

Recognizing Pre-eclampsia

  1. Go to the doctor if you have symptoms of pre-eclampsia. If you are unsure whether your symptoms are just discomfort associated with being pregnant or signs of pre-eclampsia, contact your doctor to see if you should get checked. Signs of pre-eclampsia can include:[1][2]
    • Headaches
    • Shortness of breath
    • Blurred vision, loss of vision, light sensitivity or other vision changes
    • Nausea and/or vomiting
    • Abdominal pain on your right side under your ribs
    • A decrease in urination
  2. Seek immediate medical attention for severe symptoms. Pre-eclampsia can range from mild to severe. If you are experiencing severe symptoms, then it is important to seek immediate medical care. Call your doctor or go to an emergency room right away if you notice a sudden increase in your symptoms or if you are having:[1]
    • severe headaches
    • blurry vision
    • intense abdominal pain
    • difficulty breathing or severe shortness of breath
  3. Let the doctor monitor your blood pressure. Most often women with pre-eclampsia experience a sudden spike in their blood pressure, but it can also increase slowly. Not all women who have high blood pressure feel other symptoms. Because of this it is important for your doctor to monitor your blood pressure regularly.[1]
    • Your blood pressure should be below 140/90 mm Hg (millimeters of mercury).
    • If it is higher for more than four hours when you are at rest, this is cause for concern.
  4. Get other tests if the doctor recommends it. The doctor will likely do additional tests to check the health of your other organs and your baby. This may involve:[3]
    • Blood tests. This will enable the doctors to check how well your liver and kidneys are working. The doctors will also likely evaluate whether your blood has the right platelet count so that your blood clots properly.
    • Urine analyses. This will measure whether you have too much protein in your urine. This may involve either a single sample or repeated sampling over 24 hours.
    • An ultrasound. During an ultrasound, the doctor uses sound waves that are higher than we can hear to create an image of the baby in your womb. It does not hurt and is not dangerous for you or the baby. The doctor will be able to see if the baby is developing properly by measuring the baby’s size and the amount of amniotic fluid that surrounds the baby.
    • A nonstress test. During this test the doctor will measure your baby’s heart beat as it moves.
    • A biophysical test. During this test, the doctor may do an ultrasound at the same time as the nonstress test or at a separate time. The biophysical test uses an ultrasound to detect amniotic fluid levels, fetal movement, tone, and breathing.
  5. Ask your doctor about your diagnosis. If you are diagnosed with pre-eclampsia, there are several different combinations of symptoms that may have produced the diagnosis. Your doctor will have detected high blood pressure and at least one of the following symptoms:[3][4]
    • Protein in your urine. The doctor may refer to this as proteinuria.
    • Other signs of kidney malfunction
    • Decreased liver function
    • Not enough platelets in your blood
    • Pulmonary edema. This occurs when your lungs fill with fluid.
    • Vision problems
    • Headaches that are new or different than usual.

Evaluating Your Options

  1. Talk to your doctor about the risks. If you have preeclampsia, this is dangerous for both you and the baby. You are at risk of:[5]
    • Seizures
    • Stroke
    • Severe bleeding
    • Placental abruption
  2. Discuss your baby’s age with your doctor. Babies born before 37 weeks are considered premature. They are at an increased risk of breathing problems and bleeding. If possible, your doctor may try to prolong your pregnancy to get you closer to the 37 week mark. However, if it is necessary to deliver your baby before 37 weeks, your doctor may recommend a steroid injection.[6]
    • A steroid injection to help the lungs develop faster if your baby is born at 34 weeks or younger. However, it may take 24 to 48 hours to give the steroids time to take effect.
  3. Determine if your body is preparing for delivery. If you get pre-eclampsia towards the end of your pregnancy, the doctor may feel that the safest option for you and your baby is to induce pregnancy. The doctor will likely examine your cervix to determine if it is preparing for delivery. If so it will:[5]
    • Start to open. The doctor will refer to this as dilating.
    • Get thinner. The doctor may call this effacing.
    • Soften. The doctor may say that your cervix is ripening.
  4. Go to the hospital for monitoring. The doctor may want you to stay in the hospital to be watched until your delivery. If the baby is not yet mature enough to be born or requires medication to speed up lung development, you may need constant monitoring during this time. The doctor may request:[7]
    • Regular monitoring of your blood pressure to make sure it does not increase further
    • Regular urine analyses to evaluate any changes in the protein levels in your urine
    • Blood tests to check for damage to your kidneys or liver
    • Monitoring the baby’s heart rate for signs of distress
    • Ultrasound checks to evaluate the baby’s growth and activity levels
  5. Understand that bed rest is unlikely to help. Doctors used to tell women to stay in bed, but since then research has shown that it may not be helpful. In addition, it may increase the women’s risk of:[5]
    • Blood clots due to reduced activity levels
    • Financial difficulties due to being unable to work
    • Disruption of her social life and social support

Planning a Course of Action

  1. Talk to your doctor about inducing delivery if you are at 37 weeks. Labor will need to be induced in a pre-eclampsia pregnancy past 37 weeks of gestation. At this point your baby should be fully developed and ready to live outside the womb. Delivering at this time should alleviate the pre-eclampsia and may prevent other complications. If the doctor induces delivery, he or she may:[7]
    • Do a membrane sweep. During this procedure the doctor uses a finger to separate the amniotic sac from the cervix. It will stimulate your body to release hormones which may start labor. It may be a little uncomfortable or cause some bleeding.
    • Insert a medication into your vagina. This may be in the form of a tablet or gel. This will help your cervix to soften. It may take up to 24 hours for labor to start. If this does not work you may be given another dose or an intravenous hormone drip.
    • Administer anticonvulsant medications during labor if necessary. For example, if you have severe pre-eclampsia, then you may receive magnesium sulfate during labor to help prevent seizures.[5] However, magnesium sulfate is not necessary if your pre-eclampsia is mild.
  2. Have a Cesarean delivery if necessary. If your symptoms are very severe, it may be necessary for you to have an emergency C-section (Cesarean delivery). This procedure requires that the doctor make an incision through your abdomen wall and into the uterus so that they baby can be removed from the uterus without being delivered vaginally.[5]
    • This would be done if it is too dangerous for you or the baby to continue the pregnancy.
    • If necessary, the doctors may give you magnesium sulfate to keep you from having seizures during the procedure.
  3. Prolong the pregnancy with medications if necessary. Medications would combat the symptoms and may enable the pregnancy to continue for a bit longer. This would give the baby more time to mature in the womb. If you do take medications, talk to your doctor about whether they may cause harm to your baby. Possible medications include:[5][7]
    • Blood pressure medications. If your blood pressure is borderline, 140/90 m Hg, you may not be prescribed medications. But if it is dangerous or you or the baby, the doctor may feel it is necessary to control your blood pressure and reduce your risk of a stroke. The medication labetalol is licensed to be used in women with high blood pressure. Other medications that are not licensed for pregnant women but sometimes prescribed include nifedipine or methyldopa. If you have been prescribed either of these, be sure to discuss the risks to you and your baby with your doctor.
    • Corticosteroids. These medications can be used to stimulate lung maturation in your baby in 1-2 days. This may be necessary if your baby will have to be born premature. In addition, these medications may be used to reduce symptoms due to problems with your liver or platelets.
    • Anticonvulsant medications. These medications would be prescribed if your risk of having a seizure is high or if you have already had seizures.

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Sources and Citations

  1. ↑ Jump up to: 1.0 1.1 1.2 http://www.mayoclinic.org/diseases-conditions/preeclampsia/basics/symptoms/con-20031644
  2. Jump up ↑ https://www.nlm.nih.gov/medlineplus/ency/article/000898.htm
  3. ↑ Jump up to: 3.0 3.1 http://www.mayoclinic.org/diseases-conditions/preeclampsia/basics/tests-diagnosis/con-20031644
  4. Jump up ↑ <https://www.nlm.nih.gov/medlineplus/ency/article/000898.htm
  5. ↑ Jump up to: 5.0 5.1 5.2 5.3 5.4 5.5 http://www.mayoclinic.org/diseases-conditions/preeclampsia/basics/treatment/con-20031644
  6. Jump up ↑ http://www.nhs.uk/conditions/pregnancy-and-baby/pages/premature-early-labour.aspx
  7. ↑ Jump up to: 7.0 7.1 7.2 http://www.nhs.uk/Conditions/Pre-eclampsia/Pages/Treatment.aspx
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