Preeclampsia and Your Pregnancy
Preeclampsia is a complication of pregnancy that happens when high blood pressure is combined with kidney or liver or blood clotting problems. It can happen any time after 22 weeks, but generally occurs around the due date and onset of labor. Toxemia and PIH are old names for preeclampsia. Preeclampsia affects pregnant mothers directly, and babies indirectly.
- Preeclampsia can include HELLP Syndrome; severe liver or blood count problems (H- hemolysis: breakdown of red blood cells, EL- elevated liver enzymes: liver function, LP- low platelets counts: platelets help the blood clot).
- Preeclampsia may progress to eclampsia; seizures of pregnancy.
Preeclampsia is either “mild” or “severe,” based on how high the blood pressure gets, how low the platelet blood count goes, and a number of other diagnostic criteria. Pregnancies with severe preeclampsia and HELLP Syndrome are usually treated with anti-seizure medicine and delivery. Pregnancies with mild preeclampsia are closely monitored to detect progression to severe preeclampsia AND delivery is usually indicated after 37 weeks. Bed rest is commonly prescribed in the treatment of mild preeclampsia, even though it has NOT shown to improve mom’s or baby’s outcomes.
The cure for all presentations of preeclampsia is delivery. Most women will delivery vaginally after induction of labor, though cesarean section may still be done for regular pregnancy reasons. Women are more likely to deliver by cesarean section in a first pregnancy with induction before 35 weeks.
What We Watch
- Platelet Count: Blood platelets make bleeding stop so a low platelet count can make epidural anesthesia unsafe. We can give platelet blood transfusion to treat super-low platelet counts.
- Kidney Function: To measure kidney function a catheter is placed in the bladder. A low urine output level can be a sign of more serious trouble.
- Blood Pressure: We treat high blood pressure with medication, to prevent more direct heart, kidney, and brain damage to the pregnant mother. High blood pressure can also cause the placenta to separate from the uterus before delivery of the baby which is called placental abruption; this can become a surgical emergency for both the mother and baby…[read more]
- Liver Function: The liver can swell, causing damage to liver cells and an increase in liver enzymes in the blood. In rare cases the liver can rupture, causing massive internal bleeding.
- Fetal Well Being: The placenta may not function well as a result of the high blood pressure. We will monitor the baby’s heartbeat for any signs of fetal distress.
- Labor Progress: Labor induction can be a slow process. We need to consider the benefits of vaginal delivery as well as the potential for the preeclampsia to get worse, which can happen without warning.
What We Do
- Prevent Seizures. Eclampsia, the pregnancy seizure, is prevented with intravenous Magnesium Sulfate (MgSO4). MgSO4 is proven more effective than other anti-seizure medication. [MgSO4 feels like an invisible lead blanket, with nausea and blurred vision. MgSO4 is excreted by the kidney and its effects are rapidly reversible with intravenous calcium, in the event of overdose.]
- Corticosteroids can help keep the blood counts and liver cells protected.
- Treat Blood Pressure to prevent direct heart, kidney, brain damage to the mother.
- Platelet Transfusion to prevent spontaneous bleeding… which is RARE but serious.
- Ventilator. Fluid can collect in the mother’s lungs making it difficult to get oxygen into the bloodstream, in the event a ventilator may be used.
- Cesarean Delivery could be necessary if we can not keep the mother and baby safe during labor…[read more]
After delivery the blood pressure, kidney function, liver function, and blood counts normalize. Medical care will make sure all the numbers are kept in the safe zone while the preeclampsia wears off. We will continue the anti-seizure medication for 24 hours, or until the mother’s organs begin to function properly again.
What About the Next Pregnancy?
What is your chance of Getting HELLP syndrome or preeclampsia AGAIN in the next pregnancy? The answer is based on a woman’s medical history, some blood tests done when she is NOT pregnant and the details of what happened in the previous pregnancy…[read more]