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Preeclampsis and Eclampsia

Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy. At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant. This problem occurs without other symptoms. 

The causes of preeclampsia and eclampsia are not known. 

Typically, gestational hypertension does not harm the mother or fetus and resolves after delivery. However, about 15% to 25% of women with gestational hypertension will go on to develop preeclampsia.

Preeclampsia is a condition that develops in women with previously normal blood pressure at 20 weeks of pregnancy or greater and includes increased blood pressure (levels greater than 140/90), increased swelling, and protein in the urine. The condition can be serious, and, if it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.

One of the serious complications of hypertensive disorders in pregnancy is HELLP syndrome, when a pregnant woman with preeclampsia or eclampsia sustains damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:

Risks to the Mother

Preeclampsia is mild in 75% of cases. However, a woman can progress from mild to severe preeclampsia or full eclampsia very quickly?even in a matter of days?especially if she is not treated. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant.

Preeclampsia affects the placenta as well as the mother's kidneys, liver, brain, and other organ and blood systems. The condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm delivery, and pregnancy loss. In some cases, preeclampsia can lead to organ failure or stroke. In severe cases, preeclampsia can develop into eclampsia, which can lead to seizures. 

Risks After Pregnancy

In uncomplicated preeclampsia, the mother's high blood pressure and increased protein in the urine usually resolve within 6 weeks of the infant's birth. Studies, however, have shown that women who have had preeclampsia are four times more likely to develop hypertension and twice as likely to develop ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks), a blood clot in a vein, and stroke.

Less commonly, mothers who had preeclampsia during pregnancy could experience permanent damage to their organs. Preeclampsia could lead to kidney and liver damage or fluid in the lungs.

Risks to the Fetus

Preeclampsia affects the flow of blood to the placenta. Risks to the fetus include:

Risk Factors for Preeclampsia

Preeclampsia occurs primarily in first pregnancies. Other factors that can increase a woman's risk include:

Preeclampsia is more common among women who have histories of certain health conditions, such as migraine headaches, diabetes, rheumatoid arthritis, lupus, scleroderma, urinary tract infection, gum disease, polycystic ovary syndrome, multiple sclerosis, gestational diabetes, and sickle cell disease.

Symptoms of Preeclampsia

Possible symptoms of preeclampsia include:

Symptoms of Eclampsia

Women with preeclampsia can develop seizures. The following symptoms are cause for immediate concern:

HELLP Syndrome

HELLP syndrome can lead to serious complications, including liver failure and death.

A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine.

Diagnosing preeclampsia, eclampsia, and HELLP syndrome

A health care provider should check a pregnant woman's blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other abnormalities.

Gestational hypertension is diagnosed if the woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women with normal blood pressure levels before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can develop into preeclampsia.

Mild preeclampsia is diagnosed when a pregnant woman has:

Severe preeclampsia occurs when a pregnant woman has:

Eclampsia occurs when women with preeclampsia develop seizures.

A health care provider may do other tests to assess the health of the mother and fetus, including:

HELLP syndrome is diagnosed when laboratory tests show hemolysis, elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine

Treatment

Treatment of Preeclampsia

The only cure for preeclampsia is delivering the fetus. Treatment decisions need to take into account the severity of the condition and the potential for maternal complications, how far along the pregnancy is, and the potential risks to the fetus. Ideally, the health care provider will minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.

If the fetus is at 37 weeks or later, the health care provider will usually want to deliver it to avoid further complications.

If the fetus is younger than 37 weeks, however, the woman and her health care provider may want to consider other options that give the fetus more time to develop, depending on how severe the condition is. A health care provider may consider the following treatment options:

When a woman has severe preeclampsia, the doctor will probably want to deliver the fetus as soon as possible. Delivery usually is suggested if the pregnancy has lasted more than 34 weeks. If the fetus is less than 34 weeks, the doctor will probably prescribe corticosteroids to help speed up the maturation of the lungs.

In some cases, the doctor must deliver the fetus prematurely, even if that means likely complications for the infant because of the risk of severe maternal complications The symptoms of preeclampsia usually go away within 6 weeks of delivery.

Treatment of Eclampsia

The onset of seizures in a woman with preeclampsia is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother’s seizures; treat blood pressure levels that are too high; and deliver the infant.

Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure.

The only cure for eclampsia is to deliver the fetus.

Treatment of HELLP Syndrome

HELLP syndrome, a special type of severe preeclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The health care provider may consider the following treatments after a diagnosis of HELLP syndrome:


Reference: National Institutes of Child Health and Human Development