Enhancing Healthcare Team Outcomes
The care and management of patients with preeclampsia serve significant challenges and obstacles, given the complexity of caring for both the patient and fetus. Thus, the most successful outcomes are attained with a robust team of physicians, nurses, pharmacists, and healthcare aids, all with the similar goal of providing the best possible care, ensuring patient safety, and improving maternal and fetal outcomes. This includes ensuring patients feel supported and well-educated, with a sense of understanding of their current pregnancy condition. This also includes effective communication between teams regarding patient complaints, signs and symptoms, vital signs, laboratory values, current treatment regimens, goals of therapy, and proposed delivery plan .
Expectant Management Of Preeclampsia With Severe Features
If a patient presents with preeclampsia with severe features before 34 weeks’ gestation but appears to be stable, and if the fetal condition is reassuring, expectant management may be considered, provided that the patient meets the strict criteria set by Sibai et al . This type of management should be considered only in a tertiary center. In addition, because delivery is always appropriate for the mother, some authorities consider delivery as the definitive treatment regardless of gestational age. However, delivery may not be optimal for a fetus that is extremely premature. Therefore, in a carefully chosen population, expectant management may benefit the fetus without greatly compromising maternal health.
All of these patients must be evaluated in a labor and delivery unit for 24 hours before a decision for expectant management can be made. During this period, maternal and fetal evaluation must show that the fetus does not have severe growth restriction or fetal distress. In addition, maternal urine output must be adequate. The woman must have essentially normal laboratory values and hypertension that can be controlled.
Daily blood tests should be performed for liver function tests , CBC count, uric acid, and LDH. Patients should be instructed to report any headache, visual changes, epigastric pain, or decreased fetal movement.
Are You At Risk For Preeclampsia
We dont know for sure what causes preeclampsia, but there are some things that may make you more likely than other women to have it. These are called risk factors. If you have even one risk factor for preeclampsia, tell your provider.
You’re at high risk for preeclampsia if:
- You’ve had preeclampsia in a previous pregnancy. The earlier in pregnancy you had preeclampsia, the higher your risk is to have it again in another pregnancy. Youre also at higher risk if you had preeclampsia along with other pregnancy complications.
- Youre older than 35.
- Youre African-American. African-American women are at higher risk for preeclampsia than other women.
- You have low socioeconomic status . SES is a combination of things, like a persons education level, job and income . A person with low SES may have little education, may not have a job that pays well and may have little income or savings.
If your provider thinks youre at risk of having preeclampsia, he may want to treat you with low-dose aspirin to help prevent it. Talk to your provider to see if treatment with low-dose aspirin is right for you.
Protein In Your Urine
Proteinuria, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into your urine. This is because preeclampsia temporarily damages this filter. Albumin, as well as many other proteins, are lost this way.
A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria, though other methods may be used in clinics and medical offices such as a Protein:Creatinine Ratio or a timed urine collection.
What you can do…
During each prenatal visit, ask your health care provider for the results of your urine test. A nurse will have dipped a reagent strip into a sample of your urine. A reading of trace protein is relatively common and is usually not a cause for concern. However, if the reading is 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is below 140/90. If you are concerned, or have had preeclampsia before, you can buy reagent strips at some pharmacies or online. Should you record a reading of 2+ or greater at home, call your healthcare provider that very same day.
What Are The Possible Complications Of Untreated Preeclampsia
If preeclampsia is left untreated, it can:
- Progress to eclampsia, a much more serious pregnancy condition that results in seizures and other more serious consequences for you and your baby
- Cause HELLP syndrome, another more serious condition that can result in complications including liver damage without prompt treatment. HELLP, which can happen on its own during pregnancy or in conjunction with preeclampsia, is characterized by low red blood cell count, elevated liver enzymes and clotting problems.
- Cause placental abruption, or early separation of the placenta from the wall of the uterus
- Damage your liver and kidneys
Having preeclampsia puts you at greater risk later in life of kidney disease and heart disease, including heart attack, stroke and high blood pressure. It also puts you at a higher risk of developing preeclampsia in subsequent pregnancies.
Remember, as long as youre regularly seeing your doctor, youll receive a prompt diagnosis and treatment which gives you the same great odds of having a healthy pregnancy and birth as women with normal blood pressure.
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Is It Just A Pregnancy Symptom Or Something More
Pregnancy is a confusing time. Your body is going through a lot of changes and it can be hard to tell what’s normal and what’s a red flag. Learning more about the signs and symptoms of preeclampsia, HELLP syndrome and other hypertensive disorders of pregnancy can help you identify a problem early and ensure the best possible outcome. Some characteristics of preeclampsia are signs that can be measured, but may not be apparent to you, such as high blood pressure. A symptom is something you may experience and recognize, such as a headache or loss of vision.
Shortness Of Breath Anxiety
Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs .
What you can do…
Contact your healthcare provider immediately if these symptoms are new. If you’ve experienced these conditions before pregnancy, be sure to mention them to your care provider during your next visit so they can be monitored closely.
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Are There Any Complications From Pre
The majority of pregnant women with pre-eclampsia will not have any complications once they are on blood pressure medicines and give birth to their baby. However, some pregnant women may experience serious complications such as seizures, a stroke, kidney failure, liver failure or bleeding due to clotting problem.
Women who have had pre-eclampsia may be at an increased risk of high blood pressure, heart disease, diabetes, or ongoing clotting disorders later in life. Your doctor may ask you to have more regular check-ups so you can receive treatment as early as possible if any of these disorders occur.
Many women feel overwhelmed or distressed after a diagnosis of pre-eclampsia. If this has been your experience, let your doctor or midwife know you need some support. You can also call Pregnancy, Birth and Baby, 7 days a week on 1800 882 436 to speak with a maternal child health nurse.
What You Can Do To Prevent Eclampsia
Experts cant predict which women with preeclampsia will go on to develop eclampsia. Being proactive about your health, knowing the signs of both conditions, and seeking medical attention right away if you think something might be wrong can help both you and your baby.
Follow these tips for reducing your chances of eclampsia and preeclampsia:
As for remedies you might have heard about, like taking vitamins C or E, eating a low salt diet or supplementing with fish oil? For now, theres not enough evidence to show that any of those things are beneficial. If youre still considering trying them, talk with your doctor first.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.
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Research Data On Race And Ethnicity
While the prevalence of preeclampsia is 3 to 5 percent, a 2020 research review found that its impact is not equal across all populations. The rates of occurrence and outcomes are disproportionate among certain groups. These include non-Hispanic Black women and American Indian or Alaskan Native women.
The existing data on disparities mostly compares the differences between non-Hispanic Black and white women. Only a few studies have looked at outcomes for Asian, American Indian, Alaskan Native, or mixed-race women.
A examined the prevalence of preeclampsia in 2014. It included data from nearly 177,000 deliveries in women with preeclampsia or eclampsia.
The total rates of preeclampsia and eclampsia based on race and ethnicity:
- 69.8 per 1,000 deliveries for Black women 60 percent higher than for white women
- 46.8 per 1,000 deliveries for Hispanic women
- 43.3 per 1,000 deliveries for white women
- 28.8 per 1,000 deliveries for Asian/Pacific Islander women
Its also important to note that, overall, morbidity and mortality in pregnancy arent equal across racial and ethnic groups.
For example, a 2019 study found that, between the years of 2007 and 2016, Black and American Indian or Alaskan Native women experienced more pregnancy-related deaths than white, Hispanic, and Asian American or Pacific Islander women.
When Should I See My Healthcare Provider
Preeclampsia can be a fatal condition during pregnancy. If you’re being treated for this condition, make sure to see your healthcare provider for all of your appointments and blood or urine tests. Contact your obstetrician if you have any concerns or questions about your symptoms.
Go to the nearest hospital if you’re pregnant and experience the following:
- Symptoms of a seizure-like twitching or convulsing.
- Shortness of breath.
- Severe headache that won’t go away.
- Dark spots in your vision that don’t go away.
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What Are Types Of High Blood Pressure Conditions Before During And After Pregnancy
Your doctor or nurse should look for these conditions before, during, and after pregnancy:1,11
Chronic hypertension means having high blood pressure* before you get pregnant or before 20 weeks of pregnancy.1 Women who have chronic hypertension can also get preeclampsia in the second or third trimester of pregnancy.1
This condition happens when you only have high blood pressure* during pregnancy and do not have protein in your urine or other heart or kidney problems. It is typically diagnosed after 20 weeks of pregnancy or close to delivery. Gestational hypertension usually goes away after you give birth. However, some women with gestational hypertension have a higher risk of developing chronic hypertension in the future.1,12
Preeclampsia happens when a woman who previously had normal blood pressure suddenly develops high blood pressure* and protein in her urine or other problems after 20 weeks of pregnancy. Women who have chronic hypertension can also get preeclampsia.
Preeclampsia happens in about 1 in 25 pregnancies in the United States.1,13 Some women with preeclampsia can develop seizures. This is called eclampsia, which is a medical emergency.1,11
Symptoms of preeclampsia include:
Some women have no symptoms of preeclampsia, which is why it is important to visit your health care team regularly, especially during pregnancy.
You are more at risk for preeclampsia if:1
How Is It Diagnosed
Preeclampsia is often diagnosed during routine prenatal appointments when your healthcare provider checks your weight gain, blood pressure and urine.
If preeclampsia is suspected, your healthcare provider may:
- Order additional blood tests to check kidney and liver functions.
- Suggest a 24-hour urine collection to watch for proteinuria.
- Perform an ultrasound and other fetal monitoring to look at the size of your baby and assess the amniotic fluid volume.
Preeclampsia can be categorized as mild or severe. You may be diagnosed with mild preeclampsia if you have high blood pressure plus high levels of protein in your urine.
You are diagnosed with severe preeclampsia if you have symptoms of mild preeclampsia plus:
- Signs of kidney or liver damage .
- Low platelet count
- Visual impairment or seeing spots.
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How Is Mild Preeclampsia Treated
Most women with mild preeclampsia after 37 weeks of pregnancy dont have serious health problems. If you have mild preeclampsia before 37 weeks:
- Your provider checks your blood pressure and urine regularly. She may want you to stay in the hospital to monitor you closely. If youre not in the hospital, your provider may want you to have checkups once or twice a week. She also may ask you to take your blood pressure at home.
- Your provider may ask you to do kick counts to track how often your baby moves. There are two ways to do kick counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell your provider.
- If youre at least 37 weeks pregnant and your condition is stable, your provider may recommend that you have your baby early. This may be safer for you and your baby than staying pregnant. Your provider may give you medicine or break your water to make labor start. This is called inducing labor.
Genetic Factors In Preeclampsia
Preeclampsia has been shown to involve multiple genes. Over 100 maternal and paternal genes have been studied for their association with preeclampsia, including those known to play a role in vascular diseases, BP regulation, diabetes, and immunologic functions.
Importantly, the risk of preeclampsia is positively correlated between close relatives a study showed that 20-40% of daughters and 11-37% of sisters of women with preeclampsia also developed the disease. Twin studies have shown a high correlation as well, approaching 40%.
Because preeclampsia is a genetically and phenotypically complex disease, it is unlikely that any single gene will be shown to play a dominant role in its development.
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Failure Of Pseudovascularization In Preeclampsia
The shallow placentation noted in preeclampsia results from the fact that the invasion of the decidual arterioles by cytotrophoblasts is incomplete. This is due to a failure in the alterations in molecular expression necessary for the differentiation of the cytotrophoblasts, as required for pseudovascularization. For example, the upregulation of matrix metalloproteinase-9 and HLA-G, 2 molecules noted in normally invading cytotrophoblasts, does not occur.
The invasive cytotrophoblasts therefore fail to replace tunica media, which means that mostly intact arterioles, which are capable of vasoconstriction, remain. Histologic evaluation of the placental bed demonstrates few cytotrophoblasts beyond the decidual layer.
The primary cause for the failure of these invasive cytotrophoblasts to undergo pseudovascularization and invade maternal blood vessels is not clear. However, immunologic and genetic factors have been proposed. Early hypoxic insult to differentiating cytotrophoblasts has also been proposed as a contributing factor.
Does Preeclampsia Go Away After Delivery
Preeclampsia typically goes away within days to weeks following delivery. Sometimes, your blood pressure can remain high for a few weeks after delivery, requiring treatment with medication. Your healthcare provider will work with you after your pregnancy to manage your blood pressure. People with preeclampsia â particularly those who develop the condition early in pregnancy â are at greater risk for high blood pressure and heart disease later in life. Knowing this information, those women can work with their primary care provider to take steps to reduce these risks.
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How Is It Treated
As soon as preeclampsia is diagnosed, mom and baby are very closely monitored. Once preeclampsia occurs, it cannot be reversed. The only real cure is to deliver the baby and placenta as safely as possible. Certain medications to reduce blood pressure may help prolong a pregnancy, but in some cases the baby must be delivered immediately to save either the moms or babys life.
For severe cases, mothers are often kept in the hospital so they can be monitored. They may receive an IV medicine called magnesium sulfate to reduce the risk of stroke and seizure.
How Is Preeclampsia Treated
Your healthcare provider will advise you on the best way to treat preeclampsia. Treatment generally depends on how severe your preeclampsia is and how far along you are in pregnancy.
If you’re close to full term , your baby will probably be delivered early. You can still have a vaginal delivery, but sometimes a Cesarean delivery is recommended. Your healthcare provider may give you medication to help your baby’s lungs develop and manage your blood pressure until the baby can be delivered. Sometimes it is safer to deliver the baby early than to risk prolonging the pregnancy.
When preeclampsia develops earlier in pregnancy, you’ll be monitored closely in an effort to prolong the pregnancy and allow for the fetus to grow and develop. You’ll have more prenatal appointments, including ultrasounds, urine tests and blood draws. You may be asked to check your blood pressure at home. If you are diagnosed with severe preeclampsia, you could remain in the hospital until you deliver your baby.
If the preeclampsia worsens or becomes more severe, your baby will need to be delivered.
During labor and following delivery, people with preeclampsia are often given magnesium intravenously to prevent the development of eclampsia .
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