Pre-eclampsia and eclampsia are forms of high blood pressure that occur during pregnancy and are accompanied by protein in the urine and edema (swelling). As the names suggest, these two disorders are related. Pre-eclampsia, sometimes called toxemia of pregnancy, may develop into the more severe eclampsia, which is pre-eclampsia together with seizure. These conditions usually develop during the second half of pregnancy (after 20 weeks), though sometimes they develop shortly after birth, and, in very rare situations, they occur before 20 weeks of pregnancy.
You are at increased risk of developing pre-eclampsia if:
- This is your first pregnancy.
- Your mother or sister had pre-eclampsia or eclampsia during pregnancy.
- You are carrying more than one baby.
- You are a teenager.
- You are over 40 years old.
- You already have high blood pressure, kidney disease or diabetes.
- You are a smoker.
- You are obese.
- You suffer from malnutrition.
- You carry a baby with so-called "non-immune hydrops."
If you are pregnant, increasing blood pressure may not make you feel different until it is dangerously high. So you should watch for signs of pre-eclampsia. If you develop pre-eclampsia, the first thing you notice may be rapid weight gain, on the order of two to five pounds in a single week. Many pregnant women have swelling of their feet or legs; however, swelling of your face or arms may be a sign of pre-eclampsia. If pre-eclampsia progresses from mild to moderate or severe, you may begin to notice other symptoms. Headache, vision changes and abdominal pain should prompt concern.
It is dangerous to allow blood pressure to stay high during pregnancy. High blood pressure may interfere with the placenta's ability to deliver oxygen and nutrition to your fetus, so your baby may be born weighing less than normal and may have other health problems. If your blood pressure continues to get higher and higher, your kidneys may have trouble functioning. You may have changes in the makeup of your blood, such as destruction of red blood cells (causing anemia), disturbed liver function, and decreased platelets (blood cells involved in clotting). Too few platelets can increase your risk of bleeding uncontrollably during delivery or even spontaneously. Your blood pressure may continue to climb, and you may develop seizures.
Once you begin to have seizures, you are considered to have eclampsia. This is a life-threatening situation for both you and your baby. During a seizure, you and your baby are at risk of being deprived of oxygen. In addition, the high blood pressure may cause the placenta to begin to separate from the wall of the uterus (called abruptio placentae). This can cause severe bleeding and death of the fetus and possibly the mother.
- Rapid weight gain
- Swelling of the arms or face
- Changes in vision (blurred vision, seeing double, seeing spots of light)
- Dizziness, faintness
- Ringing in the ears
- Abdominal pain
- Decreased production of urine
- Nausea, vomiting
- Blood in vomit or urine
Pre-eclampsia and Eclampsia: Causes and Treatments
Doctors are not sure exactly what causes pre-eclampsia or eclampsia.
Diagnostic and Test Procedures
During your pregnancy, your health-care provider will check your blood pressure at every prenatal visit. If your blood pressure increases greatly compared to before or early in pregnancy, or if your blood pressure numbers reach certain thresholds and you start having protein in your urine, then your health-care provider may diagnose you with pre-eclampsia. You can be diagnosed with this disorder without ever having had noticeable symptoms. Mild pre-eclampsia is diagnosed when your blood pressure is only a little elevated, while severe pre-eclampsia is diagnosed with very high blood pressures and other symptoms, such as headache, abdominal pain, blood and liver abnormalities, and having a large amount of protein in your urine.
Your health-care provider will want to perform urine tests and blood tests, too. These will reveal whether your kidneys and liver are functioning normally, as well as whether you are developing other complications of pre-eclampsia (such as low red blood cells or low platelets).
If you develop pre-eclampsia too early in your pregnancy for your baby to be delivered safely, then your health-care provider may try to treat you for a while, until the baby has developed enough to be delivered. Your provider will also order on a regular basis tests such as ultrasounds, non-stress testing, or biophysical profiles to check whether the baby is doing well. You probably will be put on bed rest and allowed to get up only to use the bathroom. You'll be asked to lie on your left side as much as possible, to take pressure off certain important blood vessels, allowing your kidneys and the placenta to benefit from greater blood flow. You may be given medication to lower your blood pressure to a safe range.
Many women with pre-eclampsia are admitted to hospital. If you are allowed to go home, you'll probably have to have your blood pressure checked at home, or have a home nurse visit every day or two, to make sure that your blood pressure is stable. In the past, women with pre-eclampsia were asked to eliminate their salt intake. Current understanding of pre-eclampsia, however, suggests that this is incorrect advice, and that women with pre-eclampsia can continue to eat salt, though not excessively.
If home bed rest doesn't improve your blood pressure, or at least stabilize it, or if you develop severe pre-eclampsia, then you may need to be admitted to the hospital. You'll probably need to receive fluids and medicines intravenously (through a needle in your vein). You might be given medication to lower your blood pressure, as well as a medication called magnesium sulfate, which is used to prevent seizures.
If your blood pressure stays dangerously high, if you develop seizures, or once your baby reaches a safe point in development, your health-care provider will deliver your baby. This does not necessarily mean that you will need a cesarean section. Many times your provider can give you medicines to start labor. In some special cases, you may need to have a cesarean section. If your health-care provider is convinced that your baby must be delivered before their lungs are fully matured, you may be given special medicines to speed lung development prior to delivery.
Because pre-eclampsia and eclampsia take several days to resolve after delivery, you will probably need to stay on blood pressure medications or magnesium sulfate for some time after your baby is born.
Methods of preventing pre-eclampsia and eclampsia are somewhat controversial. Researchers are investigating whether taking an aspirin or more calcium each day would help decrease the risk of developing these disorders.
Call Your Doctor If:
- You notice sudden weight gain during pregnancy.
- You begin to experience swelling of the arms or face.
- You develop a severe headache.
- You notice changes in your vision.
- You have abdominal pain.
- You have vaginal bleeding.
- You feel dizzy or faint.
- You hear ringing in your ears.
- You have trouble with nausea or vomiting.
- You notice a decrease in your urine production.
- There is blood in your urine or vomit.
- You become confused.
- You develop seizures.