High Blood Pressure In Pregnancy
What is preeclampsia?
Preeclampsia is high blood pressure in pregnancy, accompanied by swelling that doesn't go away, and by large amounts of protein in the urine (found in urine tests). It occurs typically after the 20th week of pregnancy. Your blood pressure goes up, you retain water, and there is protein in your urine. It is also called toxemia or pregnancy-induced hypertension (PIH).
Preeclampsia may be mild or severe. Severe preeclampsia affects the mother's blood system, kidneys, liver, brain, and other organs. It can cause serious problems for the mother and the baby. Sometimes, but very rarely, it causes death. If convulsions or seizures occur, the disease is called eclampsia.
How does it occur?
The cause of preeclampsia is not known. About 6 to 8% of pregnant women have preeclampsia. It is more likely to occur during first pregnancies than later pregnancies and in women less than 25 years old or over 35 years old. Women who have chronic hypertension, kidney disease, or diabetes, or who are pregnant with more than one baby, also have a greater risk of preeclampsia. It is thought to be caused by a substance or toxin produced by the placenta.
What are the symptoms?
If you have mild preeclampsia, you may not have any symptoms and may feel perfectly well. You should go to all prenatal checkups so we can spot the condition quickly if you have it.
The main symptoms of mild preeclampsia is puffiness or swelling of the face, arms and fingers (also called edema) and excessive weight gain (more than a pound a week during the last trimester).
Additional symptoms of severe preeclampsia include:
- continued blood pressure rise
- continued swelling and puffiness
- changes or problems with your vision
- sensitivity to bright light
- pain in the right upper abdomen
- nausea and vomiting
- urinating less than a pint in 24 hours
- shortness of breath
- tendency to bruise easily
- slowed growth of the baby in severe cases.
Who is at risk for preeclampsia?
Women who have the following conditions may have a higher risk for preeclampsia:
- diabetes mellitus
- prepregnancy high blood pressure
- chronic kidney disease
- immune disorders such as lupus
- teenage mothers
- women over 40
- preeclampsia during one pregnancy does not mean it will recur with subsequent pregnancies, but it does increase the risk of recurrence
multiple gestation (twins, etc.)
- family history of preeclampsia or eclampsia
How is it diagnosed?
You will have your blood pressure and urine tested at each prenatal checkup. If preeclampsia is suspected, you will perform a 24 hr urine test. This allows us to see how much protein you are spilling in your urine throughout the day.
A 24 hr urine study is done by beginning after you have urinated first thing in the morning. That is the time that you mark, so you'll collect all urine after that for 14 hrs. You will be given a hat to fit on top of the toilet that will allow you to collect all urine with each void. You will pour this urine into the container that was given to you by the office. Do not miss collecting any urine. Keep the container either in the refrigerator or on ice so the bacteria does not start to grow in the urine. This could alter the test results. Once you have collected all the urine in a 24 hr period, you will bring it to the office that day and have some blood tests drawn. All will be sent to the lab for evaluation.
How is it treated?
Treatment depends on how close you are to your due date. Delivery of the baby is the best treatment. If your due date is near and your baby has developed enough, Dr. Hardy will schedule an induction to deliver your baby right away.
If your baby has not developed enough and the preeclampsia is not too severe, you will need to:
- Rest in bed, lying on your left side as much as possible to take the weight of the baby off your major blood vessels.
- Have more frequent checkups with fetal monitoring.
- Ultrasounds to check baby's growth, amniotic fluid volume and blood flow through the umbilical arteries.
- Eat less salt.
- Drink 8 glasses of water a day.
- If your symptoms become more severe, you may need to stay in the hospital. You will be given medicine to lower your blood pressure. You may also be given Magnesium Sulfate through the IV in order to prevent seizures. You will probably have blood tests and various other tests to check your condition and the health of the baby. In some cases Dr. Hardy may decide to start your labor early and deliver the baby before the due date.
How long will the effects of preeclampsia last?
The symptoms of preeclampsia last until shortly after the baby is born (about 3 to 7 days).
When should I call the office?
Call the office right away if:
- You have swelling of your hands, feet, or face.
- You have changes or problems with your vision.
- You have severe headaches.
- You have nausea and vomiting.
- You have abdominal pain.
- You have suddenly gained a lot of weight.
- You are urinating very little or infrequently.
- You become short of breath.
- You start bruising easily.
- You become very tired more easily.
- How can I help prevent hypertension in pregnancy?
Currently, there is no sure way to prevent preeclampsia. Many factors may contribute to the development of high blood pressure during pregnancy. Some can be controlled and some can't. Practice the following good health habits:
- Use little or no added salt in your meals
- Don't eat a lot of fried foods and junk food.
- Get enough rest.
- Exercise regularly.
- Elevate your feet several times during the day.
- Avoid drinking alcohol and beverages containing caffeine.
- If you have a high risk for preeclampsia, Dr. Hardy may recommend that you take low doses of aspirin and calcium daily.