Preeclampsia
Preeclampsia, or toxemia, has been around as long as women have been having babies. Hippocrates described headache, swelling, and convulsions in pregnant women and noted that this was bad (no kidding!). Although we recognize and treat preeclampsia better today, the condition remains a mystery in many respects. We don't really know what causes it, or why some women seem to be at greater risk for developing it. Here is what we do know:
Preeclampsia is more common in women having their first babies, women carrying more than one baby, women who have hypertension, diabetes, kidney disease, autoimmune disorders, or obesity, and those who had preeclampsia with a previous pregnancy. With that said, any pregnant woman can develop it.
It appears most commonly in the third trimester of pregnancy, although we sometimes see it earlier. In general, the earlier it appears, the more of a problem it can be, since the only cure for preeclampsia is delivery of the baby.
Although we don't know exactly what causes preeclampsia, we do know some of the things that happen when you get it. The typical signs are high blood pressure, swelling, and protein in the urine. Additional symptoms may include abdominal pain, vaginal bleeding, visual changes, headaches, seizures, decreased fetal movement, or difficulty breathing. Here are some of the changes that happen in your body with preeclampsia:
Blood vessels narrow, causing your blood pressure to rise (hypertension).
Your blood vessels become more "leaky," causing fluid to accumulate in your tissues (swelling of hands, face, and feet, or fluid accumulating in your lungs).
Kidney and liver function may be affected (proteinuria and liver enzyme changes).
The placenta can separate from the wall of the uterus, causing abdominal pain and bleeding (placental abruption).
Clotting factors can be used up, causing low platelets and/or blood clotting abnormalities.
When blood vessels constrict, blood flow to the uterus may be reduced, and babies may be smaller or have less amniotic fluid (intrauterine growth restriction or oligohydramnios).
Swelling in your central nervous system can increase the risk of headaches, visual changes, and seizures.
Preeclampsia is sneaky - it can look different in different women, and even in the same person with a new pregnancy. It is important to remember that you may have one or some combination of these features.
When preeclampsia is diagnosed in the last few weeks of pregnancy, the best option is usually delivery. When it develops earlier, we have to determine whether the features are severe enough to place mom or baby at risk for a bad outcome. If this is the case, delivery may be indicated prematurely. We never make this decision lightly.
If you have any of the above symptoms, make your OB provider aware. Many times, swelling is simply a normal part of pregnancy, and a headache can happen for a lot of reasons. But always better to be cautious. Never think that you are bothering us with your concerns. It's our job, and yours too, to bring your baby here safely.