Hypertension can complicate a pregnancy. Preeclampsia and other hypertensive disorders of pregnancy can have serious effects to you and your baby, made worse by delayed diagnosis or management. By making yourself aware of the signs and symptoms, just might spell the difference between life and death.
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What is preeclampsia?
Understanding preeclampsia can save you and your baby from potential medical emergencies during pregnancy and childbirth. This highlights the importance of understanding this condition because even though it is serious, it is manageable especially with early diagnosis and prompt treatment.
Originally known as “toxaemia,” preeclampsia is a complication that occurs during pregnancy or rarely after the baby is born. While the cause remains unknown, it is associated with problems in the placenta, which is the temporary organ that serves as a lifeline between your own blood supply and that of your baby’s.
In preeclampsia, changes in blood vessels deprive the placenta of proper blood supply resulting in harmful effects to you and your baby. The first identifying factor is the time in which it occurs – that is during the second half of pregnancy, or anytime after the 20th week. On rare occasions, it can also happen earlier, during labour, or six weeks postpartum.
Preeclampsia is diagnosed by persistent high blood pressure with increased amounts of protein in the urine. It must not be confused with elevated blood pressure occurring after the 20th week unaccompanied by any traces of protein in the urine, which is gestational hypertension.
Swelling that is localised to the face and hands is also a classic sign of preeclampsia. This significant increase in body fluids also explains the sudden weight gain. This may be accompanied by mild symptoms, or fall seriously ill with problems extending to the lungs, liver, brain, and even your blood clotting system.
What puts me at risk of developing preeclampsia?
Preeclampsia can strike at any pregnancy, however there are also predisposing factors. Your risk of developing preeclampsia increases if:
- This is your first pregnancy.
- You are aged 40 and above
- You have an existing high blood pressure (140/90 mm/Hg and above)
- You are carrying more than one baby
- You have a history of obesity or a Body Mass Index (BMI) of 35 or more
- You have certain medical conditions such as diabetes, thrombophilia, lupus, or migraine
- You have developed preeclampsia in a previous pregnancy
- You have chronic hypertension and kidney disease
- It has been a decade or more since your last baby
- If you have any close relatives who have had preeclampsia
- You have had an in vitro fertilization
If you fall under any of these criteria, seek medical help to ensure that you get a thorough assessment and close monitoring.
What are the complications associated with preeclampsia?
If left untreated preeclampsia can develop into a full-blown eclampsia, where high blood pressure results in seizures. It also involves loss of consciousness and agitation.
Your health can be further compromised when eclampsia results in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). This is characterised by damaged red blood cells, impaired clotting, and internal bleeding of the liver resulting in chest or abdominal pain. This is a medical emergency that can have lifelong effects or fatal consequences.
Aside from maternal risks, preeclampsia also has profound effects on your little one. The lack of oxygen and nutrients caused by poor placental circulation can impair your baby’s growth. It can also result in preterm birth which can cause serious complications (e.g. congestive heart failure, high blood pressure, diabetes) later in life that would require ongoing medical care. Babies who are born early may sometimes fail to thrive especially with immature systems.
What signs and symptoms should I look out for?
Learning to recognise the warning signs of preeclampsia is critical to you and your baby’s safety. Remember that you will be your own first responder to any unusualities. Along with elevated blood pressure, important symptoms that may suggest preeclampsia include:
- Headaches, similar to migraine, that don’t go away and is sometimes accompanied by nausea and vomiting.
- Shortness of breath
- Severe pain just below the ribs, on your right side.
- Heightened state of anxiety
- Visual disturbances (e.g. oversensitivity to light, blurred vision, seeing flashing spots or auras)
- Severe swelling on the hands
- Sudden weight gain
Since you know your body, the key here is to trust your instincts if you notice anything that is off. While these symptoms are not always serious, it is important that you immediately seek medical attention once you experience them.
How is preeclampsia diagnosed?
With this risk present in each expectant mom, a routine screening will be done which includes blood pressure monitoring and urine protein tests. Along with thorough assessment, the doctor will determine if what you have is mild or severe preeclampsia from which they will base their management on.
How is preeclampsia managed?
Mild preeclampsia can be managed in a hospital or an outpatient basis. This means you can stay at home while your doctor or midwife closely monitors your condition. By yourself, you can do a daily kick count to keep track of your baby’s movements alongside blood pressure monitoring.
Report your observations during your antenatal doctor visits which is done once or twice weekly. At 37 weeks, you may be recommended to deliver your baby, but if test results continually stay in the red, you may be advised to have the baby earlier.
Preeclampsia with severe features require hospital admission. It is often recommended that you have your baby at 34 weeks once your condition has stabilised. But, if you are less than 34 weeks pregnant and under stable conditions, you may be advised to wait to deliver your baby. Medications will also be given to control your blood pressure and a seizure precaution. Magnesium sulfate will be given intravenously to prevent eclampsia. Corticosteroids will also be administered to help the baby’s lungs mature.
How is postpartum preeclampsia managed?
Preeclampsia eventually goes away after the delivery of the placenta. This may take hours or up to six months after giving birth. However, in some cases, this condition makes its entrance for the first time up to 4 weeks after birth.
Blood pressure monitoring must be continued soon after birth because there are cases where a woman’s condition could deteriorate after delivery. This necessitates a longer hospital stay until it is established that your blood pressure has stabilised for 24-48 hours. Medications to control blood pressure and prevent seizures may be given as well.
Most women with preeclampsia are able to deliver healthy babies and fully recover, while others proceed to experience life-threatening complications. Since the condition has a tendency to escalate quickly, it’s important for pregnant women to be proactive in observing symptoms and in monitoring their blood pressure at home.
With this knowledge, we hope that expectant moms or those planning to have a baby, seek medical guidance as soon as possible. Preeclampsia is manageable when caught early, so, get your blood pressure levels closely monitored. Talk to your OB-GYN now, or book an appointment with Dr. Pamela Tan today.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.