Preeclampsia
Preeclampsia
Facts and Fallacies
Preeclampsia has probably been around for as long as women have been getting pregnant. It’s also known as toxemia, pregnancy -induced hypertension, or EPH gestosis. Preeclampsia is the most misunderstood and myth-ridden disease in pregnancy. Let’s clear up some of the more common myths with some facts.
- Preeclampsia isn’t related to obesity or excessive weight gain during pregnancy.
- It isn’t caused by salt (sodium chloride). Women with preeclampsia actually have normal sodium levels. Salt restriction isn’t recommended.
- The condition isn’t cured or alleviated by taking water pills (diuretics) for the swelling.
- Preeclampsia isn’t caused by a diseased placenta, poisons, or toxins in the body. The term “toxemia” is still used, but it isn’t an accurate one to describe the disease.
- It isn’t prevented by vitamin therapy or high-protein or other special diets. There’s no known prevention.
Preeclampsia is one of the most studied diseases in pregnancy. In spite of all the research, we still don’t know what causes the disease or how to prevent it T he only cure at this time is to deliver the baby.
The Computer Goes Kaput
Preeclampsia usually occurs during a first pregnancy. Five percent of pregnancies develop preeclampsia. In addition to the first-time mother, women with diabetes, chronic hypertension, and multiple pregnancies are at risk for developing the disease. Preeclampsia seems to result from a number of interacting factors that affect the response of the mother’s immune system. Her immunological system may short-circuit because of poor nutrition plus exposure to placental hormones for the first time. Genetic factors may play a part… some unknown incompatibility between mom and dad. Who knows for sure? The body’s immunological computer, because of some unknown variable, doesn’t “program” the body’s response to the pregnancy in a normal way and preeclampsia results.
Software Snafu-What Goes Wrong
Preeclampsia has important effects on you and your baby. Your vascular system, which holds and carries blood throughout your body, changes in shape with this disease. Instead of being straight hollow tubes with unrestricted blood flow, your vessels look more like sausages. Some areas are very narrow and others very wide. The increased pressure inside the blood vessels forces fluid out into the tissues, to relieve the pressure. Your blood becomes thicker without the fluid. Your blood pressure (BP) rises because of the areas of constriction in the vessels. The changes in the vessels produce the three symptoms used to diagnose preeclampsia: edema (swelling), hypertension (increased blood pressure), and protein in the urine.
The blood flow to the baby is decreased due to the decrease in fluid volume inside your vessels and the increase in blood pressure. These “short rations” produce a small baby whose physical growth potential isn’t reached. Intrauterine growth retardation (IUGR) is the term used to describe the condition.
Signs and Symptoms
Preeclampsia is similar to a computer virus. It’s present long before you realize something is wrong. The disease makes its appearance some time after the twentieth week of pregnancy. The first sign is usually a weight gain of more than 2 pounds in I week. Generalized swelling (edema) appears next. It’s normal to have swelling of the feet and ankles, but it isn’t normal for the face and hands to swell. Pay attention if you can’t get your rings off and your face seems fuller than usual.
After the swelling, your blood pressure starts rising. A BP of 140/ 90 is abnormal in pregnancy. You can still have preeclampsia even if your blood pressure doesn’t reach that level. If the top number of your BP rises 30 points above your early or prepregnancy BP and the bottom number rises 15 points, it’s still possible to have preeclampsia. For example, if your first trimester pressure was 90/60 and now you consistently register 120/75, you need to be evaluated, particularly if you have swelling also. With mild preeclampsia, you may not have protein in your urine.
Downtime-Treatment
Since delivery is the only cure for preeclampsia, your doctor tries to slow the progress of the disease until your baby’s lungs are mature enough for safe delivery. There are no advantages to waiting if it isn’t necessary – the disease doesn’t get better with time.
Preeclampsia is classified as mild or severe. Each category is managed differently. With mild preeclampsia, you may have generalized swelling and your BP is elevated but under 160/ 110. You probably have no protein in your urine. You feel fine, which is misleading. With this disease, you can rapidly progress from the mild to the severe form in a matter of hours. It’s very unpredictable. Listen to what your doctor tells you and cooperate fully. Your doctor may let you stay at home instead of hospitalizing you if you have mild preeclampsia. Your doctor’s instructions usually include lots of rest while lying on your side. This position helps the edema fluid be reabsorbed back into your vessels. Your blood pressure usually decreases, and your baby benefits from the extra blood flow. You can enjoy catching up on your favorite soap or reading a romantic novel for the third time. Strict bed rest usually isn’t necessary, but cooking, cleaning, shopping, and bouncing babies around are off limits. If you try to continue your normal activities, your preeclampsia will only get worse and you’ll end up in the hospital.
Besides rest, your doctor will have you take your BP several times a day. Check your BP in the same arm in the same position each time for consistency in the readings. She may also have you check your urine for protein with a dipstick.
Your trips out of the house will be short. You can go to the doctor’s office or hospital to have stress or nonstress testing to monitor how the baby is handling the effects of the preeclampsia. You may have blood tests done weekly to monitor the progress of the disease. Ultrasound exams may be done to reassure everyone your baby is growing on schedule. If you aren’t getting better despite the decreased activity, hospitalization may be necessary.
With severe preeclampsia, your BP will be 160/ 110 or higher on two or more checks 5 minutes apart after resting. Your urine will show 2+ or more protein. You probably won’t feel well. You may have what you think is heartburn and a headache. The treatment is hospitalization. The decision to deliver your baby will depend on what your doctor decides is the best course of action for both you and your baby.
With severe preeclampsia, your doctor is worried about convulsions. She’ll give you magnesium sulfate, the drug used to prevent seizures, usually administered intravenously. When the drug is first administered, you may develop a stuffy nose, headache, and feel very flushed. These common side effects subside within a short period of time.
Your doctor will discuss the available options and help you understand the best course of action for both you and your baby. Remember, with delivery comes the cure. Preeclampsia has no long-term effects, you get well, and everything returns to normal. You’re soon feeling better and getting acquainted with your newborn baby.