Updated: Jul 4, 2019
Our high blood pressure in pregnancy series continues...
Clearly eclampsia is the worst case scenario when it comes to elevated blood pressures in pregnancy. Preeclampsia is basically all of the signs and symptoms that precede eclampsia. It is the thunder you hear that makes you take cover because you know lightning is coming. (See our Eclampsia article if you don't know what I'm talking about) The best way to understand preeclampsia is as a vessel disease. While we do not understand the exact cause, we know that there are substances in the placenta that when it goes through a mother’s circulation can cause damage to her blood vessels causing them to tighten or elevate her blood pressure. In addition to having elevated blood pressures, some women may also spill protein into their urine because the kidney that filters our blood becomes leaky, causing increased urine protein. All of the other damage that preeclampsia causes is mainly through the blood vessels on different organs.
While preeclampsia may not be as severe as eclampsia in most cases, there are severe forms that warrant quick clinical decision making.
HELLP Syndrome: This acronym stands for Hemolysis, Elevated Liver enzymes and Low Platelets. This unique, severe form of preeclampsia affects your red blood cells, causing them to be chewed up and ineffective at carrying oxygen, an increase in your liver levels and a decrease in your platelets. Most of this is detected on labs but sometimes women do have liver issues that can be seen on imaging. If delivery does not happen, these labs can continue to worsen.
Stroke: If a mother’s high blood pressure reaches an unsafe level, usually >160/110 mmHg, she can have a stroke. There are tiny blood vessels in the brain that cannot tolerate extreme pressures. A stroke of this type is like blowing a gasket and can cause bleeding in the brain. This is why headaches are very serious when it comes to preeclampsia because sometimes it is the first symptom of high blood pressures.
Pulmonary Edema: Again, preeclampsia is a blood vessel disease and having leaky vessels in the lungs can make it difficult to breathe. Fluid leaking in the lungs can almost feel like drowning with shortness of breath and difficulty transferring oxygen to the body. This is another serious complication because sometimes it can appear gradual or just show up in a flash. There are medications like water pills that can be given to remove this fluid off of the lungs.
Placenta Abruption: The placenta is a collection of blood vessels in the uterus connecting a mother to her baby, bringing nutrients and oxygen. Just like all of the other vessels in preeclampsia are damaged and tighten, the same can happen in the placenta. If this happens, this can shift oxygen away from the baby putting the baby into distress. With this loss of good blood flow, mothers can start painfully bleeding and may need immediate delivery.
Basically Preeclampsis is all of the bad things that can happen short of seizing. Depending on how a patient shows up to the hospital with preeclampsia, there may be time to help optimize a premature baby for delivery. Typically, if a mom presents with preeclampsia to the hospital they will give her magnesium in her IV to prevent a seizure. If she is less than 34 weeks, she may get steroids to help the baby develop and if everything is stable, they may keep her pregnant until 34 weeks. After 34 weeks, there is very little benefit keeping a mother pregnant because the benefits of delivery outweigh the baby’s chance of survival. Preeclampsia is all about timing and trying to deal with two patients, baby and mom, and trying to make decisions that optimize the health of both.
Oh and Beyonce actually had preeclampsia, but brought back a retro term toxemia to describe it in her Vogue article in September 2018.
Don't Forget the Symptoms of Preeclampsia
Severe or persistent headache
Seeing spots or flashes of light
Shortness of breath
New nausea and vomiting
Pain under your right breastbone
Incredible sense of doom