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Frequently Asked Questions
Signs and Symptoms
Frequently Asked Questions
Statistics
What Is the Difference between Preeclampsia, Toxemia, PET and PIH?
What Is Eclampsia?
How Is Eclampsia Treated?
What Is HELLP Syndrome?
What Is the Definition of Eclampsia?
Who Gets Preeclampsia?
What Causes Preeclampsia?
What Does Preeclampsia Do?
How Does Preeclampsia Affect Pregnancy?
When Does Preeclampsia Occur in a Pregnancy?
Can Preeclampsia Occur after the Baby Is Born?
How Does Preeclampsia Affect the Baby?
What Is the Cure?
What Can We Do?
Will I Get Preeclampsia in a Subsequent Pregnancy?
If my first pregnancy was normal…
If I had preeclampsia in my first or an earlier pregnancy…
If I had it in a first but not a second…
If I have been advised against getting pregnant again…
More answers to your questions coming soon!
What is difference between Preeclampsia, Toxemia, PET, and PIH?
Preeclampsia, Toxemia, PIH, PET, as well as ephegesis gestosis refer to serious, closely related hypertensive conditions of pregnancy. Toxemia is an older term based on a belief that the condition was the result of toxins (poisons) in the blood. PET (preeclamptic toxaemia) is a term used by older physicians in the UK and elsewhere. Ephegesis gestosis, rarely used in the U.S., is a term that is generally synonymous with preeclampsia. PIH, a newer term, stands for Pregnancy Induced Hypertension. The Preeclampsia Foundation uses the term "preeclampsia" as an umbrella term to cover all variants of hypertensive disorders of pregnancy. Researchers will be more specific and refer to each subset of the syndrome as separate entities. While to the medical researcher these terms may have subtle differences, they all represent serious conditions that you should not ignore.
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What is Eclampsia?
Eclampsia is one of the
most serious complications of severe preeclampsia. In the developed world, it is exceedingly rare and nearly always
treatable if appropriate intervention is promptly sought. According to “Pre-Eclampsia: The Facts”
(Redman, Walker, copyright 92),
Pre-eclampsia is so named because it was originally identified as a
disorder preceding eclampsia, although it is now known that eclamptic
convulsions is only one of the several potential complications of the disease.
These convulsions, which lead to temporary loss of consciousness, look
no different from epileptic fits…the spasms stop the mother from breathing,
make her bite her tongue and sometimes cause urinary incontinence…Eclamptic fits usually occur as a third-stage complication of severe
pre-eclampsia. But sometimes they arise
out of the blue, without any evidence of preceding disturbances…
These seizures can occur at any time in the second half of the
pregnancy…in 1974, a case of eclampsia at 16 weeks was reported in the Journal
of the American Medical Association. At
the other extreme…one case has been reported as late as 3 weeks after delivery.
Left untreated, eclamptic
seizures can result in coma, brain damage, and possibly maternal or infant
death.
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How is Eclampsia Treated?
The standard course of
treatment for eclampsia is magnesium sulfate. This simple salt saves mothers lives. According to the Collaborative Eclampsia Trial (CLASP) published in The
Lancet, June 95, women on magnesium sulfate had
- 52% lower risk of recurrent seizures than those on diazepam;
- Those who did have recurrent seizures had fewer than those on diazepam;
- 26% lower risk of maternal death than those on diazepam;
- Babies of mothers on magnesium were in better condition after delivery and less likely to need special care;
- Less likely to be ventilated or develop pneumonia or to need intensive care than those on phenytoin;
- 67% lower risk of recurrent seizures than those on phenytoin;
- 50% lower risk of maternal death than those on phenytoin.
Nevertheless, magnesium
sulfate, is not a benign drug and must be used by a skilled health care
provider with appropriate support facilities. Overdoses can and do occur.
It is important to note
that while magnesium sulfate has often been compared to Epsom salts--they are
not the same. Ingesting Epsom salts, or
magnesium vitamin supplements have not been shown to prevent maternal death due
to eclamptic seizures.
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What is HELLP Syndrome?
HELLP Syndrome occurs in 4 percent to 12 percent of the women who have preeclampsia. It is one of the most severe forms of preeclampsia. HELLP stands for: hemolysis, elevated liver enzymes, and lowered platelets. HELLP Syndrome most often affects the liver, causing stomach and right shoulder pain. HELLP Syndrome is most dangerous because it can occur before you exhibit the classic symptoms of preeclampsia. It is often mistaken for the flu or gallbladder problems. It is most important that you listen to your body: if you don't feel right, check with your health professional. If you have any of these symptoms, contact your health professional immediately. An excellent source of support and information is the HELLP Syndrome Society started by Stephen and Jennifer Bohach after the loss of their daughter, Taylor Hope.
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What is the definition of the term eclampsia?
Main Entry: eclamp·sia
Pronunciation: i-'klam(p)-sE-&
Function: noun
Etymology: New Latin, from Greek eklampsis sudden flashing, from eklampein to shine forth, from ex- out + lampein to shine
Date: circa 1860
: a convulsive state; especially : an attack of convulsions during pregnancy or parturition
- eclamp·tic /i-'klam(p)-tik/ adjective
Merriam-Webster's Online Dictionary
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Who gets Preeclampsia?
Preeclampsia occurs in 5-8 percent of all pregnancies, though it is most common in first-time pregnancies. Some research suggests that one's risk of preeclampsia is increased with a first pregnancy with a new partner/husband, however recent research suggests that the key factor in that increased risk is not the new husband, but in fact increased maternal age. The most significant risk factors for preeclampsia are:
- Previous history of preeclampsia, particularly if onset is before the third trimester
- History of chronic high blood pressure, diabetes or kidney disorder
- Family history of the disorder (i.e., a mother, sister, grandmother or aunt who had the disorder)
- Women with greater than 30% Body Mass Index (BMI). To determine your
BMI, click on the following link http://nhlbisupport.com/bmi/bmicalc.htm
and follow the instructions there.
- Multiple gestation
- Over 40 or under 18 years of age
- Polycystic ovarian syndrome
- Lupus or other autoimmune disorders such as rheumatoid arthritis, sarcoidosis or MS.
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What causes Preeclampsia?
There are a number of theories ranging from too much blood flow to too little. Some current theories include:
Medical Description |
Layperson's Description |
Uterine ischemia/ underperfusion |
Insufficient blood flow to the uterus |
Prostacyclin/thromboxane imbalance (ASA) |
Disruption of the balance of the hormones that maintain the diameter of the blood vessels. |
Endothelial activation and dysfunction |
Damage to the lining of the blood vessels that regulates the diameter of the blood vessels keeping fluid and protein inside the blood vessels and keeps blood from clotting. |
Calcium deficiency |
Calcium helps maintain vasodilation, so a deficiency would impair the function of vasodilation (see above) |
Hemodynamic vascular injury |
Injury to the blood vessels due to too much blood flow,i.e. the garden hose hooked up to a fire hydrant |
Preexisting maternal conditions |
Mother has undiagnosed high blood pressure or other preexisting problems such as diabetes, lupus, sickle cell disorder, hyperthyroidism, kidney disorder, etc. |
Immunological Activation |
The immune system believes that damage has occurred to the blood vessel and in trying to fix the "injury" actually makes the problem worse (like scar tissue) and augments the process. |
Nutritional Problems/Poor Diet |
Insufficient protein, excessive protein, not enough fresh fruit and vegetables (antioxidants), among others theories. |
High Body Fat |
High body fat may actually be the symptom of the tendency to develop this disorder linked to the genetic tendency towards high blood pressure, diabetes and insulin resistance. |
Insufficient Magnesium Oxide and B6 |
Magnesium stabilizes vascular smooth muscles and helps regulate vascular tone. Too much magnesium acts as a laxative and is not absorbed into the body. |
Genetic Tendency |
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What does preeclampsia do?
It can cause your blood pressure to rise and puts you at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary edema (fluid on the lungs), seizures and, in severe forms, maternal and infant death. Because preeclampsia affects the blood flow and placenta, babies can be smaller and are often born prematurely. Ironically, sometimes the babies can be much larger. While maternal death from preeclampsia is rare in the U.S., it is a leading cause of illness and death globally for mothers and infants.
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How does preeclampsia affect pregnancy?
Preeclampsia is often silent, showing up unexpectedly during a routine blood pressure check and urine test. In cases like this, if the baby is near term (after 36 weeks) the baby is induced, delivered and the mother watched and sent home as usual.
If preeclampsia occurs earlier in the pregnancy, especially for a mother expecting multiple births, its impact is more profound. Time off work, bed rest, medication and even hospitalization may be prescribed to keep the blood pressure under control. It is in the best interest of the babies to be kept in-utero as long as possible. Unfortunately, the only "cure" for the disease is delivery of the baby. Sometimes it is in the best interest of the mother to delivery the baby before term. Medical personnel may prescribe anti-hypertensive medications, such as beta-blockers, and in rare cases, lasix or diuretics (water pills), though that is generally not advised. If the blood pressure cannot be managed with medication and treatment and the mother's and/or infant's health is at risk, then the mother may be given steroids to aid the maturation of the infant's lungs and the baby will be delivered.
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When does preeclampsia occur in a pregnancy?
Preeclampsia can appear at any time during the pregnancy, delivery and up to six weeks post-partum, though it most frequently occurs in the final trimester and resolves within 48 hours of delivery. Preeclampsia can develop gradually, or come on quite suddenly, even flaring up in a matter of hours, though the signs and symptoms may have been present for months undetected or unnoticed.
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Can preeclampsia occur after the baby is born?
In some instances, preeclampsia does not show up until during the delivery, or up to two weeks post-partum. While this is less dangerous for the baby, it is actually the most critical time for the mother. Any of the above signs and symptoms should be cause for concern, and the mother should immediately contact her health care provider.
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How does preeclampsia affect the baby?
Prematurity
Preeclampsia is responsible for 15% of premature births in the US each year. It is the leading known cause of
preterm birth. According to the March of Dimes, in 2001, 476,250 infants were born prematurely…over half from unknown
causes. Preeclampsia represents 30% of the known causes of prematurely--or approximately 70,000 premature
births.
A baby is considered premature prior to 36 weeks gestation (one month early) but most severe
prematurity issues occur to babies born before approximately 32 weeks in
developed countries, and somewhat later in developing countries. (As developing
countries often lack the standard of critical care that preemies require). The impact of prematurity is not fully
known, even in infants who were only slightly premature.
Intrauterine Growth Restriction (IUGR)
Reduced blood flow to the placenta restricts the supply of food to the baby and can result in a shortage
of food and subsequent starvation. As a result, they may be smaller for their gestational age. Ultrasounds can help identify IUGR. The good news is many babies who suffer from
IUGR can catch up on their growth within a few months.
It is important to note that many women blame themselves or poor nutrition for
IUGR. Such problems are caused by a
failing placenta and not the mother’s diet. A woman could be eating all of the right things but if the placenta is
not capable of passing such nutrients along--the baby will suffer.
Acidosis
The baby survives by receiving nutrients and oxygen through the placenta. In preeclampsia, the placenta becomes compromised and the baby’s
body begins to restrict blood flow to the limbs, kidney and stomach in an
effort to preserve the vital supply to the brain and heart. If the baby reaches the point where there is
no further reserve of oxygen (as the placenta detaches or dies) the baby’s body
can extract energy from its fuel supplies without oxygen. This process generates a poisonous waste
product--lactic acid. If too much lactic acid builds up the baby will develop “acidosis” and become unconscious
and stop moving. Delivery is essential at this point. (thanks to:
Pre-Eclampsia: The Facts, by Redman, Walker, 92).
Death
Infant death is one of the most devastating consequences of preeclampsia. It is impossible to say how many infants die each year,
however, we estimate that at least 1200 babies die due to preeclampsia in the US alone. Many countries do not have the means to keep a premature baby
alive. In these countries--the death toll is significant.
At the Preeclampsia Foundation a full 20% of our members have lost at least one baby or suffered a
miscarriage. Because this disease can manifest in a very short time--a woman can have a normal prenatal appointment
in the morning and lose her baby by the afternoon. We encourage our women to err on the side of caution.
Ongoing life challenges
Preeclampsia has been linked to a host of lifelong challenges for infants born prematurely, among them learning disabilities, cerebral palsy, epilepsy, blindness and deafness. With prematurity also comes the risk of extended hospitalization, small gestational size and the interruption of valuable bonding time for families. Prematurity stresses a family unit, and this stress is compounded when the mother is also ill.
Some studies suggest that babies born to a preeclamptic mother have an increased risk of high blood pressure and diabetes later in life. Very few studies have followed the health of these babies.
Education, vigilance and being proactive patients can reduce some of these deaths but ultimately-we need more research. We need to find a cure.
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What is the cure?
The only cure is delivery of the baby. When preeclampsia develops, the mother and her baby are monitored carefully. There are medications and treatments that may prolong the pregnancy, which can increase the baby's chances of health and survival. Unfortunately, once the course of preeclampsia has begun, the health of the mother must be constantly weighed against the health of the baby. In some cases, the baby must be delivered immediately, regardless of gestational age, to save the mother's and/or baby's lives.
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What can we do?
Right now, early diagnosis through simple screening measures and good prenatal care can predict or delay many effects of the condition. Prompt treatment saves lives. Research may be able to provide insight into the causes of the condition, and even help to develop a cure. The Preeclampsia Foundation can help to fund the research needed to find a cure and work to bring the information we already have to those who need it most. In developing countries, as many as 30 percent of maternal deaths are caused by preeclampsia, and so part of our mission is to reduce maternal and infant deaths internationally. With your help we can achieve that mission.
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Will I get preeclampsia in a subsequent pregnancy?
If my first pregnancy was normal…
If you had a normal first pregnancy, your risk of having
preeclampsia in the next pregnancy is very low, however if you have other risk
factors (such as advanced maternal age, excess weight, family history of
hypertension) you should still be watchful and alert to early warning
signs. A study in Aberdeen, Scotland
showed that nearly 1 in 150 women whose blood pressures had been entirely
normal in their first pregnancy had preeclampsia in a second pregnancy. (ref: Preeclampsia: The Facts by Redman,
Walker 1992)
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If I had preeclampsia in my first or an earlier pregnancy…
There has not been significant research looking at the rate
of reoccurrence in subsequent pregnancies, however the consensus among experts
is that preeclampsia in a previous pregnancy is the single largest risk factor
for developing preeclampsia. It is
entirely wrong to say that if you had it in your first--you will not get it
again. The risk of having it again is
approximately 20%, however experts cite a range from 5-80% depending on when
you had it in a prior pregnancy and how severely you had it.
The risk increases if since your previous pregnancy you have developed chronic hypertension,
diabetes, or if you are having IVF, twins or other multiples, as well as the risk factors mentioned above.
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If I had it in a first but not a second…
If you do not have preeclampsia in a second pregnancy, your
risk for reoccurrence in a third is low, though it can happen.
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If I have been advised against getting pregnant again…
Some preeclampsia experiences are traumatic for
those who cared for you as well. Sometimes a doctor feels out of their depth and will advise against a
future pregnancy because they do not know what will happen and they fear for
your safety and well-being. We advise
all women in this position to seek out a pre-pregnancy consultation with a
perinatologist who specializes in preeclampsia and related disorders. They can review your chart and give you a
clearer idea of your risks. Even a
well-meaning OB may not have the experience to make this call. No one will be able to decide for you,
however, they can help you weigh your options.
Some of our experts have weighed in on this topic in the Forum.
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More answers to your questions coming soon!
Impact of preeclampsia
After preeclampsia
Coping with a loss
What to do when your wife or partner has preeclampsia?
What is the long-term impact of preeclampsia on my child?
Preeclampsia and Loss
Pregnancy after preeclampsia
Global impact
If you have a question you think we should post at "Frequently Asked Questions" please email us directly at info@preeclampsia.org
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