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Preeclampsia

Preeclampsia

Definition

Preeclampsia is high blood pressure and protein in the urine that develops after the 20th week of pregnancy.

Alternative Names

Toxemia; Pregnancy-induced hypertension

Causes, incidence, and risk factors

The exact cause of preeclampsia is not known. Possible causes include:

Preeclampsia occurs in a small percentage of pregnancies. Risk factors include:

Symptoms

Symptoms of preeclampsia can include:

  • Headaches
  • Swelling of the hands and face (edema)
  • Weight gain
    • More than 2 pounds per week
    • Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with pregnancy.

Other symptoms that can occur with this disease:

Signs and tests

  • Increase in blood pressure
  • Elevated liver function tests
  • Platelet count less than 100,000 (thrombocytopenia)
  • Protein in the urine (proteinuria)
  • Swelling in the upper body
  • Weight gain

Treatment

The only way to cure preeclampsia is to deliver the baby. However, if that delivery would be very early (premature), the disease can be managed by bed rest, close monitoring, and delivery as soon as the fetus has a good chance of surviving outside the womb.

Patients are usually put in the hospital, but sometimes can be managed at home with careful monitoring of blood pressure, urine, and weight.

Ideally, the condition can be managed so that the mother can deliver after the 37th week of pregnancy.

Labor may be induced if any of the following occur:

  • Abdominal pain
  • Abnormal biophysical profile (a test to monitor the health of the fetus)
  • Abnormal liver function tests
  • Diastolic blood pressure greater than 100 mmHg consistently for a 24-hour period, or any confirmed reading over 110 mmHg
  • Eclampsia
  • Failure of the fetus to grow (found on ultrasound)
  • Fluid in lungs (pulmonary edema)
  • HELLP syndrome
  • Low platelet count (thrombocytopenia)
  • Persistent or severe headache
  • Rising serum creatinine

In cases of severe preeclampsia when the pregnancy is between 32 - 34 weeks, delivery is the treatment of choice. For pregnancies less than 24 weeks, inducing labor is recommended, although the likelihood that the fetus will survive is ver

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