What Is Preeclampsia?
Preeclampsia is a form of hypertension, or high blood pressure, that occurs in women who previously had normal blood pressure, which is why it’s sometimes referred to as “new-onset” high blood pressure. Preeclampsia usually begins later in a pregnancy, after the 20th week or so, but some cases are diagnosed earlier than that. The high blood pressure can also last long after delivery, Medscape reports. Post-partum, some women will experience preeclampsia symptoms for an extra four to six weeks.
Symptoms & Signs
While obstetricians diagnose the condition based on two specific signals (high blood pressure and urine protein content), some preeclampsic women will experience a number of associated symptoms:
- swelling in the hands, face and eyes
- sudden weight gain (caused by an increase in fluid retention)
- severe nausea and vomiting
- abdominal pain (especially in the upper right side)
- decreased urine output
- visual disturbances – blurred vision, sensitivity to light
The symptoms of preeclampsia can be hard to interpret. From the list above, we can already notice that many of the symptom’s conditions, like nausea and vomiting, are strikingly similar to the normal side effects of being pregnant. And some swelling, especially in the feet and ankles, is to be expected during pregnancy.
To complicate matters, many women develop “silent” cases of the disorder, in which no symptoms are present. And, in any event, preeclampsia’s leading markers (high blood pressure and protein in the urine) can’t be felt at all. That’s why you should have your blood pressure and urine protein content checked at every prenatal visit.
How Doctors Diagnose Preeclampsia
In the clinical setting, preeclampsia is identified by two co-occurring factors:
- new-onset hypertension – high blood pressure
- new-onset proteinuria – protein in the urine
Obstetricians should administer routine blood pressure tests to monitor their pregnant patients for signs of preeclampsia. Medical experts agree that preeclampsia-related hypertension should be diagnosed when a woman’s diastolic blood pressure (the pressure inside the heart when it beats) reaches at least 140 mm Hg or when systolic blood pressure (the pressure between beats) reaches 90 mm Hg. When these readings are taken is also important. The clinical standard requires two consistently-high readings taken at least four hours apart.
Severe High Blood Pressure
Obviously, higher numbers should also be considered evidence of preeclampsia, too. Especially high blood pressure levels are usually approached with extra caution. When a woman’s diastolic blood pressure reaches 110 mm Hg, or the systolic blood pressure reaches 160 mm Hg, immediate treatment is almost always the answer. Beyond absolute numbers, extreme changes in blood pressure can also be cause for concern, according to the Preeclampsia Foundation.
Urine Protein Tests
Another diagnostic test that should be performed on a regular basis looks at the chemical content of your urine, to check for signs of proteinuria. According to guidelines from the American Congress of Obstetricians and Gynecologists (ACOG), a high urine protein content should be diagnosed when a 24-hour urine collection shows 300 mg or more of protein.
An alternative measurement looks at the ratio between protein and creatinine, a waste molecule released as muscles work. A protein-to-creatinine ratio of 0.3 or higher is an accepted sign of proteinuria.
A dipstick test can also help in diagnosis, but should never be considered conclusive. In performing a dipstick test, doctors immerse a urine test strip into the patient’s urine. The test strip features different chemical agents that change color when they come into contact with protein, blood and other substances.
But dipsticks don’t tell you how much protein is in the urine; they’re either positive or negative. That’s why urine test strips often result in false positives or false negatives and most experts believe a dipstick test should only supplement, rather than replace, more-accurate testing. As ACOG writes, dipstick tests should only be relied on “if other quantitative methods [are] not available.”
Additional Diagnostic Factors
High levels of protein in the urine are a primary signal of preeclampsia, but some women who should be considered preeclampsic don’t develop proteinuria, ACOG writes. Tragically, some doctors have been unwilling to diagnose the condition and treat it properly without evidence of proteinuria, a failure of understanding that has certainly led to unnecessary deaths, both of mothers and their children. When a pregnant woman has new-onset high blood pressure, but no sign of proteinuria, we can still diagnose preeclampsia based on other factors:
- thrombocytopenia – low blood platelet count (less than 100,000 / microliter)
- renal insufficiency – poor kidney function (usually determined using a blood test)
- impaired liver function (usually determined using a blood test)
- pulmonary edema – excessive fluid in the lungs
- visual disturbances
Note that any one of these side effects, when paired with a clinically-relevant high blood pressure, is enough to reach a diagnosis of preeclampsia. You don’t need to experience all of them, or even more than one of them, to be properly-diagnosed with the condition. But with any of these additional signs, we’ve also moved from preeclampsia to a form of the condition known as preeclampsia with severe features.
Preeclampsia With Severe Features
As the name suggests, preeclampsia with severe features is another step on the way to eclampsia, a rare but severe complication in which high blood pressure causes seizures. This progression, from preeclampsia to eclampsia, can happen very quickly, often just a few days.
Once preeclampsia has been diagnosed, physicians should approach the condition as a serious problem. Doctors, ACOG suggests, should provide treatment assuming the distinct possibility that preeclampsia can get worse, because it can. As a pregnant woman approaches eclampsia, along with the serious seizures, organ failure and strokes that can threaten her own life and that of her child, her symptoms can become more extreme:
- severe headaches
- altered consciousness
- labored breathing
- intense abdominal pain
- clonus – involuntary muscle contractions
- visual disturbances – flickering blind spots
Women with preeclampsia are often hospitalized after their diagnosis, to make monitoring their health and the health of their baby easier. There is, in the traditional sense, no cure for the condition, except delivering the child.
Treating High Blood Pressure In Pregnancy
Labor induction is really the only way to avert danger when a case of preeclampsia is progressing. Without severe features, most pregnant women who develop preeclampsia are induced at some after 37 weeks, depending on their symptoms and the results of diagnostic tests.
Severe features usually require more-immediate intervention. After 34 weeks of pregnancy, labor induction becomes a possibility, but the benefits of stopping the progression of preeclampsia must be weighed against the risks posed by delivering a premature infant.
While several risk factors for preeclampsia have been suggested, none are conclusive enough to be relied on in medical practice. Doctors just can’t tell, before the condition has developed, which women will get preeclampsia and which women won’t get it. Even so, it’s good to note these risk factors, because they can change how physicians attempt to prevent preeclampsia from happening.
- multiple pregnancy
- history of obesity
- personal or family history of preeclampsia
- personal history of diabetes, kidney problems or autoimmune disorders
Statistical evidence also gives us a clue to who is more likely to experience preeclampsia, irrespective of the risk factors we mentioned above. As the National Institute of Child Health reports, women are most likely to develop the condition during their first pregnancy. The risk falls during subsequent pregnancies, but also rises as the mother gets older. Pregnant women older than 40 are at an increased risk, as, for yet unexplained reasons, are African American women. Preeclampsia is also more common among women who became pregnant through in vitro fertilization (IVF), donor insemination or egg donation.
Do these risk factors change how doctors treat pregnant women? A little. The US Preventive Services Task Force recommends, for women who live at high risk for preeclampsia, to take a low-dose of aspirin (81 mg per pay) beginning after the 12th week of pregnancy.
Who Can File A Malpractice Lawsuit?
Women who were given a preeclampsia misdiagnosis may be eligible to secure financial compensation by filing a medical malpractice lawsuit. While not every case of mismanaged preeclampsia is enough to constitute medical negligence, hundreds of mothers have been able to recover significant damages for their trauma, as well as the birth injuries inflicted on their children. In some states, women who lost a child to undiagnosed preeclampsia may be able to file a wrongful death lawsuit and pursue financial compensation, as can widowers who lost a loved one to mismanaged cases of the disorder.
To learn more about filing a lawsuit, contact the experienced attorneys at Monheit Law today for a free consultation.