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Preeclampsia and Eclampsia

Preeclampsia and Eclampsia

Many women develop preeclampsia through their pregnancy and a handful go onto develop eclampsia. The only definitive cure is delivering the baby, but it can still take up to 3 months for all the symptoms to stop. There are medications that help manage the symptoms of preeclampsia to assist in keeping Mum and baby safe while trying to continue the pregnancy for as long as possible. Approximately 30% to 50% of patients with eclampsia also have the HELLP syndrome.

What is preeclampsia and eclampsia?

Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive disorders that can occur during pregnancy. Preeclampsia and eclampsia generally develop after 20 weeks of pregnancy, but in rare cases can present prior to 20 weeks. Postpartum preeclampsia and eclampsia can be fatal if not treated urgently.

What causes preeclampsia and eclampsia?

Experts are still not entirely sure what causes preeclampsia, but recent research has provided some good clues. The best hypothesis is that preeclampsia occurs when the placenta does not anchor itself as deeply as expected within the wall of the uterus during the first trimester. What causes this abnormal anchoring is unclear, but it may be influenced by the mother's or father's genes or the mother's immune system, and medical conditions the mother may have, such as diabetes or high blood pressure. They are also doing studies into other factors like placenta abnormalities, environmental exposure, nutritional factors, cardiovascular and inflammatory changes, autoimmune disorders and hormonal imbalances.

What are the symptoms?

- High blood pressure

- High levels of protein in the urine

- Edema of the face, hands, legs and feet

- Headache

- Blurred vision/flashing lights/or floating particles

- Right upper abdominal pain

- Severe vomiting or nausea

- Difficulty breathing

- Decrease in urine output

- Fluid build-up in your chest

- Seizures (only present in eclampsia)

- Stroke (only present in eclampsia)

- Blindness (only present in eclampsia)

- Internal bleeding from the liver (only present in eclampsia)

- Haemorrhaging post birth

How is preeclampsia and eclampsia diagnosed?

- High levels of protein in the urine

- Low platelets in your blood

- High levels of kidney related chemicals in your blood

- High levels of liver related chemicals in your blood

- Fluid in your lungs

- Headaches that will not go away with medication

- Ultrasound

What are the risks to the mother?

Mild preeclampsia can progress to eclampsia within a matter of days. Women with preeclampsia are at increased risk for damage to the kidneys, liver, brain, and other organ and blood systems. Preeclampsia may also affect the placenta. The condition could lead to a separation of the placenta from the uterus (placental abruption), preterm birth, and pregnancy loss or stillbirth. In some cases, preeclampsia can lead to organ failure or stroke. When preeclampsia becomes eclampsia seizures manifest which can result in death. In first world countries, preeclampsia and eclampsia and usually professionally managed however preeclampsia and eclampsia still make up 14% of maternal deaths worldwide.

Post birth the symptoms of preeclampsia and eclampsia should resolve within 6 weeks. Studies have shown that women who have preeclampsia/eclampsia are 4 times more likely to develop hypertension and 2 times more likely to develop ischemic heart disease, a blood clot in the vein and stroke in life. Less commonly, mothers who had preeclampsia can experience permanent damage to their organs, such as their kidneys and liver. They can also experience fluid in the lungs. In the days following birth, women with preeclampsia remain at increased risk for developing eclampsia and seizures. Postpartum preeclampsia and eclampsia are of concern even if you did not display symptoms during pregnancy.

What are the risks to the baby?

Preeclampsia and eclampsia can cause lack of nutrients and oxygen traveling through the placenta, foetal growth restriction, preterm birth and stillbirth due to placental abruption. Stillbirth is more likely to occur if the mother also has HELLP syndrome. Infants who experienced poor growth in utero are at higher risk of diabetes, congestive heart failure and high blood pressure later in life.

What is the treatment?

The only definitive treatment for preeclampsia and eclampsia is delivery of the baby via induction or c-section, however you must weigh up the risks of managing the preeclampsia or eclampsia for as long as possible against the risks of a premature birth. There are medications that can help manage the symptoms of preeclampsia to get you as close to your due date as possible. Anyone who develops preeclampsia will be put on bed-rest at home or in the hospital if the doctors feel you need to be very closely monitored. Foetal heart rate monitoring and regular ultrasounds, blood and urine tests as well as medications to lower blood pressure. Magnesium may also be administered to control seizures. You may also be given corticosteroid injections to mature the baby’s lungs giving it the best chance of survival if preterm birth occurs.

What is the likelihood of developing preeclampsia in subsequent pregnancies?

Once you have had preeclampsia, you are at risk of developing it again in a subsequent pregnancy. It all depends on how early you developed the condition and how severe it was. If you had preeclampsia at the very end of your previous pregnancy, the chance of it happening again is low (about 13%). In general, the earlier you develop it in pregnancy, the more severe it is and the more likely you are to develop it again. Your doctor may also recommend you have a low dose of aspirin for your first trimester, and possibly further into the pregnancy to help maintain blood pressure.

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