Preeclampsia and Eclampsia: What You Need to Know

TABLE OF CONTENTS

• Key Takeaways
• What Is Preeclampsia?
• Are You at Increased Risk of Developing Preeclampsia?
• Symptoms of Preeclampsia
  • Signs and Symptoms of Severe Preeclampsia
  • Preeclampsia’s Effects on Babies in Utero
• Can Preeclampsia Be Prevented?
• How Is Preeclampsia Treated?
• What Should I Expect After Delivery?
• Eclampsia
• What Should I Expect if I Have a Seizure?
  • Potential Complications of Eclampsia
  • What Happens to My Baby if I Have a Seizure?
• HELLP Syndrome
  • Risk Factors for HELLP Syndrome
  • Symptoms of HELLP Syndrome
  • Is There a Test for HELLP Syndrome?
  • Treatment for HELLP Syndrome
  • How Will HELLP Syndrome Affect Me and My Baby?
  • What Should I Expect After Delivery?
• Summary

Key Takeaways

• Preeclampsia is a disorder that affects women who are pregnant or have just given birth.
• High blood pressure, excess protein in the urine, problems with internal organs, and poor growth of your baby are some of the problems associated with preeclampsia.
• Women with preeclampsia can also develop eclampsia—seizures that can occur before, during, or after delivery.

What Is Preeclampsia?

Preeclampsia is a serious blood pressure disorder that can affect all the organs in your body. It is a complication of pregnancy, meaning it only occurs in pregnant and postpartum women (women who have just given birth).

Preeclampsia can cause:

• High blood pressure (hypertension).
• Too much protein in your urine (proteinuria).
• Problems with organs like your liver, kidneys, brain, eyes, or placenta.
• Poor growth of your baby.

Preeclampsia can occur during pregnancy even if your blood pressure was previously normal.

Preeclampsia usually develops during the second half of pregnancy (after 20 weeks). However, it can also happen during labor or even after the baby is born. Preeclampsia that occurs before 34 weeks of pregnancy is called early-onset preeclampsia.

In the United States, preeclampsia occurs in 5% of pregnancies. 90% of these cases occur after 34 weeks of pregnancy, and most occur after 37 weeks.

There are several different types of preeclampsia. Different categories of preeclampsia include:

• Preeclampsia occurring alongside gestational hypertension or chronic hypertension.
• Preeclampsia with severe features.
• Eclampsia.
• HELLP syndrome.

Preeclampsia can be a dangerous medical condition. Even mild preeclampsia must be monitored closely to make sure it doesn’t get worse. Without treatment, preeclampsia can cause kidney, liver, and brain damage. Preeclampsia can be life-threatening.

For example:

• Eclampsia causes seizures and can lead to coma.
• HELLP syndrome can damage your blood cells, liver, kidneys, and placenta.

Are You at Increased Risk of Developing Preeclampsia?

Several factors may increase your risk of developing preeclampsia during or after pregnancy, including:

• First pregnancy (excluding miscarriages and abortions).
• Chronic high blood pressure (hypertension), kidney disease, lupus, or diabetes prior to pregnancy.
• A history of preeclampsia in a prior pregnancy.
• Gestational diabetes.
• Multiple gestation (e.g., having twins or triplets).
• Obstructive sleep apnea.
• A family history of preeclampsia in your sister or mother.
• Obesity.
• Age under 20 years or over 35 years.
• Thrombophilia.
• Antiphospholipid antibody syndrome.
• Pregnancies conceived with assisted reproductive technology (in vitro fertilization [IVF], for example).

Symptoms of Preeclampsia

Generally, preeclampsia does not cause symptoms unless it is severe. In fact, you may have no symptoms with preeclampsia. This is why prenatal visits to check for high blood pressure occur more frequently in the second half of pregnancy.

Most women with preeclampsia have mildly high blood pressure (140/90 on more than one occasion) and a small amount of excess protein in the urine. 40% of women with new-onset high blood pressure or protein in the urine will develop preeclampsia. Preeclampsia can also impair the ability of the placenta to support your baby.

Preeclampsia is a progressive disease. This means that preeclampsia does not get better until after you have given birth. Approximately 25% of patients with preeclampsia develop severe hypertension or at least one severe feature of preeclampsia.

Signs and Symptoms of Severe Preeclampsia

• Persistent or severe headache.
• Visual abnormalities, including “floaters,” light sensitivity (photophobia), and blurred vision.
• Pain in the chest or the upper abdomen/below the ribs.
• Altered mood or behavior (confusion, aggressive behavior, agitation).
• New onset shortness of breath, coughing, wheezing.
• Increase in blood pressure to 160/110 or higher on more than one occasion (blood pressures in this range put you at an increased risk of stroke).
• Abnormal lab values.
• Fluid in the lungs.
• Seizure (eclampsia).

Preeclampsia’s Effects on Babies in Utero

• Abnormal testing of fetal well-being (such as a nonreactive nonstress test or low biophysical profile score).
• Slowed growth of the fetus or intrauterine growth restriction [UGR] (usually evident on ultrasound exams).
• Decreased amount of amniotic fluid around the fetus (usually evident on ultrasound exams).
• Decreased blood flow through the umbilical cord (noted on Doppler tests performed during ultrasound examination).

Prenatal visits to check for high blood pressure occur more frequently in the second half of pregnancy. This allows for early diagnosis of preeclampsia, if present.

Can Preeclampsia Be Prevented?

To date, no single test reliably predicts preeclampsia. In fact, experts are not completely sure why some women get it while others do not.

Strategies to prevent preeclampsia have been studied extensively over the past 30 years. No treatment or therapy has been proven effective at eliminating the risk of preeclampsia. Currently, the best approach is increased monitoring and reducing health risks. Heightened monitoring for signs of preeclampsia, identifying those at high risk of developing the disease, and using low-dose aspirin in certain groups are the best strategies.

Studies have shown that starting low-dose aspirin (LDA) therapy before 16 weeks of pregnancy and continuing it daily until 36 weeks can be an effective mechanism for preventing preeclampsia in high-risk patients.

The use of low-dose aspirin in certain high-risk pregnancies may help prevent preeclampsia.

The American College of Obstetricians and Gynecologists (ACOG) recommends the use of low-dose aspirin in pregnancy if you have certain high risk factors for developing preeclampsia.

You may benefit from the use of low-dose aspirin in pregnancy if you have at least one of the following risk factors:

• History of preeclampsia
• Multiple gestation (e.g., twins, triplets)
• Kidney disease
• Autoimmune disease
• Type 1 or type 2 diabetes
• Chronic hypertension

You may also benefit from the use of low-dose aspirin in pregnancy if you have at least two of the following risk factors:

• First pregnancy
• Maternal age of 35 years or older
• Family history of preeclampsia
• Obesity (BMI >30)
• Low socio-demographic status
• Conception with IVF
• Personal history factors (previous health issues during pregnancy, low birth weight, more than 10 years since your previous pregnancy)

The use of low-dose aspirin (LDA) is not recommended in pregnancies that are at average risk for preeclampsia. Do not take LDA without consulting your obstetrician.

How Is Preeclampsia Treated?

The only cure for preeclampsia is delivery of the baby and placenta. While medication can lower your blood pressure (reducing the risk of stroke), it does not prevent the disease from worsening.

The two main considerations in managing preeclampsia are:

• How many weeks along is your pregnancy?
• Do you have severe features of preeclampsia?

The method of delivery that will be used (vaginal or cesarean birth) depends on:

• The position of the fetus.
• The dilation and effacement (thinning) of the cervix.
• You and your baby’s health.

In most situations, vaginal delivery is possible.

Pregnancies complicated by preeclampsia at ≥37 weeks (i.e., full term) are delivered to minimize the risk of harm to you and your baby and prevent the worsening of preeclampsia.

If preeclampsia develops before full term and there are no severe features of the disease, it may be possible to delay delivery to 37 weeks to give the fetus more time to grow and mature. Alternatively, prompt delivery is recommended to manage preeclampsia with severe features occurring at >34 weeks of pregnancy.

In some cases, preeclampsia with severe features diagnosed prior to 34 weeks may need to be delivered despite the baby being very preterm. The management decision will be made by your team of doctors, including your perinatologist (high-risk obstetrician).

What Should I Expect After Delivery?

Delivery is the only cure for preeclampsia. It may take weeks for your symptoms to completely resolve. Occasionally, your symptoms may worsen before they get better, even after delivery. But the healing process will not start until you are no longer pregnant.

You will be monitored closely in the postpartum period. Mildly elevated blood pressure over a few weeks or months is not usually harmful.

Severe high blood pressure after delivery should be treated, and you will require hypertension medication after being discharged from the hospital. This can be discontinued when the blood pressure returns to normal levels (usually within six weeks).

Blood pressure that remains elevated longer than 12 weeks after delivery is unlikely to be related to preeclampsia and may require long-term treatment. Having preeclampsia puts you at increased risk of cardiovascular disease later in life. A healthy diet, avoiding obesity, not smoking, and good management of cholesterol, blood sugar, and blood pressure are important lifestyle modifications.

Eclampsia

Eclampsia is the new onset of one or more seizures in a woman with preeclampsia who has no other conditions that could have caused the seizure. In the US, the incidence of eclampsia is low and has been stable at 1.5 to 10 cases per 10,000 deliveries. Risk factors for eclampsia are similar to those for preeclampsia.

Eclampsia occurs in patients with preeclampsia. Sometimes, however, a seizure is the first sign of the condition. Eclampsia can occur before, during, or after labor, and 20–38% of women do not demonstrate the classic signs of preeclampsia (hypertension or proteinuria) before the seizure occurs. However, you may have warning signs in the hours leading up to the initial seizure.

In a review of 59 studies involving over 21,000 patients with eclampsia, the most common pre-seizure signs were:

• Hypertension (75% of cases)
• Persistent headache (66% of cases)
• Visual disturbances (27% of cases)
• Right upper quadrant or epigastric pain (25% of cases)
• Asymptomatic (i.e., no symptoms) (25% of cases)

What Should I Expect if I Have a Seizure?

The complication rate if you have an eclamptic seizure is 70%. Typically, complications like liver and kidney damage, lab abnormalities, hypertension, and neurologic abnormalities resolve in the hours and days following delivery. Although lasting neurologic damage is rare, some women may have short-term and long-term consequences, such as impaired memory and cognitive function, especially after recurrent seizures or uncorrected severe hypertension.

Brain damage from bleeding in the brain or a lack of oxygen to the brain may result in permanent neurologic damage. This is the most common cause of death in patients with eclampsia.

Maternal mortality rates from eclampsia of 0–14% have been reported over the past few decades. Maternal morbidity and mortality are lowest when you receive regular prenatal care from an experienced physician in a tertiary care center.

Potential Complications of Eclampsia

• Abruption (tearing of the placenta)
• Disseminated intravascular coagulation.
• Pulmonary edema.
• Acute renal failure.
• Aspiration pneumonia.
• Cardiopulmonary arrest.
• Liver hematoma.
• HELLP syndrome.
• Perinatal death.
• Preterm birth.
• Bleeding in the brain.
• Transient (temporary) blindness.

What Happens to My Baby if I Have a Seizure?

It is common for the fetal heart to slow down for three to five minutes during and right after an eclamptic seizure. Administering anti-seizure medication and oxygen and controlling severe hypertension help the baby to recover inside the uterus. However, if the heart rate does not return to normal within 10–15 minutes, an emergency delivery may be necessary. A study from Canada reported a fetal death rate in eclamptic pregnancies of 10.8 per 1,000 total births (1.08% of total births).

Your risks related to eclampsia is lowest when you receive regular prenatal care from an experienced physician in a tertiary care center.

HELLP Syndrome

HELLP is an acronym that refers to a syndrome seen in pregnant and postpartum women. It stands for:

• Hemolysis (the breakdown of red blood cells).
• Elevated Liver Enzymes.
• Low Platelets (platelets are cells in your body that prevent excess bleeding).

HELLP syndrome develops in 0.1 to 1.0% of pregnancies. Among patients with severe preeclampsia/eclampsia, 1 to 2% develop HELLP. Some researchers and doctors believe that HELLP syndrome represents a severe form of preeclampsia. However, the relationship between the two disorders remains controversial.

Risk Factors for HELLP Syndrome

Risk factors for HELLP syndrome include having a previous history of preeclampsia or of HELLP syndrome. HELLP syndrome usually occurs in the last 3 months of pregnancy, but it can also happen earlier, or even 1 or 2 days after the baby is born. 30% of cases of HELLP occur after delivery.

Symptoms of HELLP Syndrome

Symptoms of HELLP syndrome include:

• Abdominal pain, especially in the middle or upper-right abdomen.
• Nausea or vomiting (50% of cases).
• Generally feeling sick (malaise) (90% of cases).

Is There a Test for HELLP Syndrome?

HELLP syndrome causes many changes in your laboratory values. A series of blood tests can diagnose HELLP.

Treatment of HELLP Syndrome

The cornerstone of therapy for HELLP occurring during pregnancy is delivery, which is the only effective treatment. Most experts agree that prompt delivery is indicated after the mother’s health has stabilized.

How Will HELLP Syndrome Affect Me and My Baby?

HELLP syndrome damages or destroys red blood cells and interferes with blood clotting. It can also cause chest pain, abdominal pain, bleeding in the liver, and placental abruption. HELLP syndrome is a medical emergency. It has been associated with increased rates of maternal morbidity and mortality.

Maternal complications are primarily related to bleeding. Neonatal (newborn) complications are primarily related to the gestational age at birth, which is commonly preterm.

What Should I Expect After Delivery?

Laboratory values may worsen in the 48 hours following birth. Because of this, lab testing is usually done at 12-hour intervals in the postpartum period. The outcome for patients with HELLP is generally good. However, serious complications can occur.

Patients who are critically ill or at substantial risk for developing serious complications may need to be transferred to an intensive care unit (ICU) for observation. Bleeding that requires a blood transfusion is the most common complication, occurring in 55% of women.

In a study of 512 patients with HELLP who became pregnant again:

• 7% developed HELLP in a subsequent pregnancy.
• 18% developed preeclampsia.
• 18% gestational hypertension.

Despite the frequency of maternal complications from HELLP, maternal mortality is low (approximately 1%). The baby’s risk of death (perinatal mortality) is 7 to 20%. Complications of preterm birth, intrauterine growth restriction, and abruption are the leading causes of perinatal death.

Summary

Regular prenatal visits are the most effective way to diagnose preeclampsia in its early stages. If left untreated, preeclampsia carries the risk of serious long-term complications, including death, for both mother and baby.

Written by: Lisa Shephard, MD | Editor: Victoria Menard and Dayna Smith MD | Reviewed July 28, 2022 | Copyright myObMD Media, LLC, 2022