Pre-eclampsia: The silent stalker
Ann* was not enjoying the last trimester of her pregnancy. Her feet and legs were swollen, her back hurt and she suffered from constant headaches. All typical symptoms of pregnancy, she thought. Her blood pressure results were normal and her doctor said everything was going well. Even the sharp pains she felt in her pelvis and right side were normal, attributed to the baby dropping and the body preparing for delivery.
Just days before her due date, Ann headed to the doctor's office, feeling worse than usual, for her last appointment. To her surprise, her blood pressure had skyrocketed. Within 12 hours, she was lying in a hospital bed with an IV of beta-blockers to try and bring down her pressure which had already doubled since her appointment, while doctors induced labor.
Ann is one of the lucky ones. She was diagnosed with pre-eclampsia in time to save her and her baby, but over 50,000 women and infants die from this frighteningly sudden disease every year around the world.
Pre-eclampsia is a disorder that is exclusive to pregnancy and immediately afterwards. It usually occurs after the 20th week, and can (rarely) occur up to six weeks after delivery of the baby, but usually is resolved within 48 hours of delivery.
Although your obstetrician will be checking you at your monthly visits, it is important to be aware of the symptoms of pre-eclampsia since it can come on very rapidly and cause severe complications, ranging from headaches to premature delivery of the baby and all the way to convulsions and death for both mother and child.
High blood pressure is usually one of the major symptoms, but it doesn't always appear first. A blood pressure reading of 140/90 is generally considered to be high if it continues at that level for more than 6 hours. If your doctor notices your pressure rising, he may recommend bed rest until it drops again.
Edema or swelling of feet is a typical pregnancy complaint. If you notice that your hands and face are puffy, call your doctor. When your feet and legs are swollen (often caused by prolonged sitting or standing) put your feet up for a while and get some rest. Any discoloration in your legs or feet is something you should tell your doctor about. He will also check you for "pitting edema" which is when you press your finger into the swollen tissue and an indent remains. This is a sign of pre-eclamsia as well.
Protein in the urine is another symptom, but it could also mean you have a serious bladder infection. From mid-pregnancy onward, you should have your urine checked at each checkup. A trace amount of protein is normal, but a higher reading means your doctor will check you for pre-eclampsia. Dark colored or reddish urine could indicate a severe problem, so let your doctor know if you have these symptoms.
Sudden weight gain (more than 2 lbs in a week, or 6 in a month) could also be a sign of trouble. To avoid skyrocketing weight, try to eat a balanced diet and take your prenatal vitamins. Avoid caffeine, alcohol and smoking as well.
Headaches that just won't go away could be caused by a rise in blood pressure and should be mentioned to your practitioner, especially when accompanied by any of the above symptoms. If you start seeing spots, lights or losing vision, call your doctor immediately as these could indicate cerebral swelling. Light sensitivity and resistance to pain killers could also mean there is a problem.
Nausea and vomiting in the second and third trimester are danger signs when they come on suddenly. Even if you suspect that chow mien you ate last night, talk to your doctor. He can check your urine and blood pressure to make sure everything is fine.
Pain in your stomach or under your right ribs could be caused by a form of pre-eclampsia called HELLP Syndrome or a related liver problem. You should also be alert for shoulder pain, pain when lying on your right side and lower back pain (if accompanied by one or more of the above symptoms).
Pre-eclampsia occurs in 5-8% of all pregnancies, and globally, is the leading cause of death among women and infants. Fortunately, it can be treatable if diagnosed early enough. In severe cases, you may have to be admitted to the hospital for observation and possible emergency delivery of the baby. If you are less than 36 weeks into your pregnancy, your doctor will want to wait as long as possible before delivering the baby since the longer she is in the womb, the better developed her lungs will be. When medication and bed rest don't stabilize your pressure, you may be given steroids to augment the baby's lung maturity so she can be delivered.
While no one is certain of the exact cause of pre-eclampsia, we do know that certain factors can raise the possibility of having it. If you have had a pre-eclamptic pregnancy previously or have a family history of the problem, your risk could go up to 20%. A history of diabetes, kidney problems or chronically high blood pressure also put you at risk. So does carrying more than one baby and being older than 40 or younger than 18. If you suffer from an autoimmune disorder such as lupus, you could suffer from pre-eclampsia as well.
Since pre-eclampsia can cause so many problems in a pregnancy, it's important that your doctor keep an eye on your blood pressure during the later months. You may also have to provide urine samples. It's always better to prevent than to cure.
