Preeclampsia involves the development of hypertension accompanied by protein
in the urine and edema in women, and occurs between the 20th week of pregnancy
and the first week after delivery. Early-stage preeclampsia produces few
clinical signs, but symptoms progressively appear. Left untreated, it can
develop into eclampsia, a potentially fatal ailment that produces seizures,
bleeding, or liver or kidney problems in the woman and threatens the life of her
unborn child. Preeclampsia develops in about 5% of pregnant women. That
proportion has fallen in recent years, presumably because of improved prenatal
care. The mothers of 26 in every 1,000 live-born infants will have had the
condition, which may develop into the second leading cause of maternal
mortality. The condition, sometimes called toxemia, is more common in first
pregnancies and in women who already have hypertension or vascular disease.
Babies of women with preeclampsia may weigh less than those born to women
without preeclampsia, and are four to five times more likely than others to
experience problems soon after birth. About one woman in 200 with preeclampsia
Eclampsia also may be associated with a bleeding problem called disseminated
intravascular coagulation, in which the body's blood clotting products are
depleted. A group of symptoms called HELLP (hemolysis, elevated liver function
tests, and low platelets) may also occur.
The cause for preeclampsia or eclampsia is unknown. Despite the nickname
toxemia, no one has isolated any toxic substance in pregnant women's blood that
can cause the symptoms. Potential causes include genetic, dietary, vascular, and
- First pregnancy
- Teenage pregnancy
- Pregnancy over the age of 40
- Multiple pregnancies, multiple fetuses
- Preeclampsia in prior pregnancy
- History of hypertension
- History of diabetes
- History of kidney disease
- African-American patient
- Strenuous jobs that require a hectic pace or heavy
|Signs and Symptoms|
- Blood pressure of more than 140/90 mm of Hg
- Increase of 30 mm Hg systolic or 15 mm Hg diastolic, when blood
pressure is under 140/90
- Excessive weight gain of more than five pounds per week
- Very sudden weight gain over one or two days
- Edema, particularly of the hands and face on arising
- Protein in the urine
- Reduction of amount of urine
- Pain in the upper right side of the abdomen
- Disturbances to vision, such as seeing flashing
- Chronic hypertension
- Pregnancy-induced hypertension
- Pregnancy-worsened hypertension
- Kidney disease
- Lupus or autoimmune diseases
Measure blood pressure. Look for edema in the hands and face, particularly
around the eyes, caused by fluid retention. Pitting edema in lower extremities.
Check reflexes for hyperreflexia.
- A 24-hour urine indicates the level of protein and amount of
- Obtain routine laboratory tests, including CBC with platelets,
urinalysis, electrolyte levels, uric acid concentration, prothrombin time, and
partial thromboplastin time.
- Obtain levels of BUN and creatinine, to rule out unsuspected kidney
- Obtain liver function tests to rule out liver
Fibrin in kidneys and liver.
A 24-hour urine test to measure protein. Assess lab results for
The type of treatment depends on the severity of preeclampsia. Patients with
a blood pressure of 150/110 mm, with marked edema, or high levels of protein in
the urine have severe preeclampsia, and require hospitalization and vigorous
therapy. The initial goal of treatment is to prevent development of eclampsia or
the HELLP syndrome, which poses great risk of maternal or fetal/neonatal
morbidity and mortality.
Having stabilized the hospitalized patient, the provider should aim to
deliver the fetus as soon as possible. Delivery may represent the best form of
treatment for severe preeclampsia, yet a balanced treatment plan should consider
the severity of preeclampsia, the gestational age of the fetus, and the
assessment of maternal and fetal well-being. For patients near term, the
provider can induce labor or perform a cesarean section.
In pregnancies that are less than 28 weeks, in which the fetus has low
chances of surviving delivery, many providers try to forestall labor. However,
prolonging such pregnancies with worsening symptoms causes maternal
complications and death of the fetus in 87% of cases. Providers often recommend
induction of labor in pregnancies less than 24 weeks with severe preeclampsia,
despite the minimal likelihood of a viable fetus. For pregnancies of 24 to 28
weeks, conservative management with constant monitoring of mother and fetus is
generally the therapy of choice.
In cases of mild preeclampsia, prescribe bed rest and advise the patient to
lie on her left side, to increase her output of urine and lessen intravascular
dehydration. She should also drink more water than usual. Check blood pressure
and urinary protein every two days. Ensuring fetal well-being includes fetal
heart tones and a nonstress test. Fetal growth should be monitored by ultrasound
every few weeks. If the mother's condition does not improve, she should be
hospitalized, stabilized, and prepared for delivery. If possible, close
monitoring should continue after delivery, as one in four cases of eclampsia
occurs at this stage—normally within two to four days
of delivery. Examine patients every two weeks for the first two months after
For hospitalized patients with mild preeclampsia, fluids and intravenous
magnesium sulfate usually reduce blood pressure to normal levels. Loading dose
of 4 g IV in 200 ml saline over 20 to 30 minutes, maintenance dose then 1 to 2
g/hour IV. Toxicity therapy for above is calcium gluconate, 1 g over two to
three minutes. If intravenous magnesium sulfate does not reduce blood pressure
within four to six hours, use an intravenous infusion of hydralazine.
Avoid driving the blood pressure below 130/80 in cases of severe
preeclampsia, which would decrease perfusions of the uterus so severely as to
endanger the fetus. If the patient's urine output does not increase, a solution
of furosemide, given intravenously, produces diuresis.
|Complementary and Alternative
Preeclampsia can appear and progress rapidly. It is imperative that the
patient be under qualified medical care. Alternative therapies can be used
preventively or concurrently with medical treatment.
- Omega-3 oils (1,000 mg tid) are highly beneficial in pregnancy, and
help reduce inflammation.
- Increasing protein intake may help minimize preeclampsia.
- Magnesium 200 mg bid to tid, has mild vasodilatory effects and helps
reduce high blood pressure.
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites, or tinctures (alcohol extracts). Unless otherwise indicated, teas
should be made with 1 tsp. herb per cup of hot water. Steep covered 10 to 20
minutes and drink 2 to 4 cups/day. Tinctures may be used singly or in
combination as noted.
Herbs that can be used to treat mild hypertension in pregnancy include the
following. Passionflower (Passiflora incarnata), hawthorn berries
(Crataegus laevigata), cramp bark (Viburnum opulus), milk thistle
(Silybum marianum), and Indian tobacco (Lobelia inflata). Use
equal parts of each in a tincture, 20 drops tid to qid.
May be helpful in lowering blood pressure and generally improving
Hospitalized patients require ongoing assessment after delivery. Examine
patient at least every two weeks for the first two months after delivery. Blood
pressure may remain high for up to eight weeks after
Patients should remove rings as soon as fingers begin to
Eclampsia remains a threat after delivery, usually within four
Preeclampsia is a condition to be aggressively and continually managed.
Patients hospitalized should be closely followed, depending on the severity of
the preeclampsia and the absence or presence of any complications.
Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th edition.
Rahway, NJ: The Merck Publishing Group; 1992.
Berkow R, Beers MH, Fletcher AJ, eds. Merck Manual, Home Edition.
Rahway, NJ: Merck & Co; 1997.
Klonoff-Cohen HS, Cross JL, Pieper CF. Job stress and preeclampsia.
Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY:
William Morrow and Company; 1996.
Murray M. Encyclopedia of Nutritional Supplements. Rocklin, Calif:
Prima Health; 1996.
Scalzo R. Naturopathic Handbook of Herbal Formulas. Durango, Colo: 2nd
ed. Kivaki Press; 1994.
Copyright © 2007 Drugs Area
This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
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