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PRE ECLAMPSIA Preeclampsia is a pregnancy condition in which high blood pressure andprotein in the urine develop after the

20th week (late 2nd or 3rd trimester) of pregnancy.

Symptoms Often, women who are diagnosed with preeclampsia do not feel sick. Symptoms of preeclampsia can include: Swelling of the hands and face/eyes (edema) Weight gain More than 2 pounds per week Sudden weight gain over 1 - 2 days Symptoms of more severe preeclampsia: Headaches that are dull or throbbing and will not go away Abdominal pain, mostly felt on the right side, underneath the ribs. Pain may also be felt in the right shoulder, and can be confused withheartburn, gallbladder pain, a stomach virus, or the baby kicking Agitation Decreased urine output, not urinating very often Nausea and vomiting (worrisome sign) Vision changes -- temporary loss of vision, sensations of flashing lights, auras, light sensitivity, spots, and blurry vision Causes & Risk Factors The exact cause of preeclampsia is not known. Possible causes include: Autoimmune disorders Blood vessel problems Diet Genes Preeclampsia occurs in a small percentage of pregnancies. Risk factors include: First pregnancy Multiple pregnancy (twins or more) Obesity Older than age 35 Past history of diabetes, high blood pressure, or kidney disease

Tests & Diagnostics The doctor will perform a physical exam and order laboratory tests. Signs of preclampsia include: High blood pressure, usually higher than 140/90 mm/Hg Protein in the urine (proteinuria) The physical exam may also reveal: Swelling in the hands and face

Weight gain Blood and urine tests will be done. Abnormal results include: Protein in the urine (proteinuria) Higher-than-normal liver enzymes Platelet count less than 100,000 (thrombocytopenia) Your doctor will also order tests to see how well your blood clots, and to monitor the health of the baby. Tests to monitor the baby's well-being include pregnancy ultrasound, non-stress test, and a biophysical profile. The results of these tests will help your doctor decide whether your baby needs to be delivered immediately. Women who began their pregnancy with very low blood pressure, but had a significant rise in blood pressure need to be watched closely for other signs ofpreeclampsia. Treatments The only way to cure preeclampsia is to deliver the baby. If your baby is developed enough (usually 37 weeks or later), your doctor may want your baby to be delivered so the preeclampsia does not get worse. You may receive different treatments to help trigger labor, or you may need a c-section. If your baby is not fully developed and you have mild preeclampsia, the disease can often be managed at home until your baby has a good chance of surviving after delivery. The doctor will probably recommend the following: Getting bed rest at home, lying on your left side most or all of the time Drinking extra glasses of water a day and eating less salt Following-up with your doctor more often to make sure you and your baby are doing well Taking medicines to lower your blood pressure (in some cases) Immediately call your doctor if you gain more weight or have new symptoms. In some cases, a pregnant woman with preeclampsia is admitted to the hospital so the health care team can more closely watch the baby and mother. Treatment may involve: Medicines given into a vein to control blood pressure, as well as to prevent seizures and other complications Steroid injections (after 24 weeks) to help speed up the development of the baby's lungs You and your doctor will continue to discuss the safest time to deliver your baby, considering: How close you are to your due date. The further along you are in the pregnancy before you deliver, the better it is for your baby. The severity of the preeclampsia. Preeclampsia has many severe complications that can harm the mother. How well the baby is doing in the womb. The baby must be delivered if you have signs of severe preeclampsia, which include:

Tests (ultrasound, biophysical profile) that show your baby is not growing well or is not getting enough blood and oxygen The bottom number of the mother's blood pressure is confirmed to be over 110 mmHg or is greater than 100 mmHg consistently over a 24-hour period Abnormal liver function tests Severe headaches Pain in the belly area (abdomen) Eclampsia Fluid in the mother's lungs (pulmonary edema) Low platelet count (thrombocytopenia) Decline in kidney function (low amount of urine, large amount of protein in the urine, increase in the level of creatinine in the blood) Drugs Medication for preeclampsia is usually directed toward preventing convulsions rather than controlling blood pressure. Magnesium sulfate is the drug of choice for controlling seizures during pregnancy. Prophylactic magnesium sulfate administration may continue into the postpartum period. Complications Preeclampsia can develop into eclampsia if the mother has seizures. Complications in the baby can occur if the baby is delivered prematurely. There can be other severe complications for the mother, including: Bleeding problems Premature separation of the placenta from the uterus before the baby is born (placental abruption) Rupture of the liver Stroke Death (rarely) However, these complications are unusual. Prevention Although there is no known way to prevent preeclampsia, it is important for all pregnant women to start prenatal care early and continue it through thepregnancy. This allows the health care provider to find and treat conditions such as preeclampsia early. Proper prenatal care is essential. At each pregnancy checkup, yor health care provider will check your weight, blood pressure, and urine (through a urine dipstick test) to screen you for preeclampsia. As with any pregnancy, a good prenatal diet full of vitamins, antioxidants,minerals, and the basic food groups is important. Cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol, and any medication not prescribed by a doctor is essential. Talk to your health care provider before taking any supplements, including herbal preparations.

ECLAMPSIA Eclampsia is seizures (convulsions) in a pregnant woman that are not related to brain conditions. Symptoms Muscle aches and pains Seizures Severe agitation Unconsciousness

Causes & Risk Factors The cause of eclampsia is not well understood. Researchers believe the following may play a role: Blood vessels Brain and nervous system (neurological) factors Diet Genes

Eclampsia follows preeclampsia, a serious complication of pregnancy that includes high blood pressure and excess and rapid weight gain. It is difficult to predict which women with preeclampsia will go on to have seizures. Women at high risk for seizures have severe preeclampsia and: Abnormal blood tests Headaches Very high blood pressure Vision changes Eclampsia occurs in about 1 out of every 2,000 to 3,000 pregnancies. The following increase a woman's chance for getting preeclampsia: Being 35 or older Being African American First pregnancy History of diabetes, high blood pressure, or kidney (renal) disease Multiple pregnancies (twins, triplets, etc.) Teenage pregnancy

Tests & Diagnostics

The health care provider will do a physical exam and rule out other possible causes of seizures. Blood pressure and breathing rate will be checked and monitored. Blood tests may be done to check: Creatinine Uric acid Liver function Platelet count

Treatments If you have eclampsia your health care provider should carefully monitor you. Delivery is the treatment of choice for severe eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both you and your infant. With careful monitoring, the goal is to manage severe cases until 32 - 34 weeks into the pregnancy, and mild cases until 36 - 37 weeks have passed. This helps reduce complications from premature delivery. You may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both you and your baby. Your doctor may prescribe medication to lower high blood pressure, but you may have to deliver if your blood pressure stays high, even with medication. Complications There is a higher risk for separation of the placenta (placenta abruptio) withpreeclampsia or eclampsia. There may be complications for the baby due to premature delivery. Prevention There is no known way to prevent eclampsia. However, it is important for all pregnant women to get early and ongoing medical care. This allows for the early diagnosis and treatment of conditions such as preeclampsia. Treating preeclampsia may prevent eclampsia.

PREGNANCY INDUCED HYPERTENSION Pregnancy-induced hypertension (PIH) is a form of high blood pressure in pregnancy. It occurs in about 7 to 10 percent of all pregnancies. Another type of high blood pressure is chronic hypertension - high blood pressure that is present before pregnancy begins. Pregnancy-induced hypertension is also called toxemia or preeclampsia. It occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, and in women who had PIH in a previous pregnancy. Usually, there are three primary characteristics of this condition, including the following: high blood pressure (a blood pressure reading higher than 140/90 mm Hg or a significant increase in one or both pressures). protein in the urine. edema (swelling).

Eclampsia is a severe form of pregnancy-induced hypertension. Women with eclampsia have seizures resulting from the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most cases. HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver, and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding). What causes pregnancy-induced hypertension (PIH)? The cause of PIH is unknown. Some conditions may increase the risk of developing PIH, including the following: pre-existing hypertension (high blood pressure). kidney disease. diabetes. PIH with a previous pregnancy. mother's age younger than 20 or older than 40. multiple fetuses (twins, triplets).

Why is pregnancy-induced hypertension a concern? With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta. There are other problems that may develop as a result of PIH. Placental abruption (premature detachment of the placenta from the uterus) may occur in some pregnancies. PIH can also lead to fetal problems including intrauterine growth restriction (poor fetal growth) and stillbirth. If untreated, severe PIH may cause dangerous seizures and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation. What are the symptoms of pregnancy-induced hypertension? The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may experience symptoms differently. Symptoms may include: increased blood pressure. protein in the urine. edema (swelling). sudden weight gain. visual changes such as blurred or double vision. nausea, vomiting. right-sided upper abdominal pain or pain around the stomach. urinating small amounts. changes in liver or kidney function tests.

How is pregnancy-induced hypertension diagnosed? Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish PIH as the diagnosis. Tests for pregnancy-induced hypertension may include the following: blood pressure measurement. urine testing. assessment of edema. frequent weight measurements. eye examination to check for retinal changes. liver and kidney function tests. blood clotting tests.

Treatment for pregnancy-induced hypertension: Specific treatment for pregnancy-induced hypertension will be determined by your physician based on: your pregnancy, overall health and medical history. extent of the disease.

your tolerance for specific medications, procedures, or therapies. expectations for the course of the disease. your opinion or preference.

The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications. Treatment for pregnancy-induced hypertension (PIH) may include: bedrest (either at home or in the hospital may be recommended). hospitalization (as specialized personnel and equipment may be necessary). magnesium sulfate (or other antihypertensive medications for PIH). fetal monitoring (to check the health of the fetus when the mother has PIH) may include: o fetal movement counting - keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress. nonstress testing - a test that measures the fetal heart rate in response to the fetus' movements. biophysical profile - a test that combines nonstress test with ultrasound to observe the fetus. Doppler flow studies - type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.

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continued laboratory testing of urine and blood (for changes that may signal worsening of PIH). medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies). delivery of the baby (if treatments do not control PIH or if the fetus or mother is in danger). Cesarean delivery may be recommended, in some cases.

Prevention of pregnancy-induced hypertension: Early identification of women at risk for pregnancy-induced hypertension may help prevent some complications of the disease. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease.