Signs and Symptoms of Preeclampsia.

I recently returned from the Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists. It’s our yearly meeting where all that’s new in ObGyn is discussed. I attended a program devoted to a dangerous condition of pregnancy, preeclampsia. We were fortunate to hear 3 different speakers discussing the scientific basis, the clinical management, and a view of it from the patient’s perspective.  While all of the talks were well done, the patient’s perspective brought up points that don’t get enough attention.

The first topic discussed was that women are frequently not aware of which symptoms can be signs of potential danger from preeclampsia. Preeclampsia may occur during pregnancy, especially in the third trimester, when a woman is having a baby for the first time or the first time with a new partner. This condition can be hard to detect, and can lead to serious complications for the mother or her baby. In some cases it can lead to a seizure called eclampsia, which is derived from the Greek words ek lampein meaning “to flash out” because it can strike so fast. If you are pregnant it is important to know the warning signs of preeclampsia. The Preeclampsia Foundation has a website that lists these symptoms, many of which may be mistaken for normal pregnancy aches and pains.

1. No symptoms. Some women have elevated blood pressure but have no clues so they know it is present. Elevated blood pressure is sometimes called a silent killer because you can’t usually feel that your blood pressure is up.
2. High blood pressure.  It’s usually 140/90 or greater, and can be an early indicator that preeclampsia is developing.
3. Protein in your urine. In preeclampsia your kidneys don’t work properly and protein normally protected by the kidneys leaks out into urine.
4. Swelling. Some swelling in pregnancy is normal, but when you notice that your swelling is excessive, such as around your face or your hands, this can be a sign of trouble.
5. Sudden weight gain. Weight gain of several pounds in just a few days can indicate that your blood vessels are allowing extra fluid to leak into your body’s tissues. Sometimes having extra salt in your diet makes this worse. Drinking more water can make it better.
6. Nausea or Vomiting. This is significant when it comes on quickly, especially in the last 3 months of pregnancy. Most “morning sickness” goes away after the first trimester of pregnancy.
7. Abdominal or shoulder pain. This pain is usually found in your upper right quadrant of the abdomen where the liver is located.  It can be a sign of the HELLP syndrome, which is a severe form of preeclampsia with anemia, damage to the liver, and increased bleeding. Sometimes the pain can be felt in your back.
8. Headaches.  Dull or severe, throbbing headaches that don’t go away can be due to high blood pressure.
9. Change in vision.  Vision changes are among the most serious signs of preeclampsia. There can be blurred or double vision, flashing lights or spots. This indicates danger to you and your baby. If you have this, you should seek medical care right away.
10. Hyperreflexia, racing pulse, mental confusion, anxiety, shortness of breath, sense of impending doom. These symptoms may indicate a worsening of preeclampsia and that delivery may be needed soon, even if the baby is premature.

The speaker then went on to discuss a little known fact about preeclampsia: sometimes preeclampsia may get worse in the 1-2 weeks after delivery. While we often hear that birth is the cure for preeclampsia, in some cases the symptoms may get worse when the patient is at home with her new baby. She may have headaches, swelling, and other changes that show her blood pressure has become worse instead of better. If you are experiencing any of the above symptoms after you have delivered, you must contact your physician about it so that your status can be evaluated and appropriate treatment can be given.

The last topic discussed was how preeclampsia may cause emotional harm to all of those involved. Even though the medical team may not view the patient’s condition as life threatening, the patient and her family may come to view it that way. The possible loss of life of the child or mother may cause emotional wounds that take months to heal. Depression or a post-traumatic stress disorder complicated by lack of sleep and the work involved with taking care of a newborn may delay complete recovery.

Pregnancy and childbirth are one of the wonders of life. We have to be aware of the joys but also the dangers during this most exciting time.