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Preeclampsia, Toxemia, and Pregnancy-Induced Hypertension
Patient Information
Overview
Preeclampsia is a disease that only occurs during pregnancy. Preeclampsia, pregnancy-induced
hypertension (PIH), and toxemia are essentially interchangeable terms used by your care
provider for this disease. This disease is characterized by swelling, high blood pressure, and the
presence of protein in the urine. Preeclampsia occurs in 5 to 10 percent of all pregnancies. It can
appear suddenly, without warning, any time throughout your pregnancy, labor, or in the early
postpartum period. This disease can also be chronic, gradually becoming worse over a period of
time. It may be mild or severe. But, no matter how ill you become with this disease, whether it's
sudden or gradual, the only cure is delivery of the baby. There are medications and treatments to
keep you from becoming more ill with the disease, but no medications will make the disease go
away entirely.
Your care provider will begin to look for signs of preeclampsia during your second trimester and
continue through your postpartum period. Sometimes, early treatment can prolong a pregnancy
and lessen complications for both mother and baby.
If you are diagnosed with preeclampsia before your baby's due date, your care provider will
occasionally want to prolong your pregnancy. If you are close to your due date, your care provider
will most likely prepare you and the baby for delivery.
After delivery, the disease eventually goes away, and it is unlikely that you will suffer any longterm effects of the disease. Occasionally, there are complications that will require medical
attention for a time after you deliver. This may include taking blood pressure medication and
frequent follow-up visits with your care provider.
Women who are at the greatest risk are those who are pregnant with their first baby. Women who
are having another baby but with a new partner are also at a significant risk. If you have had
preeclampsia during another pregnancy or if you have a family history of preeclampsia (for
example, if your mother or sister had preeclampsia with a pregnancy), your risk also increases.
African-American women and women who are financially challenged, underprivileged, under
twenty, or over thirty-five are also at increased risk. Medical conditions such as lupus, diabetes,
or high blood pressure (chronic hypertension) put you at risk for developing preeclampsia. If you
are pregnant with more than one baby, such as twins or triplets, the risk increases. If there is
something wrong with either your baby or your placenta, such as the presence of a chromosomal
abnormality or an abnormal maternal serum alpha feto protein (MSAFP), you also are at an
increased risk for preeclampsia.
Signs and Symptoms
Preeclampsia is known to care providers as the "Great Masquerader." Preeclampsia can look like
many other conditions such as the flu, a kidney infection, or gallbladder disease. Pregnant
women with this illness may have any or all of the signs and symptoms and be equally as ill. For
instance, a woman with this disease may have high blood pressure and protein in her urine but
not appear swollen. Or, she may have horribly high liver enzymes, very few platelets, and a
normal blood pressure. Diagnosing it is like putting together a puzzle. Your care provider will
need to gather information about how you are feeling, how you look, how the baby looks by
ultrasound and fetal monitor, as well as evaluate your laboratory tests.
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After you are approximately twenty weeks into your pregnancy, your care provider will become
especially interested in following your weight gain, your blood pressure, and your urine for
protein. Other specific signs and symptoms can include swelling of your face, hands, and feet;
headaches; blurred vision or seeing spots; persistent painful heartburn; or poor growth in the
baby. All of these things can be discovered during a prenatal visit. If you think you have any of
these signs or symptoms at home or at work call your care provider right away. Remember, there
is no such thing as a dumb question. It is smart to ask if you think something is wrong with you or
your baby.
How Will I Know If I Have Preeclampsia?
If you are considered high risk for getting preeclampsia during your pregnancy -- for example, if
you are diabetic or have twins -- your care provider may see you more frequently in the office
after you are approximately twenty-four to twenty-six weeks along in your pregnancy. Your care
provider may also start you on one baby aspirin per day throughout your pregnancy. It is also
possible that a visiting nurse will come to your home to check your weight, your blood pressure,
your urine for protein, and to listen to the baby's heart rate. But you can also be trained to do all
of these things for yourself at home with a scale, home blood pressure monitor, urine test strips,
and an external fetal heart rate monitor.
If your care provider becomes concerned, blood will be drawn and tested while you are in the
office to help identify preeclampsia. Testing your blood for worrisome changes can indicate poor
kidney function, liver function abnormalities, and a decrease in platelets. Your care provider may
even want to have you collect your urine for a twenty-four hour time period and bring it in for
testing.
If your care provider becomes suspicious, you may be hospitalized for testing. This way the
nurses in the hospital can follow your weight daily, check your blood pressure frequently, obtain
laboratory tests, and monitor the baby's heart rate.
Following the baby's progress can also give your care provider a lot of information about whether
or not you have this disease. An ultrasound of the baby for growth measurements and checking
the blood flow in the umbilical cord (Doppler flow studies) are helpful in determining whether or
not the baby is being affected. The external fetal monitor is also useful to determine the well
being of the baby by tracing his fetal heart rate pattern.
Your care provider may send you to a perinatologist, an obstetrician specializing in high-risk
pregnancies. Further investigation may require a repeat ultrasound of your baby or additional
blood for analysis.
Essentially, you will be diagnosed with preeclampsia if your blood pressure is elevated, if you
have significant swelling, and/or if there is protein in your urine. A high blood pressure would be
considered 140/90, or if the top number (systolic pressure) is greater than 30 points or the bottom
number (diastolic) is greater than 15 points from the blood pressure reading when you first
became pregnant. For example, if you started with a blood pressure of 100/60, a high blood
pressure for you would be 130/90. Normally, a large amount of protein is not found in a woman's
urine so such a finding would be significant. Some swelling of your hands and feet is normal
during pregnancy, but your care provider will be able to determine whether it is serious or not.
WebMD Medical Reference from "The High-Risk Pregnancy Sourcebook"
©2005-2007 WebMD, Inc.
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