new high blood pressure after 20 weeks of pregnancy. It usually goes away after you give birth.
Not all high blood pressure is preeclampsia. In some women, blood pressure goes up very high in the second or third trimester. This is sometimes called gestational hypertension, and it can lead to preeclampsia.
Preeclampsia can be dangerous for the mother and baby. It can
keep the baby from getting enough blood and oxygen. It also can harm the
kidneys, and brain. Women with very bad preeclampsia
can have dangerous seizures. This is called
Experts don't know the exact cause.
Preeclampsia seems to start because the
placenta doesn't grow the usual network of blood vessels deep in the wall of
the uterus. This leads to poor blood flow in the
If your mother had
preeclampsia while she was pregnant with you, you have a higher chance of
getting it during pregnancy. You also have a higher chance of getting it if the
mother of your baby's father had preeclampsia.
Already having high blood pressure when you
get pregnant raises your chance of getting preeclampsia.
preeclampsia usually doesn't cause symptoms.
But preeclampsia can cause
rapid weight gain and sudden swelling of the hands and face.
preeclampsia causes symptoms such as a very bad headache and
trouble seeing and breathing. It also can cause belly pain and decreased
Preeclampsia is usually found during a prenatal
This is one reason why it's so important to go to all of your prenatal
visits. You need to have your blood pressure checked often. During these
visits, your blood pressure is measured. A sudden increase in blood pressure often is the first
sign of a problem.
You also will have a urine test to look for
protein, another sign of preeclampsia.
If you have high blood
pressure, tell your doctor right away if you have a headache or belly pain.
These signs of preeclampsia can occur before protein shows up in your
The only cure for preeclampsia is having the baby.
You may get medicines
to lower your blood pressure and to prevent seizures.
You also may get medicine
to help your baby's lungs get ready for birth.
Your doctor will try to deliver
your baby when the baby has grown enough to be ready for birth. But sometimes a
baby has to be delivered early to protect the health of the mother or the baby.
If this happens, your baby will get special care for premature babies.
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Experts don't know the exact cause of
But it may start with a poorly developed
placenta that doesn't circulate blood normally. What causes this placenta problem isn't yet clear. Experts also don't know why the
mother's body then develops high blood pressure.
occurs most often in women who are pregnant for the first time and in women who
have been pregnant before but now have a first pregnancy with a different man.
Exposure to an
antigen from the father (in the growing
placenta or fetus, for example) may trigger an immune
response in the woman's body. This immune response—the body's way of fighting infection—may result in narrowing of
the blood vessels throughout the body, causing higher blood pressure and other
Although you may have other symptoms, you will not be
diagnosed with preeclampsia unless you also have one or both of the following:
Other symptoms of mild preeclampsia may include:
In severe preeclampsia,
systolic blood pressure is over 160, or diastolic blood pressure is over
110, or both.
As blood circulation
to the organs decreases, more severe symptoms can develop, including:
When preeclampsia leads to
seizures, it is
Eclampsia is life-threatening for both a
mother and her baby. During a seizure, the oxygen supply to the baby is
Call 911 any time a pregnant woman has a
Preeclampsia can be mild or
severe. It may get worse gradually or rapidly. It affects your blood
kidneys, and brain.
It's very important to get treatment, because both you and your baby could suffer life-threatening problems involving your:
Delivery of the baby and placenta is the only "cure"
for preeclampsia. If your condition becomes dangerous enough that delivery is
necessary but you don't go into labor, your doctor will induce labor or
deliver the baby with surgery (cesarean section).
Unless you have
chronic high blood pressure, your blood pressure should return to normal in a
few days or weeks. In severe cases, this can take 6 or more weeks.
The earlier in the pregnancy that
preeclampsia begins and the more severe it becomes, the greater
the risk of preterm birth, which can cause problems for the newborn.
An infant born before
37 weeks may have difficulty breathing because of immature lungs (respiratory distress syndrome).
A newborn affected by
preeclampsia may also be smaller than normal.
This is because of inadequate nutrition from poor blood flow through the
Risk factors (things that increase your risk) for preeclampsia include:
must call 911 or other emergency services immediately if you are having a seizure (eclampsia). Eclampsia can lead to a
coma. It is life-threatening to both you and your baby.
If you are pregnant and have preeclampsia, your
family and friends should know
how to help during a seizure.
Seek medical care immediately
if you are pregnant and begin to have symptoms of preeclampsia, such as:
If you have mild high blood pressure or mild preeclampsia,
you may not have any symptoms. It is important to see a health professional
regularly throughout your pregnancy.
Symptoms such as heartburn or swelling in the legs
and feet are normal during pregnancy. They usually aren't symptoms of
preeclampsia. You can discuss these symptoms with your doctor or nurse-midwife
at your next scheduled prenatal visit. But if swelling occurs along with other
symptoms of preeclampsia, contact your doctor right away.
If you get preeclampsia during pregnancy, you can be treated by:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Preeclampsia is usually found during regular
Certain tests are given at
each prenatal visit to check for preeclampsia. These
Other tests may also be used to check for signs of
If results from
one or more of the above tests suggest that you have preeclampsia, you and your
baby will be closely monitored for the rest of your pregnancy.
Testing is more frequent and extensive when preeclampsia is severe and
the pregnancy is far from full-term (less than 36 weeks).
You may have a physical exam to check for signs that preeclampsia is getting worse.
You may also have:
If you have a
seizure (eclampsia), one or more of the following tests may be
done after delivery:
If you get preeclampsia, the baby's health also will be closely
watched. The more severe your condition, the more often you'll need testing,
ranging from once a week to daily.
Tests commonly used include:
amniocentesis is used to check fetal well-being if
preterm delivery is being considered. The test shows whether the baby's lungs are mature enough for birth.
For mild preeclampsia that is not rapidly
getting worse, you may only have to reduce your level of activity, monitor how
you feel, and have frequent office visits and testing.
For moderate or severe preeclampsia, or for preeclampsia
that is rapidly getting worse, you may need to go to the hospital for
expectant management. This typically includes bed rest,
medicine, and close monitoring of you and your baby.
Severe preeclampsia or an
eclamptic seizure is treated with
magnesium sulfate. This medicine can stop a seizure
and can prevent seizures. If you are near delivery or have severe preeclampsia,
your doctor will plan to deliver your baby as soon as possible.
your condition becomes life-threatening to you or your baby, the only treatment options are magnesium sulfate
to prevent seizures and delivering the baby.
If you are less
than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will likely
antenatal corticosteroids to speed up the baby's lung
development before delivery.
delivery is usually safest for the mother. It is tried first if she and the
baby are both stable.
If preeclampsia is rapidly getting worse or fetal
monitoring suggests that the baby cannot safely handle labor contractions, a
cesarean section (C-section) delivery is
If you have moderate to severe
preeclampsia, your risk of seizures (eclampsia) continues for the first 24 to
48 hours after childbirth. (In very rare cases, seizures are reported later in
the postpartum period.) So you may continue
magnesium sulfate for 24 hours after delivery.1
Unless you have chronic high blood pressure,
your blood pressure is likely to return to normal a few days after delivery. In
rare cases, it can take 6 weeks or more. Some women still have high blood
pressure 6 weeks after childbirth yet return to normal levels over the long
If your blood pressure is still high after delivery, you may be given a blood pressure medicine. You will then have
regular checkups with your doctor.
blood pressure helps to prevent preeclampsia. If you have chronic
high blood pressure, you can lower your
blood pressure before pregnancy by:
When you are pregnant,
regular checkups are key to early detection and treatment. Prompt treatment is
vital to preventing the development of severe and possibly life-threatening
If you develop
preeclampsia early in pregnancy, your doctor or
nurse-midwife may prescribe something called
expectant management at home, possibly for many weeks.
This may mean you are advised to stop working, reduce your activity level, or
possibly spend a lot of time resting (partial bed rest). Although partial bed
rest is considered reasonable treatment for preeclampsia, experts don't know how well it works to treat mild preeclampsia or high blood pressure.2 It is
known that strict bed rest may increase your risk of getting a blood clot in
the legs or lungs.
Whether you are required to reduce your
activity or have partial bed rest, expectant management limits your
ability to work, remain active, take care of children, and fulfill other
responsibilities. It may be helpful to follow some
tips for dealing with bed rest.
You may be required to monitor your own condition on a
daily basis. If so, you or another person (such as a trained family member or a
visiting nurse) will:
written record of your results, including the dates and times you checked. Take
this record with you when you visit your doctor or nurse-midwife.
Worry and reduced
activity are difficult parts of having preeclampsia. It often helps
to talk with women who are or have been in the same situation.
preeclampsia may be used
Medicines used to control chronic high blood pressure during pregnancy include:
Some high blood pressure medicines are dangerous during pregnancy.3 If you take high blood pressure medicines, talk to your
doctor about the safety of your medicine. Discuss this before you become pregnant or as soon
as you learn you are pregnant. Make sure that your doctor has a complete list
of all medicines that you take.
Other blood pressure medicines that may be used include:
Lowering blood pressure too
much or too fast can reduce blood flow to the placenta, causing problems for
the baby. So medicine is reserved for preventing severely high blood pressure
levels that may be life-threatening to you or your baby.
There is no surgical treatment for
A cesarean section delivery is used when:
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The American Pregnancy Association is a national health
organization committed to promoting reproductive and pregnancy wellness through
education, research, advocacy, and community awareness. You can call a
toll-free helpline or use the Web site to request patient education materials.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
CitationsRoberts JM, Funai EF (2009). Pregnancy-related hypertension. In
RK Creasy, R Resnik, eds., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 6th
ed., pp. 651–688. Philadelphia: Saunders.Sibai BM (2003). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1): 191–192.Cooper WO, et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23): 2443–2451.Other Works ConsultedAmerican College of Obstetricians and Gynecologists (2002, reaffirmed 2010). Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33. Obstetrics and Gynecology, 99(1): 159–167.
November 5, 2012
Sarah Marshall, MD - Family Medicine & William Gilbert, MD - Maternal and Fetal Medicine
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