Preeclampsia: Specialists and Information

The main characteristics of preeclampsia are high blood pressure and a simultaneous loss of protein in the urine, known as proteinuria.

High blood pressure is particularly dangerous in preeclampsia. It can quickly become life-threatening for both the pregnant woman and the unborn child.

If preeclampsia is diagnosed, the course of the pregnancy should be monitored as closely as possible. Under certain circumstances, labor may need to be induced early to avoid endangering the lives of both mother and child.

Preeclampsia is therefore the most common cause of preterm birth.

Worldwide, between five and eight percent of pregnant women are affected by preeclampsia. In Germany, about two percent of pregnant women suffer from preeclampsia.

In the past, preeclampsia was also referred to as EPH gestosis or pregnancy poisoning. However, the medical community no longer uses these outdated terms. The assumption that preeclampsia involves poisoning of the body has not been confirmed.

Possible symptoms of preeclampsia include, among others

• pain in the upper abdomen,
• high blood pressure,
• severe restlessness,
• significant fluid retention,
• rapid weight gain (sometimes more than one kilogram per week),
• vision problems, and
• severe headaches.

Pregnant
women with preeclampsia often suffer from severely elevated blood pressure © interstid | AdobeStock

Preeclampsia can take various forms and follow different courses. In medicine, a distinction is made between two different forms of preeclampsia:

• early preeclampsia, which occurs before the 34th week of pregnancy, and
• late preeclampsia, which occurs after the 37th week of pregnancy.

Mild preeclampsia is characterized solely by protein in the urine and high blood pressure. Eclampsia and HELLP syndrome, on the other hand, are considered severe forms of the condition.

Eclampsia

If preeclampsia is left untreated, it can lead to seizures. This affects less than one percent of women with severe preeclampsia.

The risk of severe forms is highest with early-onset preeclampsia, but it is low overall.

If preeclampsia develops later in pregnancy, it almost always has a mild course. Serious complications such as HELLP syndrome or eclampsia are then not expected.

HELLP Syndrome

About one or two out of ten women with severe preeclampsia and eclampsia develop HELLP syndrome. HELLP syndrome is characterized by the following symptoms:

• Hemolysis (increased breakdown of red blood cells),
• elevated liver enzyme levels (which indicate liver damage), and
• a decreasing platelet count, which leads to impaired blood clotting. This means that the mother is at higher risk for severe bleeding during and after delivery.

In medical terms, preeclampsia is diagnosed when a pregnant woman

• a blood pressure reading of more than 140/90 is recorded on multiple occasions, or
• a single blood pressure reading of more than 160/100.

At the same time, more than 0.3 grams of protein must have been present in a 24-hour urine sample.

The risk of preeclampsia can be accurately determined for every pregnant woman even before the aforementioned symptoms appear. To do this, the preeclampsia test must be performed between the 12th and 14th weeks of pregnancy. This test is also known as preeclampsia screening. It is performed by the obstetrician.

This screening includes

• an ultrasound,
• a blood pressure measurement, and
• a blood test for certain hormones.

This allows the risk of preeclampsia to be identified even before it develops and prevented in more than 80 percent of cases.

To date, the exact causes of preeclampsia have not been conclusively determined. As a result, it remains unclear to the medical community why preeclampsia may develop.

However, various factors are known to increase the risk of preeclampsia. These include

• the pregnant woman being very young or very old,
• high blood pressure prior to pregnancy,
• genetic factors, such as a history of preeclampsia in the grandmother, mother, or sister,
• kidney disease,
• being overweight (obesity), or
• diabetes.

If one or more of these factors are present, the risk of developing preeclampsia during pregnancy increases.

Participating in screening is considered the best way to prevent preeclampsia.

If the screening indicates an increased risk of preeclampsia, preventive treatment begins. The pregnant woman is given low-dose aspirin, which she is usually instructed to take until the 34th week of pregnancy. She must stop taking it by the 36th week of pregnancy at the latest.

This treatment must begin before the 20th week of pregnancy and before the first symptoms appear. When started this way, the onset of preeclampsia can be prevented in more than 80 percent of cases.

The only known risk factor for preeclampsia that a pregnant woman can influence herself is being overweight. For this reason, it is important for women to maintain a healthy diet before and during their pregnancy.

Don’t eat “for two”; instead, pay attention to your actual caloric needs. This advice, of course, applies to every pregnant woman regardless of preeclampsia and should be followed accordingly.

If symptoms of preeclampsia appear after the 20th week of pregnancy, close monitoring of the affected woman throughout the entire pregnancy is essential. This can be done on an inpatient basis at a maternity hospital or on an outpatient basis by the treating obstetrician.

The goal of this treatment is to allow the baby to develop as fully as possible in the mother’s womb. Full lung maturity by the 35th week of pregnancy would be highly beneficial.

If blood pressure rises too high during the course of the pregnancy, labor must be induced prematurely.