Toxemia

Alternative names
Preeclampsia; Pregnancy-induced hypertension

Definition
Preeclampsia is the development of swelling, elevated Blood pressure, and protein in the urine during pregnancy.

Causes, incidence, and risk factors

The exact cause of preeclampsia has not been identified. Numerous theories of potential causes exist, including genetic, dietary, vascular (blood vessel), and autoimmune factors. None of the theories have yet been proven.

Preeclampsia occurs in approximately 8% of all pregnancies. Increased risk is associated with first pregnancies, advanced maternal age, African-American women, multiple pregnancies, and women with a past history of Diabetes, hypertension, or kidney disease.

Symptoms

     
  • Edema (swelling of the hands and face present upon arising)  
  • Weight gain       o In excess of 2 pounds per week       o Of sudden onset, over 1 to 2 days  
  • headaches

Note: Some swelling of the feet and ankles is considered normal with pregnancy.

Additional symptoms that may be associated with this disease:

     
  • Decreased urine output  
  • nausea and vomiting  
  • Facial swelling  
  • High blood pressure  
  • Agitation  
  • Vision changes (flashing lights in the eyes)  
  • Abdominal pain

Signs and tests

     
  • Documented weight gain  
  • Nondependent edema  
  • Elevated blood pressure  
  • Proteinuria (protein noted in urine)  
  • Thrombocytopenia (platelet count less than 100,000)  
  • Elevated liver function tests

This disease may also alter the results of numerous laboratory tests.

Treatment

The only known cure for preeclampsia is delivery. However, if that delivery would be preterm, the disease may be managed by bed rest and delivery as soon as the fetus has a good chance of surviving outside the womb. Patients are usually hospitalized, but occasionally they may be managed on an outpatient basis with careful monitoring of Blood pressure, urine checks for protein, and weight.

Optimally, attempts are made to manage the condition until a delivery after 36 weeks of pregnancy can be achieved.

Labor may be induced if any of the following occur:

     
  • Diastolic Blood pressure greater than 100 mmHg consistently for a 24 hour period, or any confirmed reading over 110 mmHg  
  • Persistent or severe headache  
  • Abdominal pain  
  • Abnormal liver function tests  
  • Rising serum creatinine  
  • HELLP syndrome  
  • pulmonary edema (fluid in lungs)  
  • Eclampsia  
  • Thrombocytopenia  
  • Non-reassuring fetal monitoring tracings  
  • Failure of fetal growth noted by ultrasound  
  • Abnormal biophysical profile

In severe cases of preeclampsia with the pregnancy beyond 28 weeks, delivery is the treatment of choice. For pregnancies less than 24 weeks, the induction of labor is recommended, although the likelihood of a viable fetus is minimal.

Prolonging such pregnancies has shown to result in maternal complications, as well as infant death in approximately 87% of cases. Pregnancies between 24 and 28 weeks gestation present a “gray zone,” and conservative management may be attempted, with monitoring for the presentation of maternal and fetal complications.

During induction of labor and delivery, medications are given to prevent seizures and to keep Blood pressure under good control. The decision for vaginal delivery versus Cesarean section is based on fetal tolerance of labor.

Expectations (prognosis)

Maternal deaths caused by preeclampsia are rare in the U.S. Fetal or perinatal deaths are high and generally decrease as the fetus matures. The risk of recurrent preeclampsia in subsequent pregnancies is approximately 33%. Preeclampsia does not appear to lead to chronic High blood pressure.

Complications

Preeclampsia may develop into eclampsia, the occurrence of seizures. Fetal complications may occur because of prematurity at time of delivery.

Calling your health care provider

Call your health care provider if symptoms occur during pregnancy.

Prevention

Although there are currently no known prevention methods, it is important for all pregnant women to obtain early and ongoing prenatal care. This allows for the early recognition and treatment of conditions such as preeclampsia.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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