I was 22 years old, 35 weeks pregnant with my first child, and at work when I felt my first contraction. Until that point, I’d experienced a textbook pregnancy with all my screenings and baby’s growth right on track. It was mid-summer, my feet were all swollen, but according to the pregnancy literature I read, swollen feet were listed under “what to expect” as my baby’s due date crept closer.
Although my gynecologist could have allowed my labor to progress, he decided to admit me overnight at the hospital to administer pain medication and drugs to halt the labor process. He explained that the best outcome would be if I carried my baby beyond 37 weeks, as at that point, her lungs would be developed enough to be of concern. One of the nurses noted that my blood pressure was a little high during the night but that she wasn’t concerned since it was most likely due to my anxiety and discomfort.
I was sent home later the following day with strict instructions to rest and drink plenty of fluids. My doctor scheduled a follow-up visit 2 weeks later. The next morning I would experience a mild headache but I put that down to the previous days’ stress. When I noticed that my feet were even more swollen, I attributed that to essentially being on bed rest and not moving around that much.
Five days after my admission for preterm labor, I woke up with a more severe headache. I was nauseated and felt an uncomfortable pain just below my ribcage. I called my doctor’s office and was asked to come in later that day. Despite the early labor scare, I was shocked to hear from the nurse who performed my routine checks that my blood pressure was dangerously elevated and a substantial amount of protein was present in my urine.
My gynecologist then confirmed that I had all the presenting signs of preeclampsia and my baby had shown early signs of distress. Instead of the natural birth I had envisaged in a month, I was admitted to the hospital immediately and delivered my baby through a cesarean section.
What does preeclampsia mean?
Preeclampsia is a condition that usually occurs after 20 weeks in pregnant women, marked by high blood pressure. Blood pressure readings of above 140/90 mmHg are considered high during pregnancy.
The condition risks damage to other organs such as the liver. The only “cure” for preeclampsia is to give birth.
How do you get preeclampsia?
How preeclampsia occurs is not fully understood. Several factors are involved, but how blood vessels surrounding the placenta develop is suspected to be a primary factor.
Early in pregnancy, new blood vessels grow and evolve to send blood to the placenta efficiently. If the blood vessels do not develop properly or are too narrow, they affect the amount of blood that flows through them. This can cause insufficient flow of blood to the uterus or damage to the blood vessels.
While any pregnant person can develop preeclampsia, some risk factors have been identified;
- A personal or family history of preeclampsia
- Chronic hypertension
- Age (very young women and women over 35 are at increased risk)
- First pregnancy (the first pregnancy is at higher risk than subsequent pregnancies)
- Race (studies indicate that black women are at higher risk of preeclampsia)
- Multiples (women carrying twin, triplets, or other multiples)
- Other chronic conditions (history of diabetes, migraines, kidney disease, clotting disorders, and auto-immune conditions)
- In-vitro fertilization (pregnancies conceived in-vitro have a higher risk)
When do you get diagnosed with preeclampsia?
Preeclampsia starts after the halfway point in pregnancy (20 weeks) when the blood vessels’ dysfunction causes an increase in blood pressure.
You are diagnosed with preeclampsia if you have 2 or more elevated blood pressure readings (more than 4 hours apart) accompanied by 2 other symptoms of preeclampsia. These symptoms include;
- Raised levels of protein in the urine
- Upper abdominal pain or discomfort
- Sudden weight gain or edema (water retention resulting in swollen feet, hands, or entire body)
- Severe headache
- Changes in vision or light sensitivity
- Nausea or vomiting
- A decrease in urine production
- Results showing an impaired liver function
- Shortness of breath
It’s important to note that edema may also occur during a normal pregnancy hence this alone can’t be a reliable sign of preeclampsia. While you can have preeclampsia without having protein in your urine, it is impossible to have preeclampsia without high blood pressure. Blood pressure may slowly increase over time or rise suddenly, but it’s the primary sign of preeclampsia.
The guilt of a high-risk pregnancy
As a young mom to be, I felt utterly overwhelmed and unprepared for this sudden development. I had a low-risk pregnancy for the most part and had done all the right things that I naïvely believed my youth would protect me from pregnancy complications. I spent the few hours leading up to my daughter’s delivery thinking back on every action I took during my pregnancy that could have caused this.
I carried the guilt of being a “bad mom” for several years until my second pregnancy when my gynecologist assured me that the preeclampsia was not my fault and that I did nothing wrong to cause it. It could just as easily happen to any expectant mother.
The stress and worry over my baby’s well-being and my own overshadowed my birth experience. My primary memory is that of the sense of urgency in the theatre. Fortunately, my daughter was born perfectly healthy and only had to spend a day in the NICU under observation before being placed with the other babies in the nursery.
My blood pressure remained high and I was given magnesium intravenously to prevent the risk of seizures. If seizures occur during pregnancy or shortly after birth, the condition becomes eclampsia. Our bodies are amazing, though. Within 72 hours of giving birth, my blood pressure was stabilizing, the protein was no longer in my urine, and most of my swelling had disappeared so we were allowed to go home.
Treatment for hypertension in pregnancy will depend on the reasons for your high blood pressure, so it’s crucial to work together with your doctors (general practitioner and gynecologist) to follow a treatment plan geared to your specific form of hypertension in pregnancy.
If you’re at risk of preeclampsia, your gynecologist may recommend a low-dose aspirin as a precaution. He may also recommend a calcium supplement if you have any signs of calcium deficiency. Make sure you eat a healthy diet and maintain a healthy weight.
The most effective treatment for preeclampsia is delivery of your baby. However, your medical team may recommend some pre-delivery treatments to obtain the best possible birth outcome. As was my case, bed rest was routinely recommended for preeclampsia, but recent studies have shown that laying in bed for long periods increases the risk of blood clots and can impact your mental well-being. Your doctor may suggest that you take things slowly.
In severe cases, you may be hospitalized for regular monitoring. Daily nursing care for preeclampsia may involve adequate nutrition, blood pressure management, fetal heart monitoring, and other tests and screenings.
Long-term effects of preeclampsia on your child
If preeclampsia isn’t diagnosed early, it can have long-term effects on the health of your child. A lack of oxygen can impair fetal growth and may in the future lead to an increased risk of diabetes, congestive heart failure, and high blood pressure.
Your baby being born preterm due to preeclampsia may increase the risk of learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Preeclampsia can also result in stillbirth or death shortly after birth.
Guidelines for preeclampsia
The International Federation of Gynecology and Obstetrics (FIGO) has released guidelines to combat preeclampsia. They highlight the importance of establishing a baseline of maternal health early during pregnancy to ensure care providers can quickly and effectively address any changes.
It’s the responsibility of doctors and childbirth practitioners (childbirth educators, midwives, and doulas) to educate pregnant women on the dangers of high blood pressure during pregnancy and provide them with a comprehensive list of warning signs to look out for.
As much as preeclampsia changed the course of my pregnancy and birth, my child and I luckily escaped unscathed. Not all women or newborns are as fortunate. Educate yourself about your risk factors and the early warning signs of preeclampsia. It could save your lives.