What do Doctors call this Condition – Toxemia of pregnancy, preeclampsia, eclampsia
What is this Condition?
Pregnancy-induced high blood pressure, a potentially life-threatening disorder, usually develops late in the second or third trimester. Preeclampsia, the nonconvulsive form of the disorder, develops in about 7% of pregnancies. It may be mild or severe and is more common in low socioeconomic groups. Eclampsia, the convulsive form, affects about 5% of women with preeclampsia; of these, about 15% die from toxemia itself or its complications. The fetal mortality rate is high because of the increased incidence of premature delivery.
What Causes it?
The cause of pregnancy-induced high blood pressure is unknown, but it appears to be related to inadequate prenatal care (especially poor nutrition), first pregnancies, multiple pregnancies, and preexisting diabetes or high blood pressure. Age is also a factor: Adolescents and women having their first child over age 35 are at higher risk for preeclampsia.
What are its Symptoms?
Mild preeclampsia generally produces high blood pressure, excessive proteins in the urine, generalized swelling, and weight gain of more than 3 pounds (1.36 kilograms) per week during the second trimester or more than 1 pound (0.45 kilogram) per week during the third trimester.
Severe preeclampsia is marked by more pronounced high blood pressure and even higher levels of protein in the urine, eventually leading to decreased urine output. Hemolysis, elevated liver enzymes. and a low platelet count (the HELLP syndrome) are often present in severe preeclampsia. Other symptoms that may indicate worsening preeclampsia include blurred vision, stomach pain or heartburn, irritability, emotional tension, and a severe frontal headache.
In eclampsia, all the symptoms of preeclampsia are magnified and are associated with seizures and, possibly, coma, premature labor. stillbirth, kidney failure, and liver damage.
How is it Diagnosed?
The following findings suggest mild preeclampsia:
• high blood pressure (140 systolic, or an increase of 30 or mar: points above the woman’s normal systolic pressure, measured on two occasions 6 hours apart; 90 diastolic, or an increase of 15 or more points above the woman’s normal diastolic pressure, measured on two occasions 6 hours apart)
• urine protein levels higher than 500 milligrams per 24 hours.
These findings suggest severe preeclampsia:
• higher blood pressure readings (160/110 or higher on two occasions 6 hours apart) while the woman is on bed rest
• urine protein levels of 5 grams or more per 24 hours
• urine output less than or equal to 400 milliliters per 24 hours • possibly hyperactive deep tendon reflexes.
The presence of seizures along with typical symptoms of severe preeclampsia strongly suggests eclampsia.
During the crisis, real-time ultrasound and stress and nonstress tests evaluate the fetus’s well-being. Electronic monitoring reveals stable or increased fetal heart tones during periods of fetal activity.
How is it Treated?
Treatment of preeclampsia is designed to halt the disorder’s progress. to prevent the early effects of eclampsia – seizures, residual high blood pressure, and kidney shutdown – and to ensure the fetus’s survival. Some doctors induce labor promptly, especially if the woman is near term, whereas others follow a more conservative approach. Therapy may include sedatives and complete bed rest to relieve anxiety, lower blood pressure, and evaluate the woman’s response to therapy. If the kidneys are working normally, a high-protein, low-sodium, low-carbohydrate diet with increased fluids is recommended.
If the woman’s blood pressure persistently rises above 160/100 despite bed rest and sedatives, or if central nervous system irritability, increases, magnesium sulfate may be given to produce general sedation, promote urine excretion, reduce blood pressure, and prevent seizures. If the woman’s condition doesn’t improve, or if the fetus’s life is endangered, cesarean section or induction of labor may be required to terminate the pregnancy.
Emergency treatment of eclamptic seizures consists of immediate intravenous administration of Valium followed by magnesium sulfate, oxygen administration, and electronic fetal monitoring. After the woman’s condition stabilizes, a cesarean section may be performed.