By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

BEST PREECLAMPSIA TREATMENT -- DELIVER BABY AS SOON AS POSSIBLE

Question: What are the current theories and treatments for preeclampsia?  I have had it twice.  The first time was when the theory was that it was a first-time pregnancy issue, also third trimester.  The second time I had it right from the start of the pregnancy, which lasted 31 weeks and resulted in a stillbirth. That was 10 years ago, what are the latest standards of care and what are patients told today?

Answer: Preeclampsia -- also called toxemia and pregnancy induced hypertension (PIH) -- is a disease that occurs in about 8 percent of all pregnancies. It can happen at any time, including even immediately after the baby is born. The symptoms are hand and facial swelling, high blood pressure and protein in the urine.

You are correct that there is a greater risk of preeclampsia with a first pregnancy. However, it can occur with any pregnancy. Other risk factors include mothers who are teenagers, over 40, African-American, carrying more than one baby, have a past history of diabetes, hypertension, or kidney disease. You are also at higher risk if your mother or sister has had preeclampsia.

While we do know a lot about preeclampsia, we still don’t know the exact cause. One of the current theories is that the mother has an immune response -- allergic reaction -- to the foreign tissue in her body. Remember that the fetus has only half of the mother’s DNA, and the other half is “foreign.”

Any one of the above signs, high blood pressure, swelling, and protein in the urine, does not constitute preeclampsia -- you must have all three. However, if you develop any one of these, your doctor will watch you closely so that if preeclampsia does develop, it will be spotted early. There is also no single diagnostic test for preeclampsia. The diagnosis requires all three of the classic symptoms.

Weight gain -- in excess of two pounds a week, or of sudden onset -- can tip off your physician to look for preeclampsia. Other symptoms that may be associated with the condition, in some cases, are decreased urine output, headaches, nausea and vomiting, agitation, vision changes (flashing lights in the eyes) and abdominal pain.

Preeclampsia causes the blood vessels in the mother’s brain, heart, liver, and kidneys to spasm. This process -- called vasospasm -- can also occur in the vessels in the placenta, causing damage to the fetus. The vasospasm plus the increased blood volume due to pregnancy increases the blood pressure, leads to swelling and can cause protein in the urine.

Once preeclampsia is diagnosed, the physician will do everything possible to keep the condition from worsening and keep the mother and baby healthy. Some women are put on bed rest, others hospitalized. There are also medications that can be used to treat some of the symptoms, such as diuretics and blood pressure medications.

To date, the definitive treatment for preeclampsia is to deliver the baby. 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. Proper management can usually prevent seizures in the mother. These can occur up to and immediately after delivery and can be very serious.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.