To diagnose preeclampsia, you have to have high blood pressure and one or more of the following complications after the 20th week of pregnancy:
- Protein in your urine (proteinuria)
- A low platelet count
- Impaired liver function
- Signs of kidney problems other than protein in the urine
- Fluid in the lungs (pulmonary edema)
- New-onset headaches or visual disturbances
Previously, preeclampsia was only diagnosed if high blood pressure and protein in the urine were present. However, experts now know that it's possible to have preeclampsia, yet never have protein in the urine.
A blood pressure reading in excess of 140/90 mm Hg is abnormal in pregnancy. However, a single high blood pressure reading doesn't mean you have preeclampsia. If you have one reading in the abnormal range — or a reading that's substantially higher than your usual blood pressure — your doctor will closely observe your numbers.
Having a second abnormal blood pressure reading four hours after the first may confirm your doctor's suspicion of preeclampsia. Your doctor may have you come in for additional blood pressure readings and blood and urine tests.
Tests that may be needed
If your doctor suspects preeclampsia, you may need certain tests, including:
- Blood tests. Your doctor will order liver function tests, kidney function tests and also measure your platelets — the cells that help blood clot.
- Urine analysis. Your doctor will ask you to collect your urine for 24 hours, for measurement of the amount of protein in your urine. A single urine sample that measures the ratio of protein to creatinine — a chemical that's always present in the urine — also may be used to make the diagnosis.
- Fetal ultrasound. Your doctor may also recommend close monitoring of your baby's growth, typically through ultrasound. The images of your baby created during the ultrasound exam allow your doctor to estimate fetal weight and the amount of fluid in the uterus (amniotic fluid).
- Nonstress test or biophysical profile. A nonstress test is a simple procedure that checks how your baby's heart rate reacts when your baby moves. A biophysical profile uses an ultrasound to measure your baby's breathing, muscle tone, movement and the volume of amniotic fluid in your uterus.
The most effective treatment for preeclampsia is delivery. You're at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of course, if it's too early in your pregnancy, delivery may not be the best thing for your baby.
If you're diagnosed with preeclampsia, your doctor will let you know how often you'll need to come in for prenatal visits — likely more frequently than what's typically recommended for pregnancy. You'll also need more frequent blood tests, ultrasounds and nonstress tests than would be expected in an uncomplicated pregnancy.
Possible treatment for preeclampsia may include:
Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of mercury (mm Hg) range generally isn't treated.
Although there are many different types of antihypertensive medications, a number of them aren't safe to use during pregnancy. Discuss with your doctor whether you need to use an antihypertensive medicine in your situation to control your blood pressure.
- Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours — an important step in preparing a premature baby for life outside the womb.
- Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.
Bed rest used to be routinely recommended for women with preeclampsia. But research hasn't shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic and social lives. For most women, bed rest is no longer recommended.
Severe preeclampsia may require that you be hospitalized. In the hospital, your doctor may perform regular nonstress tests or biophysical profiles to monitor your baby's well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby.
If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may recommend inducing labor right away. The readiness of your cervix — whether it's beginning to open (dilate), thin (efface) and soften (ripen) — also may be a factor in determining whether or when labor will be induced.
In severe cases, it may not be possible to consider your baby's gestational age or the readiness of your cervix. If it's not possible to wait, your doctor may induce labor or schedule a C-section right away. During delivery, you may be given magnesium sulfate intravenously to prevent seizures.
If you need pain-relieving medication after your delivery, ask your doctor what you should take. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), can increase your blood pressure.
After delivery, it can take some time before high blood pressure and other preeclampsia symptoms resolve.
Coping and support
Discovering that you have a potentially serious pregnancy complication can be frightening. If you're diagnosed with preeclampsia late in your pregnancy, you may be surprised and scared to know that you'll be induced right away. If you're diagnosed earlier in your pregnancy, you may have many weeks to worry about your baby's health.
It may help to learn about your condition. In addition to talking to your doctor, do some research. Make sure you understand when to call your doctor, how you should monitor your baby and your condition, and then find something else to occupy your time so that you don't spend too much time worrying.
Preparing for your appointment
Preeclampsia will probably be diagnosed during a routine prenatal exam. After that, you'll likely have additional visits with your obstetrician.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
To prepare for your appointment:
- Write down any symptoms you're experiencing, even if you think they're normal pregnancy symptoms.
- Make a list of all medications, vitamins and supplements that you're taking.
- Take a family member or friend along, if possible, to help you remember all of the information provided during your appointment.
- Write down questions to ask your doctor, listing them in order of importance in case time runs out.
For preeclampsia, some basic questions to ask your doctor include:
- Has the condition affected my baby?
- Is it safe to continue the pregnancy?
- What are the signs I need to look out for, and when should I call you?
- How often do you need to see me? How will you monitor my baby's health?
- What treatments are available, and which do you recommend for me?
- I have other health conditions. How can I best manage these conditions together?
- Do I need to follow any activity restrictions?
- Will I need a C-section?
- Do you have any brochures or other printed material that I can have? What websites do you recommend?
In addition to the questions that you've prepared, don't hesitate to ask questions that occur to you during your appointment.
What to expect from your doctor
Questions your doctor may ask include:
- Is this your first pregnancy or your first pregnancy with this baby's father?
- Have you had any unusual symptoms lately, such as blurred vision or headaches?
- Do you ever feel pain in your upper abdomen that seems unrelated to your baby's movements?
- Have you had high blood pressure in the past?
- Did you experience preeclampsia with any previous pregnancies?
- Have you had complications during a previous pregnancy?
- What other health conditions are you dealing with?
Nov. 16, 2018