What is preeclampsia? What are the symptoms? What does it do? I'm told I'm at high risk.

-- Julie

Another name for preeclampsia is toxemia, and to make things even more confusing, many times we obstetricians call it pregnancy-induced hypertension. Whatever you call it (and I'll use preeclampsia here), it is high blood pressure in pregnancy, associated with spilling protein into the urine and often swelling of the face, hands and legs as well. Preeclampsia most often affects women in their first pregnancy, and teenagers or women over 35 are at highest risk. It affects about 5 percent of all pregnancies and does run in families as well. Women who already had high blood pressure before pregnancy are also at increased risk.
Most of the time, preeclampsia develops in the third trimester. One symptom may be edema, or swelling. Swelling of the legs in pregnancy is so common that we often worry only if the face and hands are also significantly swollen. Headaches can also occur, and you should call your doctor immediately about any headache that is especially severe, is associated with blurry vision or spots in front of the eyes, or isn't relieved with acetaminophen (Tylenol). In severe cases, pain under the right ribcage or nausea and vomiting may develop; again, these must be reported to your doctor immediately.

During each prenatal visit, you will have your blood pressure taken and give a urine sample. We do these things to look for developing preeclampsia. Blood pressure greater than or equal to 140/90 is a sign, as is the presence of a substantial amount of protein in the urine. If you develop these signs, your doctor may draw some blood for tests and recommend bedrest and closer followup. If blood pressure is especially high, if you are spilling a lot of protein into your urine, or if blood tests are abnormal, then the doctor will want to deliver the baby as soon as possible.

The changes that occur with preeclampsia may harm both you and your baby. Severe preeclampsia, with very high blood pressure, may develop into a condition called eclampsia, characterized by seizures. Severe preeclampsia may also lead to liver and kidney damage. As for the baby, the high blood pressure interferes with blood flow through the placenta, and therefore with growth. Also, the placenta may come away from the uterine wall prematurely (this is called "abruption"); this is a true emergency, requiring immediate delivery of the baby to prevent a stillbirth.

The best way to avoid developing any of these problems is to get good prenatal care. If it appears you may be developing preeclampsia, follow your doctor's advice exactly -- if she says you should stay in bed, not work or run around, and sleep on your left side, then do that. Report any of the above symptoms immediately. With close monitoring and appropriate treatment, you and your baby can be safe and healthy.