Symptoms and Signs of Pre-Eclampsia

Women diagnosed with preeclampsia often do not feel sick. Preeclampsia is a serious condition of pregnancy, and can be particularly dangerous because many of the signs are silent while some symptoms resemble “normal” effects of pregnancy on your body and women may be surprised or become frustrated when they are admitted to the hospital or prescribed bed rest since they still feel well.

Prenatal care is essential. Tests taken at these visits including weight, blood pressure, urine are important to screen for preeclampsia.

A good prenatal diet full of vitamins, antioxidants, minerals and the basic food groups is important; cutting back on processed foods, refined sugars, and stopping caffeine, alcohol and any medication not prescribed by a physician is essential. It is also advisable to speak with your obstetrician before taking any supplement, herbal or otherwise.


High blood pressure is an important sign of preeclampsia. The disease is sometimes referred to as a silent killer because most people can’t “feel” their blood pressure going up.


High blood pressure (Hypertension)

High blood pressure is defined as blood pressure of 140/90 or greater as measured on two separate occasions within six hours. A rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more is cause for concern.
 
It is good to know your blood pressure prior to pregnancy. If you have had preeclampsia in a previous pregnancy you should have a full screening to rule out any underlying disease or problems, such as chronic hypertension, autoimmune disorders, thrombophilias, renal disease, etc.

The single large risk factor for getting preeclampsia is a history of having had it before.

If you are inactive or have a higher-than-average body mass index (BMI), make sure to exercise moderately and get yourself in the best shape you can. Women with a BMI of 30 or higher are at an increased risk of preeclampsia and should make efforts to reduce this risk by following the advice of their doctor.

If you are diagnosed with preeclampsia, I recommend bed rest, and in late pregnancy, lying on your left side. The thinking is that lying flat on your back might cause the pregnant uterus (and the weight of the baby) to restrict the vein that supplies the heart.


Swelling (Edema)


A certain amount of swelling during pregnancy is normal. Edema is the accumulation of excess fluid. It is particularly concerning when it accumulates in the face (eyes) or hands. It is normal to have trouble wearing rings throughout pregnancy.

If you feel your face is getting excessively puffy or the swelling in your limbs becomes severe, notify your obstetrician. You may notice pitting edema (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs.


Put your feet up every day but avoid sitting for extended periods.



Protein in your urine (Proteinuria)

Proteinuria is the result of proteins, normally confined to the blood, spilling into your urine because the small blood vessels in the kidneys become damaged. A simple urine test at each prenatal check-up can screen for proteinuria.

If the strip shows a reading of 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is less than 140/90.

You may have to do a 24-hour urine collection for a formal lab assessment. Please follow the directions and make every effort to be accurate.


Sudden Weight Gain

A gain of more than I Kilogram in a week or 3 Kiliograms in a month could be cause for concern.

Eat a healthy, balanced diet. Eat fresh raw fruit and vegetables. Take your prenatal vitamin and folic acid supplement. Be sure to drink plenty of water and get regular moderate exercise. Do not attempt to disguise any weight gain by skipping breakfast, using diet pills or fasting.

Do not diet or try to lose weight. Avoid excessive salt. Avoid alcohol, caffeine, smoking and recreational drugs. Consult with your Obstetrician regarding non-prescription drugs and any herbal medications you might take. 

I urge caution trying diets, particularly those that encourage large amounts of protein. As women with underlying kidney disease; excessive protein can be unsafe.

Similarly, while some women might benefit from low-dose aspirin, studies show that it has been linked with increased placental abruption and miscarriage and so should not be taken routinely by pregnant women.


Headaches

Persistent dull, throbbing headaches, often described as migraine . If you have tried taking over-the-counter medication without relief, or if the headache is very painful or you have light sensitivity, call your Obstetrician immediately.

Is significant if the onset is sudden and in the second or third trimesters. You should have your blood pressure checked and your urine tested for proteinuria



Changes in Vision

Sensations of flashing lights, temporary loss of vision, light sensitivity, auras and blurry vision or spots may occur if you are developing preeclampsia. They may be indicative of irritation of the central nervous system or cerebral edema (swelling of the brain). It is very important that you consult with your obstetrician immediately and if not available contact the hospital where you are booked. These symptoms are very serious and should not be left unattended, even until the next morning.


Abdominal (stomach area) and/or Shoulder Pain

Is usually under the right-side ribs. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Shoulder pain is often called referral pain because it radiates from the liver under the right ribs. Lower back pain is different from muscle strain common to pregnancy. It is usually more acute and specific. All may be a sign of HELLP Syndrome or a related problem in the liver such as bleeding under liver capsule. Shoulder pain can feel like someone is deeply pinching you along the bra strap, or it can be painful to lie on your right side.

This pain is serious; call your obstetrician immediately.



Lower back pain

Lower back pain is a very common in pregnancy. Sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms or preeclampsia. you should call your health care provider immediately.


Hyperreflexia

Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber “hammer,” your leg bounces back hard. Hyperreflexia is generally caused by an overreaction of the involuntary nervous system to stimulation. Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia.

This sign is generally measured by your obstetrician.  Like headache and visual changes, hyperreflexia may indicate changes in your nervous system.

If you are under treatment with magnesium sulfate to prevent seizures, your obstetrician may also test your reflexes to monitor for the need to start, adjust or stop the magnesium treatment. An overdose of magnesium sulfate may suppress or excessively slow your reflexes.



Shortness of breath, anxiety

Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema).

Contact your obtetrician immediately if these symptoms are new. If you've experienced these conditions before pregnancy, be sure to mention them to your care provider during your next visit so they can be monitoried throughout your pregnancy.
 
 
Please call or make an appointment to discuss anything unusual. The worst outcomes of preeclampsia can be avoided by early recognition.

 

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