Preeclampsia is a serious pregnancy complication characterized by new-onset high blood pressure, typically developing after 20 weeks of gestation. This condition can damage organ systems, such as the liver or kidneys, posing a significant health risk for both the pregnant individual and the fetus. A diagnosis at 34 weeks places the pregnancy in the late preterm period, making medical decisions regarding stabilization and delivery time-sensitive and complex. Immediate medical evaluation is necessary to manage the condition and minimize the risk of severe complications due to its potential for rapid progression.
Identifying Preeclampsia Symptoms
While elevated blood pressure defines preeclampsia, it often presents without noticeable symptoms, emphasizing the importance of routine prenatal checks. The onset of certain symptoms warrants immediate medical attention, as they signal the condition’s progression. A sudden, persistent, severe headache not relieved by over-the-counter pain medication is a common warning sign.
Visual changes, such as blurred vision, seeing spots, or flashing lights, are concerning neurological symptoms that may indicate severe preeclampsia. Persistent pain in the upper right side of the abdomen, often described as feeling like heartburn that does not respond to antacids, can signal liver involvement. While some swelling (edema) is normal in late pregnancy, a sudden, significant increase in swelling of the face and hands, along with rapid weight gain, can be an additional indicator.
Diagnostic Confirmation and Severity Assessment
Preeclampsia is confirmed by sustained high blood pressure: a systolic reading of 140 mm Hg or higher, or a diastolic reading of 90 mm Hg or higher, measured on two occasions at least four hours apart. The diagnosis is supported by proteinuria, an excess of protein in the urine, often measured using a 24-hour urine collection or a protein-to-creatinine ratio. A single blood pressure reading of 160/110 mm Hg or higher is sufficient for diagnosis and requires immediate management.
Laboratory tests check for signs of end-organ damage and determine if the condition is classified as “preeclampsia with severe features.” Blood tests check liver enzymes (AST and ALT), which become elevated with impaired liver function. Kidney function is monitored by checking serum creatinine levels; values above 1.1 mg/dL or a doubling of the baseline value suggest progressive renal insufficiency. A low platelet count, specifically below 100,000 per microliter, also indicates a severe feature.
The presence of any single severe feature, such as severe hypertension, impaired liver function, low platelet count, or new-onset visual or cerebral disturbances, dictates an urgent management plan. This severity classification guides intervention decisions, as the risk of complications like eclampsia or HELLP syndrome increases significantly. These assessments quickly determine the overall health status of the mother and the fetus to inform the next steps in care.
Immediate Management Strategies at 34 Weeks
Management of preeclampsia at 34 weeks balances the risk of disease complications against the risks associated with late preterm birth. For preeclampsia without severe features, expectant management may be considered, involving close monitoring of the mother and fetus in a hospital setting. This strategy aims to safely prolong the pregnancy for a short time to allow for further fetal maturation, provided maternal and fetal conditions remain stable.
If the condition is classified as preeclampsia with severe features, delivery is often the definitive treatment option at 34 weeks. The maternal and fetal risks of continuing the pregnancy outweigh the benefits of a few extra weeks. Medications are administered immediately to stabilize the mother and prevent complications. Antihypertensive drugs control blood pressure, typically below 160/110 mm Hg, to reduce the risk of stroke.
Magnesium Sulfate is administered intravenously to prevent eclampsia, the onset of seizures in a woman with preeclampsia. This medication acts as a central nervous system depressant and is standard for severe preeclampsia management. When delivery is anticipated within the next 24 to 48 hours, corticosteroid injections, such as betamethasone, are given. This intervention speeds up the maturation of the baby’s lungs, addressing a significant concern for late preterm infants.
Delivery is decided promptly if there is evidence of uncontrollable severe hypertension, worsening organ damage, or non-reassuring fetal monitoring results. Delivery may be induced or performed via Cesarean section, depending on the urgency and other obstetric factors. Even during expectant management, the medical team is prepared for immediate delivery should the mother’s or baby’s condition deteriorate.
Maternal and Neonatal Outcomes
Immediate risks for the mother include eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), stroke, or placental abruption. While these complications are uncommon, they are the primary reason for intensive monitoring and intervention. Following delivery, preeclampsia symptoms typically begin to resolve, but blood pressure may remain high for several days, requiring continued monitoring and medication.
In the long term, a history of preeclampsia, especially with severe features, increases the mother’s lifetime risk of chronic hypertension and cardiovascular disease. Neonatal outcomes at 34 weeks are generally favorable compared to earlier gestations, but these infants are still considered late preterm and face specific challenges. Respiratory complications, including respiratory distress syndrome, are the most common issue, even with the use of antenatal steroids.
Late preterm infants often require admission to the Neonatal Intensive Care Unit (NICU) for support with breathing, feeding, and regulating body temperature, as they are less mature than full-term infants. The risk of complications decreases with each day the pregnancy is safely prolonged, which is the rationale for balancing expectant management and immediate delivery. The goal is to intervene when the risks of remaining in the womb with a compromised placenta outweigh the risks of being born late preterm.