The medical condition once widely known as “pregnancy toxemia” is an obsolete term based on the incorrect theory that a circulating “toxin” caused the disorder. This historical name has largely fallen out of use in modern medicine. Today, the clinically accurate name for this complex hypertensive disorder of pregnancy is Preeclampsia. It is a serious condition that develops only during gestation, typically after the 20th week, and requires immediate medical attention.
Understanding Preeclampsia: The Modern Terminology
Preeclampsia is defined by the new onset of hypertension in a pregnant individual after 20 weeks of gestation. Diagnosis requires a patient’s systolic blood pressure of \(140\) mm Hg or higher, or diastolic blood pressure of \(90\) mm Hg or higher, measured on two occasions several hours apart. While high blood pressure is the defining feature, Preeclampsia is a multi-system disorder that affects the entire body, not just the circulatory system.
The condition involves widespread dysfunction of the endothelial cells lining the blood vessels, leading to poor circulation and damage in various organs. To confirm the diagnosis, hypertension must be accompanied by signs of damage to another organ system, frequently the kidneys, liver, blood, or brain.
One of the most common indicators of organ damage is proteinuria, the presence of excess protein in the urine, indicating compromised kidney function. Preeclampsia can also be diagnosed without proteinuria if other specific signs of severe end-organ damage are present. When Preeclampsia progresses to cause seizures, it is defined as Eclampsia, a life-threatening medical emergency.
Identifying Risk Factors
The exact cause of Preeclampsia remains unknown, but it is believed to originate in the placenta, where blood vessels may not develop or function correctly, leading to poor blood flow. Certain factors significantly increase an individual’s susceptibility to developing the condition, warranting closer monitoring during prenatal care. High risk factors include a history of Preeclampsia in a previous pregnancy or carrying multiple fetuses.
Pre-existing health conditions also substantially elevate the risk profile for Preeclampsia development. These include chronic conditions like hypertension, pre-gestational diabetes, and kidney disease. Autoimmune disorders, such as lupus, also place an individual in the high-risk category for this complication.
Other factors that moderately increase susceptibility include:
- Being pregnant for the first time.
- Having a family history of Preeclampsia.
- Being over the age of 35.
- Obesity.
- Having a long gap of 10 years or more between pregnancies.
Recognizable Symptoms and Diagnosis
Preeclampsia can manifest through several noticeable symptoms that indicate the condition’s progression. A sudden and severe headache that does not improve with typical pain relievers is a common complaint, often alongside visual disturbances. These visual changes can include blurred vision, light sensitivity, or seeing flashing lights or spots.
Sudden swelling, or edema, particularly in the hands and face, may be observed, which departs from expected pregnancy-related swelling. Another concerning symptom is pain in the upper right side of the abdomen, which can signal liver involvement and severe disease. These symptoms are crucial for alerting healthcare providers to a possible diagnosis.
Clinicians rely on objective diagnostic tools to confirm the presence and severity of Preeclampsia. This begins with routine blood pressure monitoring, where readings \(\geq 140/90\) mm Hg after 20 weeks raise suspicion. Urine samples are analyzed for proteinuria, and blood tests are drawn to assess platelet count, liver enzymes, and kidney function.
For instance, blood tests may show a decrease in platelet count (thrombocytopenia) or elevated liver enzymes, confirming damage to these specific organ systems. These objective measures help determine if the condition is mild or severe and guide the urgency of intervention. The combination of patient symptoms and these laboratory findings forms the basis for a definitive diagnosis.
Management and Treatment Protocols
The primary goal of managing Preeclampsia is to prevent its progression to Eclampsia and other severe complications, while optimizing outcomes for both the parent and the baby. The only definitive treatment for Preeclampsia is the delivery of the baby and the placenta, which eliminates the underlying cause of the disorder. The timing of this delivery is a carefully considered decision based on the severity of the disease and the gestational age of the fetus.
In cases of Preeclampsia without severe features, medical providers often opt for expectant management with close monitoring until 37 weeks of gestation, when delivery is typically induced. Severe Preeclampsia often requires hospitalization and a recommendation for delivery after 34 weeks, or immediately if the patient’s or baby’s health is in imminent danger. Delivery is preceded by the administration of medications to control severe hypertension and prevent seizures.
Magnesium sulfate is the medication of choice used for seizure prevention (eclampsia prophylaxis) in patients with severe Preeclampsia. Antihypertensive drugs are administered to lower blood pressure, with the aim of keeping the systolic pressure below \(160\) mm Hg to prevent a stroke. Corticosteroids may also be given if a preterm delivery is anticipated, as these drugs accelerate the development of the baby’s lungs.