Mysterious Preeclampsia

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Beloved Downton Abbey character Sybil Crawley died in childbirth. Her long-time family doctor (Dr. Clarkson) insisted that Sybil was “preeclamptic” and needed an emergency C-section. Fancy city doctor Sir Phillip — whom the Crawleys had brought in to help provide “the best of care” — insisted Sybil was fine.

 

The baby was born, but moments later, Sybil seized and died.

 

If preeclampsia escalates into eclampsia (seizures), the mother’s health is in danger. If eclampsia escalates into HELLP syndrome (severe eclampsia), vital organs can begin shutting down.

 

So why the difference in opinion between Sybil’s doctors?

 

Quite frankly, it’s because preeclampsia’s symptoms can mimic those of other conditions.

 

“The disease can affect so many organ systems and can have so many clinical presentations,” says Amberly Davidson, M.D. with Premier Obstetrics and Gynecology. “Some conditions include acute pancreatitis, acute fatty liver of pregnancy, lupus and sepsis syndromes and more,” she adds.

 

Providers need to be keenly aware of a woman’s symptoms in order to detect when preeclampsia may be present. Early detection is best, but not always possible.

 

“Preeclampsia is a pregnancy specific condition that affects different organs and is characterized by hypertension or elevated blood pressure, or protein in the urine,” says Juan Reina, M.D., an obstetrician with Hilltop Obstetrics & Gynecology (three locations in the Cincinnati area).

 

“It’s believed to be associated with the abnormal attachment of the placenta to the uterus; or changes in the walls of the small vessels within the placenta; or due to heredity genetic disposition; or all of the above,” Reina says.

 

Meanwhile, no one knows why it occurs. And while Downtown Abbey was set in the 1920s, preeclampsia remains a very dangerous complication of pregnancy for women today.

 

“It is not completely known what causes preeclampsia to develop in some women,” says Charissa Newton, a certified nurse midwife at Center for Women’s Health and Wellness in Mason. “There are, however, certain medical conditions and risk factors that have been shown to increase the risk of developing preeclampsia during pregnancy and the postpartum period,” she adds.

 

Factors that can increase the risk of preeclampsia for women are: 1) Being pregnant for the first time; 2) Being over 40; 3) Family history of preeclampsia; 4) History of hypertension, kidney disease or both; 5) Pregnant with multiples; 6) Medical conditions like diabetes and obesity.

 

According to Linda Burke-Galloway, M.D., and author of The Smart Mother’s Guide to a Better Pregnancy: How to Minimize Risks, Avoid Complications, and Have a Healthy Baby (Red Flags Publishing; 2008), about 700 women die each year in the United States as a result of pregnancy or delivery complications. But why are women still dying from it in 2017?

 

After nearly a century of enormous strides in saving women from death in childbirth, the rate of major complications more than doubled between 1998 and 2011, according to the Centers for Disease Control and Prevention. For every 10,000 delivery hospitalizations in 2010 and 2011, about 163 women had a severe complication, like needing a blood transfusion or hysterectomy or having cardiac arrest, sepsis, or seizures (eclampsia).

 

Today, it is imperative that women advocate for themselves during pregnancy and childbirth, conveying to providers what they are experiencing.

 

In order for women to freely vocalize symptomatic concerns, they need to be empowered with knowledge; knowing the difference between what’s normal in pregnancy and what’s not.

 

Research shows that more than half of the women who experience preeclampsia aren’t aware anything’s wrong.

 

Should we be frightening women with scary stories of the spiraling dangers of preeclampsia in pregnancy and postpartum? Absolutely not. But studies show that women feel less anxiety when they’re armed with accurate information they can use. And certainly with more awareness, fewer women will be lost.

 

ANYTHING BUT ROUTINE

Pregnant women see their provider routinely as part of good prenatal care, but often they’re not informed about pregnancy and childbirth risks unless they’re deemed high-risk. Once women are cleared of any high risks, pregnancy can go typically along, but OB visits are key in order to monitor your blood pressure and the protein in your urine.

 

Preeclampsia can strike any woman at any time, and there’s no way of knowing if the condition will rapidly progress when it happens or if it will linger for days on end with the mother not knowing. Every year in the U.S. upwards of 8 percent of pregnant or postpartum women develop preeclampsia or more serious eclampsia and HELLP syndrome (severe hypertension characterized by organ failure and seizures).

 

… WITHOUT KNOWING IT

Beth Frazer was dying. It was 2008 and the 33-year-old attorney’s kidneys and liver were shutting down. The twins she carried were going to be delivered 20 weeks prematurely in order to save Frazer from hemorrhaging or having a massive seizure. HELLP syndrome, the most severe form of eclampsia.

 

During a routine OB appointment, Frazer learned protein was spilling into her urine. Suddenly her headaches, rapid breathing and blurred vision were NOT typical symptoms of pregnancy like she’d thought. Frazer could be saved, but not the twins.

 

“Delivering a baby can ‘clear up’ preeclampsia,”

Reina says, “but there’s also a chance it can become severe after childbirth.”

 

Delivered 20 weeks prematurely, Frazer’s twins were too small to survive. Physically weak, heartbroken and confused, Frazer was a changed woman after the experience. She became motivated to find the Preeclampsia Foundation and learned that many, many women are unaware of preeclampsia before a diagnosis of it. Today, Frazer works hard to educate women around the world about preeclampsia.

 

LOOKING AHEAD

It’s vitally important for women to understand warning symptoms for preeclampsia and there are many of them.

 

When a woman is diagnosed with preeclampsia, she will be closely monitored during pregnancy. If the pregnancy is at 37 weeks or later, the provider will probably deliver the fetus to treat the preeclampsia and avoid complications. But if the pregnancy is less than 37 weeks, other options may be considered.

 

Typically, preeclampsia appears in the late second or third trimester of a pregnancy. A woman develops high blood pressure and protein in her urine, and depending on the severity of those symptoms, may need to deliver her baby early, or stay on bed rest until the baby is fully developed. Preeclampsia usually goes away within six weeks of delivery, but in some cases, symptoms can get worse, or even develop, after childbirth.

 

That’s why it’s important to know that you should monitor yourself closely after being discharged from the hospital. You may be at home, but you’re still in recovery from childbirth and if any symptoms aren’t normal to you — if you have an instinct that something’s wrong — call your doctor.

 

While there’s no specific screening test for preeclampsia, watching vital signs, labs and urine tests can help to find it sooner.

 

“That’s why we encourage our pregnancy patients to come in early in the pregnancy and to continue their routine prenatal care diligently,” Reina says.

 

PREECLAMPTIC SYMPTOMS

  • High blood pressure
  • Protein in urine
  • Relentless headaches
  • Swelling in the hands and face
  • Vision changes
  • Upper abdominal pain
  • Extreme breathlessness
  • Bleeding
  • Sudden swelling with headache after week 28

 

LEARN MORE

Preeclampsia Foundation

preeclampsia.org

An empowered community of patients and experts plus resources and support to help you have the best possible pregnancy.

 

Susan Day is editor-in-chief of Cincinnati Family Magazine and a mother of four.

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