Preeclampsia. I HATE preeclampsia. It is my nemesis. So atypical in its presentation. I recently had to do a STAT c-section on a patient who was abrupting; i.e, she was bleeding due to the fact that her placenta was separating from her uterus. Turns out, she had preeclampsia! This was a woman who was a first time mom. Pregnancy had been going along beautifully; absolutely no issues at all. All of her lab work and blood pressure meds were normal. All of a sudden, one day, she just started bleeding. No trauma, no nothing. It was only after the emergency c-section when her pressures shot up to stroke-like levels, we’re talking 180s/110’s range, that it FINALLY all started making sense. PREECLAMPSIA! Mother F’er.
Here are my Top 5 Things You Need To Know About Pre-eclampsia:
- What is preeclampsia? It is a hypertensive disorder that occurs in pregnancy after the 2oth week of gestation. It is characterized by high blood pressure and proteinuria; i.e., your kidney excreting a certain amount of protein in the urine. In its most severe form it can affect other organ systems. YIKES!
- Symptoms. Can range anywhere from NO SYMPTOMS to headaches that won’t go away with conservative measures like tylenol, visual changes, right upper quadrant pain, heartburn not relieved by TUMS, nausea, vomiting…….the list goes on and on. If you’re just not feeling right, call your ob/gyn.
- Causes. Honestly, no-one really knows. There are numerous hypothesis; the most popular identifying the placenta as the origin.
- Risk factors. Lots of risk factors. One of the risk factors that was discovered post delivery of the above patient was that her sister developed preeclampsia at the same gestational age as she did. Who said family history doesn’t matter? Previous pregnancy complicated by preeclampsia. Multiple Gestation. Extremes of age; i.e., young and old. Being a first time mom. Different paternity; i.e., current pregnancy with a different father than the previous pregnancies. Having intervals between pregnancies longer than 10 years or shorter than 2 also increases your risk of developing preeclampsia. Then of course, underlying medical conditions such as hypertension, any of the autoimmune disorders; lupus for example. Obesity. Diabetes; gestational or pre-existing.
- Treatment. Delivery. But remember, timing is EVERYTHING! Preeclampsia can have pretty significant complications; abruption, as noted in the above case is just one of them. Increased risk of developing coronary artery disease later in life, eclampsia; i.e., preeclampsia plus seizures, placental abnormalities which can lead to growth restriction of the fetus due to decreased oxygenation. The list goes on and on…..Now do you see why preeclampsia is my nemesis? It can literally just STRIKE out of no where. Even developing post delivery, as in the above case. The abruption was just the presenting factor…..it had likely been brewing all along; only post delivery when the blood pressures reached stroke-like levels did it truly reveal itself.
So happy this story had a happy ending. Hoping this blog post has managed to inform and perhaps stir up the super hero in YOU. Remember, we ALL have the power to make a difference.
Until Next Time,
Look Better. Feel Better. Be Better.
Dr. Angela
