Mismanaged Preeclampsia and High Blood Pressure During Pregnancy
Preeclampsia is a health issue in pregnancy that occurs when a mother with previously normal blood pressure develops high blood pressure. Additionally, pregnant women with preeclampsia either have too much protein in the urine or end-organ dysfunction after about 20 weeks of pregnancy. Untreated preeclampsia places the mother at risk for seizures, liver and kidney failure, blood clots, and central nervous system issues. In the developing fetus, preeclampsia can result in health issues from placental abruption, low blood flow, and premature delivery. Preeclampsia is usually diagnosed during normal prenatal appointments. There is no treatment for preeclampsia, but doctors typically recommend C-section delivery or induction to decrease health risks and complications associated with the condition.
Preeclampsia and Birth Injury
Preeclampsia – formerly known as toxemia – is high blood pressure and either excess protein in the urine or end-organ dysfunction after 20 weeks of pregnancy in a woman who previously had normal blood pressure. If left untreated, the condition can progress into eclampsia, which is accompanied by maternal seizures.
Preeclampsia is severe in about 25% of the cases and can result in liver and kidney failure, blood clots in the body’s small blood vessels, and central nervous system disorders in the mother. The unborn baby may also be affected by potential problems like placental abruption, lack of blood flow to the placenta and premature delivery, which can result in serious birth injuries and complications such as:
- Hypoxic-ischemic encephalopathy (HIE)
- Intrauterine (fetal) growth restriction (IUGR/FGR)
- Cerebral palsy
- Developmental disabilities
- Breathing difficulties
- Hearing and vision impairments
Mothers with preeclampsia often do not show symptoms until the condition is severe and becomes life-threatening, which is why it is crucial for physicians to diagnose preeclampsia early in pregnancy.
Preeclampsia and the Link to Birth Injury: Hypoxic-Ischemic Encephalopathy
Preeclampsia can change how blood flows to the developing fetus. In preeclampsia, the mother’s high blood pressure increases resistance in the blood vessels. This increased resistance, in turn, can result in decreased blood flow across the placenta, depriving the baby of oxygen. This can increase the risk of hypoxic-ischemic encephalopathy (HIE), a brain injury caused by a lack of oxygen flow to the baby’s brain.
Preeclampsia and the Link to Birth Injury: Intrauterine Growth Restriction
The high blood pressure caused by preeclampsia reduces blood flow across the placenta, depriving the baby of oxygen and other nutrients. When babies don’t have the nutrients they need, they grow and develop more slowly than normal. This condition is called intrauterine (fetal) growth restriction, abbreviated IUGR or FGR. These small babies may have underdeveloped and more delicate bodily structures, as well as decreased oxygen reserves. This means they may not be able to tolerate labor well: the safest method of delivering a baby with IUGR is often a planned C-section. If these babies undergo labor, it is likely that their oxygen reserves will be quickly depleted, which can cause birth asphyxia and hypoxic-ischemic encephalopathy (HIE).
Preeclampsia and the Link to Birth Injury: Cerebral Palsy
Untreated or improperly treated preeclampsia increases the risk of birth complications such as birth asphyxia. Research has long demonstrated that a substantial portion of cerebral palsy cases are caused by birth asphyxia (or as it is more commonly known hypoxic-ischemic encephalopathy or HIE). Transitively, uncontrolled or poorly controlled preeclampsia increases the risk of cerebral palsy.
Preeclampsia and the Link to Birth Injury: Placental Abruption
Preeclampsia and high blood pressure are tied to a higher risk of placental abruption, a condition in which the placenta separates from the uterus too soon. This can cause heavy bleeding in the space where the placenta was previously attached, and a drop in blood flow to the baby. An emergency C-section is usually the safest and quickest way to deliver the baby in cases of placental abruption. Delays in performing one can result in birth asphyxia, cerebral palsy, and developmental disabilities.
Maternal Complications Associated with Mismanaged Preeclampsia
Preeclampsia may cause the following injuries and conditions in the mother:
- Brain hemorrhage
- Acute renal failure
- Blood clotting disorders
- Possible blindness
- Doubled risk of heart attack and stroke over 5-15 years after treatment
- HELLP syndrome: HELLP stands for Hemolysis (the destruction of red blood cells), Elevated Liver enzymes and Low Platelet count. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it can occur before signs or symptoms of preeclampsia appear.
- Eclampsia: When preeclampsia isn’t controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. Eclampsia can permanently damage the mother’s vital organs, including the brain, liver, and kidneys. If mismanaged, it can cause coma in the mother and hypoxic-ischemic encephalopathy (HIE), brain damage, and cerebral palsy in the baby.
- Cardiovascular disease: Having preeclampsia may increase the risk of future cardiovascular disease, heart attack, and stroke in the mother.
What Causes Preeclampsia?
Preeclampsia was previously believed to have been caused by a toxin in the mother’s bloodstream (thus the former name “toxemia”). Although this theory was proven incorrect, researchers still have not found an exact cause for preeclampsia. Some experts believe that preeclampsia is caused by insufficient blood supply to the uterus and placenta, causing the development of high blood pressure in the mother. This rise in blood pressure is a compensatory response to improve the baby’s condition. The following conditions are also thought to be possible causes:
- Damage to the blood vessels
- Immune system irregularities
- Poor diet or maternal obesity
- Genetic predisposition
The following may increase the risk of developing preeclampsia:
- First-time pregnancy or first pregnancy with a new partner: Preeclampsia affects ~2-6% of healthy first-time moms.
- Personal or family history of preeclampsia: If you’ve had the disorder before, the odds are 25% to 50% that you’ll develop it in a future pregnancy.
- Women aged 35 and older and younger than 20.
- Multiple gestations (twins, triplets, etc.).
- Having high blood pressure, kidney disease, migraines, diabetes, rheumatoid arthritis, or lupus prior to pregnancy.
- Women who are obese or have a BMI of 30+.
- Prolonged interval between pregnancies.
- Vitamin D insufficiency.
- High levels of certain proteins.
Preeclampsia is normally diagnosed during routine blood pressure checks and urine tests at prenatal appointments. A blood pressure reading higher than 140/90 mm Hg is abnormal in pregnancy. However, a single high blood pressure reading doesn’t necessarily indicate preeclampsia. Medical staff usually do a second blood pressure check 6 hours after the first. If it is also abnormal, it may confirm preeclampsia. Medical staff often do additional blood pressure readings and urinary protein measurements for further confirmation.
If doctors diagnose pregnancy-induced hypertension, they may order additional tests:
- Blood tests to determine how well the liver and kidneys are functioning
- Prolonged urine collection tests to determine how much protein is being lost in the urine (an indication of the severity of preeclampsia)
- Fetal ultrasound, nonstress tests, and biophysical profiles to make sure the baby is getting enough oxygen and nourishment.
Signs and Symptoms of Preeclampsia
In addition to protein in the urine and high blood pressure, preeclampsia symptoms can include:
- Edema (swelling) especially in the hands and face
- Rapid weight gain over 1-2 days caused by a significant increase in bodily fluid
- Abdominal pain, especially in the right side
- Chest pain
- Shortness of breath
- Severe headaches
- Change in reflexes
- Reduced urine or no urine output
- Excessive vomiting and nausea
- Blurry vision, flashing lights, and floaters
Sometimes preeclampsia occurs with no identifiable symptoms. It’s important for pregnant women to have regular prenatal visits with their medical practitioner to ensure blood pressure and urine levels are being checked appropriately.
Treatments for Preeclampsia
Unfortunately, pregnancy-induced hypertension is not a disease that can be simply treated and cured. The preeclampsia will continue until the baby is delivered. Generally, delivery will be induced or the baby will be delivered via C-section if more than 34 weeks gestation. Prolonging the pregnancy may be detrimental to the mother and of no benefit to the baby.
If the preeclampsia is mild and the baby is not near full term, the mother will likely be ordered to:
- Rest, lying on the left side in order to take the weight of the baby off major blood vessels.
- Increase prenatal checkups for observation of the baby, including fetal heart rate monitoring along with frequent ultrasounds, blood tests, and urine checks.
- Consume less salt
- Drink at least 8 glasses of water a day
- Change diet to include more protein
With severe preeclampsia, the doctor may try blood pressure medication until the pregnancy is far enough along to deliver safely. This is usually done in conjunction with home or hospital bed rest, dietary changes, supplements, and steroid injections to help the baby’s lungs develop more quickly.
Preeclampsia: Ensuring a Healthy Pregnancy and Delivery
One of the key ways to prevent or reduce the risk of complications developing from preeclampsia is early screening of pregnant women for high blood pressure. While different organizations may have different recommendations about screening criteria, the US Preventive Services Task Force (USPSTF) recommends that all pregnant women be screened by having their blood pressure taken at each prenatal care visit to their doctor.
In addition to screening at prenatal care appointments, recent recommendations also include the use of low-dose aspirin (81mg/d) as preventive medication after 12 weeks of gestation for women who are at high risk for preeclampsia, a recommendation consistent with the AHA’s guidelines for preventing stroke in women.
Prompt treatment of preeclampsia is also important, though there is some debate regarding what regiments should be used.
One of the critical things that medical professionals can do to help reduce the risk of birth injuries due to preeclampsia and high blood pressure is properly monitoring the mother and child throughout pregnancy. This means that doctors should be frequently checking up on the mother and baby’s health, especially during the third trimester. They can use a variety of tests, including non-stress tests (NSTs), biophysical profiles (BPPs), amniotic fluid index (AFIs), and Doppler flow monitoring. Proper monitoring allows medical staff to identify and address risk factors before they become severe and cause birth injury. If the medical staff isn’t monitoring the mother and baby’s healthcare properly, and either the mother or baby are injured, the medical staffer has committed negligence.
Different kinds of monitoring are done for different reasons. Mothers typically have non-stress tests periodically – if the nonstress tests are not reassuring, then they come in for a more comprehensive biophysical profile (BPP), which includes both amniotic fluid index (AFI) tests and Doppler flow testings. In preeclampsia and hypertension (as well as in diabetes), one of the key problems that can occur is oligohydramnios (low amniotic fluid levels), which is why AFI testing is so critical – it allows for medical practitioners to confirm what the baby’s amniotic fluid levels are. To read more about antenatal testing, please see our FAQ page: What tests should my doctors give me during prenatal care?
In many cases, early delivery is recommended for the safety of both the mother and baby. There are different recommendations depending on individual mothers and babies’ health situations, but the following chart summarizes a few of these recommendations. Note that chronic hypertension is high blood pressure that occurred before the pregnancy began, while preeclampsia is high blood pressure diagnosed for the first time during pregnancy.
Maternal Health Condition
|Gestational Age at Delivery|
|Chronic hypertension with no medication||38-39 weeks|
|Chronic hypertension controlled with medication||37-39 weeks|
|Difficult-to-control hypertension (needing frequent med adjustments)||36-37 weeks|
|Gestational hypertension||36-37 weeks|
|Mild preeclampsia||37 weeks|
|Severe preeclampsia||At diagnosis (for pregnancies 34 weeks gestation or more)|
Source: Spong, Catherine et al. Timing of Indicated Late-Preterm and Early-Term Birth. Obstet Gynecol 2011;118:323-33.
Legal Help for Preeclampsia and Birth Injury
Reiter & Walsh, P.C. | Trusted Birth Injury Attorneys
If you or a loved one were injured as the result of mismanaged preeclampsia or maternal high blood pressure, we encourage you to call the award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers. We’ve handled cases involving dozens of different complications, injuries, and instances of medical malpractice related to obstetrics and neonatal care, many of which directly involve preeclampsia. From our main location in Detroit, Michigan, our team helps clients and their families in Michigan, Ohio, Arkansas, Mississippi, Wisconsin, Pennsylvania, Washington D.C., Tennessee, Texas, and other parts of the United States.
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Video: Prenatal Care Appointments
During prenatal care appointments, medical professionals must properly diagnose and monitor preeclampsia. Learn more about what to expect from your prenatal care in this video.
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