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)
- Cerebral palsy
- Premature birth
- Intellectual and developmental disabilities (I/DD).
In many cases, babies impacted by preeclampsia do not grow at the same rate that typical babies do, in a condition called intrauterine (fetal) growth restriction (IUGR/FGR). Because growth restricted babies do not tolerate labor and contractions well, brain damage and HIE can occur when the pregnancy is allowed to go too long or the baby goes too long through labor. The earlier preeclampsia starts in pregnancy, the higher the risk of the baby being injured.
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, mothers develop high blood pressure, which 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: Fetal 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, their growth and development are impacted, causing them to grow smaller than babies developing at a normal percentile. Smaller babies may have underdeveloped and more delicate bodily structures, as well as decreased oxygen reserves. These decreased oxygen reserves means they can’t tolerate labor as well, which means that their delivery is often best with a planned C-section. If they undergo labor, it’s more likely their oxygen reserves will be depleted more quickly during labor, 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 where the placenta separates from the uterus too soon. This can cause heavy bleeding in the space where the placenta was previously attached. This bleeding can cause a drop in blood flow to the baby, causing birth asphyxia, cerebral palsy, and intellectual or developmental disabilities (I/DD).
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.
Preeclampsia may cause the following injuries and conditions in the fetus (baby):
- Lack of blood flow to the placenta: Because preeclampsia can cause blood vessels to constrict, the baby may receive less oxygen and fewer nutrients which can result in slow growth, low birth weight, preterm birth and breathing difficulties for the baby. In fact, pregnancy-related hypertension is one of the leading causes of premature births, and the complications that can follow, including hypoxic ischemic encephalopathy (HIE), cerebral palsy, learning disabilities, seizures, hearing impairments, and vision problems.
- Placental abruption: Preeclampsia increases the risk of placental abruption. This is where the placenta separates from the inner wall of the uterus before delivery causing heavy bleeding and damage to the placenta, which can be life-threatening for both the mother and the baby. An emergency C-section is the safest and quickest way to deliver the baby to avoid birth asphyxia and hypoxic-ischemic encephalopathy.
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. Other conditions that are 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 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 including:
- 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’s and baby’s health, especially during the third trimester, using 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 medical staff aren’t monitoring the mom’s 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 delivered is recommended for the safety of both the mother and baby. There are different recommendations depending on each mother’s and baby’s 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 in 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.
To begin your free preeclampsia or birth injury case evaluation, contact us in any of the following ways. We’re available to speak with you 24/7.
Free Case Review | Available 24/7 | No Fee Until We Win
Video: Reiter & Walsh, P.C. Discusses the Causes of Birth Injuries
Watch a video of award winning birth injury lawyers Jesse Reiter & Rebecca Walsh discussing causes of birth injuries, including a delayed C-section delivery when the baby is in distress.
Related Reading on Preeclampsia
- New Research on HPV and Preeclampsia
- Can Preeclampsia Cause Brain Damage?
- Exercise and Preeclampsia
- Biomarkers in Preeclampsia
- Alexander JM, Bloom SL, McIntire DD, Leveno KJ. Severe preeclampsia and the very low birth weight infant: is induction of labor harmful? Obstet Gynecol 1999; 93:485.
- American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
- American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.
- Coppage KH, Polzin WJ. Severe preeclampsia and delivery outcomes: is immediate cesarean delivery beneficial? Am J Obstet Gynecol 2002; 186:921.
- Gulati M. Early Identification of Pregnant Women at Risk for Preeclampsia. JAMA Cardiology 2017; E1-E3.
- Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol 2000; 95:24.
- Heard AR, Dekker GA, Chan A, et al. Hypertension during pregnancy in South Australia, part 1: pregnancy outcomes. Aust N Z J Obstet Gynaecol 2004; 44:404.
- Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25:391.
- Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. NICE Clinical Guideline. http://www.guideline.gov/content.aspx?id=24122 (Accessed on January 11, 2012).
- Nassar AH, Adra AM, Chakhtoura N, et al. Severe preeclampsia remote from term: labor induction or elective cesarean delivery? Am J Obstet Gynecol 1998; 179:1210.
- Magee LA, Pels A, Helewa M, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36:416.
- Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol 1999; 180:499.
- Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102:181.
- Spong CY, Mercer BM, D’alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.