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 and either too much protein in the urine or end-organ dysfunction after about 20 weeks of pregnancy. If preeclampsia is left untreated, it places the mother at risk for seizures, liver and kidney failure, blood clots and central nervous system issues. In the developing fetus, health issues can result from placental abruption, low blood flow and premature delivery. It is usually diagnosed during normal prenatal appointments. There is no treatment for preeclampsia, but delivery is usually done via C-Section or induction to decrease associated health risks.
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 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 such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
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 has been found to be incorrect, researchers still have not found an exact cause for preeclampsia. Some conditions that are thought to be possible causes:
- Insufficient blood flow to the uterus
- Damage to the blood vessels
- A problem with the immune system
- Poor diet; high body fat
- Genetic predisposition
The following may increase the risk of developing preeclampsia:
- First-time pregnancy or first pregnancy with new partner. Preeclampsia affects about 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 babies.
- Women who had high blood pressure, kidney disease, migraines, diabetes, rheumatoid arthritis or lupus prior to pregnancy.
- Women who are obese or have a BMI of 30 or greater.
- 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 mean preeclampsia exists. A second blood pressure check is usually done six hours after the first. If it is also abnormal, it may confirm preeclampsia, although additional blood pressure readings and urinary protein measurements are usually taken for further confirmation.
If pregnancy-induced hypertension is diagnosed, a doctor may order additional tests including: blood tests to determine how well the liver and kidneys are functioning; prolonged urine collection test to determine how much protein is being lost in the urine, an indication of the severity of preeclampsia; fetal ultrasound; and a nonstress test or biophysical profile 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
- 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 preeclmpsia 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 the major blood vessels.
- Increase prenatal checkups for observation of the baby with a fetal heart rate monitor and 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.
Complications Associated with Mismanaged Preeclampsia
Complications of preeclampsia may include:
- 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 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.
- 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 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.
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. With over 100 years of joint legal experience, our legal team has the education, qualifications, results and accomplishments necessary to succeed. 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 handles cases all over the United States. We’re able to help 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.
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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
- 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.
- 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.
- 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).
- 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.
- Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol 1999; 180:499.
- 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.
- Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102:181.
- 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.
- Spong CY, Mercer BM, D’alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
- 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.