High Blood Pressure (Hypertension) During Pregnancy
That Can Affect a Mother and Baby
Preeclampsia is a medical problem that happens during pregnancy when a pregnant woman develops high blood pressure that can cause other medical issues. It is a relatively common complication of pregnancy occurring in approximately 1 out of every 20 pregnant women, and can range in severity from mild to very severe.
Often, preeclampsia can be managed so that it doesn’t cause major problems. However, preeclampsia is potentially dangerous condition for both the mother and the baby. If not diagnosed timely and treated properly, it can lead to serious or even fatal complications for mother and child.
What Is Preeclampsia?
Preeclampsia is a form of hypertension or high blood pressure that occurs during pregnancy. Preeclampsia is characterized by a new onset of high blood pressure in a mother who previously had normal blood pressure and often proteinuria or too much protein in the urine that occur after 20 weeks gestation. Pregnancy-induced hypertension (PIH) or "toxemia of pregnancy" are older medical terms for preeclampsia.
In preeclampsia, the mother’s high blood pressure causes a reduction in the blood supply that moves through the placenta to the baby which can cause the baby to get less oxygen and less nutrients. If the baby is deprived of oxygen, preeclampsia can cause hypoxic-ischemic encephalopathy (“HIE”), which is a brain injury caused by lack of oxygen, and ultimately cerebral palsy.
Preeclampsia is believed to be caused by a malfunction of the placenta or the mother’s vascular (blood vessel) system. Preeclampsia resolves after delivery of the baby, so delivery is the only “cure” for preeclampsia. Although most pregnancies complicated by preeclampsia deliver at term or near term with good outcomes for the mother and the baby, these pregnancies are at risk for serious complications, including seizures of the mother placental abruption, bleeding, and lack of adequate oxygen to the baby (hypoxia and ischemia). Because of the severity of this condition, it is critically important for medical providers to accurately recognize and diagnose preeclampsia, to treat the mother appropriately and to be prepared for the severe complications, including placental abruption, which can lead to catastrophic injury or death to the mother and baby. Doctors and nurses must carefully monitor the mother and the baby to be prepared to provide treatment and to deliver the baby, if necessary, to protect the mother and the baby.
Symptoms of Preeclampsia
Besides high blood pressure and excess protein in the urine, there are other symptoms that may develop slowly or suddenly. The symptoms of preeclampsia include:
- High Blood Pressure (Hypertension): All patients that have preeclampsia have high blood pressure. High blood pressure may be the first symptom and is a very important clue that medical providers should identify.
- Proteinuria (Excess Protein in the Urine)
- Swelling (Edema)
- Headache: Headache is a symptom of worsening preeclampsia that may become severe.
- Nausea or Vomiting
- Abdominal or stomach pain (“Epigastric” pain): When a patient has epigastric pain, that is a very important symptom of preeclampsia that is worsening and could become severe.
- Changes in vision (blurry vision)
- Sudden weight gain
- Shortness of breath
- Seizure: When a preeclampsia patient has a seizure, the diagnosis changes to eclampsia. Eclamptic seizures happen in about 1 in 400 women who have preeclampsia without severe symptoms and in about 1 in 50 women who have preeclampsia with severe symptoms.
- Stroke: Stroke is a very serious symptom and complication of preeclampsia and eclampsia.
Complications of Preeclampsia
Risks of Preeclampsia to the Mother:
- Damage to other organs: Mothers who have preeclampsia have an increased risk of damage to their kidneys, liver, brain and other organs.
- Placental abruption: Because preeclampsia affects the placenta, it may lead to a premature separation of the placenta from the uterine wall (uterus), a dangerous condition called placental abruption.
- Preterm birth: Preeclampsia can result in preterm birth of the baby.
Although death from preeclampsia in the United States is not common, preeclampsia is a major cause of maternal death worldwide. The World Health Organization estimates that preeclampsia and eclampsia cause approximately 50,000 to 75,000 maternal deaths worldwide every year.
Risks of Preeclampsia to the Baby:
- Brain Injury (Hypoxic-ischemic encephalopathy): The mother’s increased blood pressure can cause the flow of oxygen to the baby to be decreased. The lack of oxygen and cause damage to the baby’s brain called hypoxic-ischemic encephalopathy (HIE).
- Intrauterine growth restriction (“IUGR”): The decreased blood flow can also affect the amount of nutrients that reach the baby which can affect the baby’s growth leading to intrauterine growth restriction.
- Preterm birth or stillbirth: Preeclampsia can cause preterm birth which can subject the baby to complications of being born preterm and can cause the baby to day in utero, or stillbirth. Stillbirth is more likely to happen if the mother has a more severe type of preeclampsia or HELLP syndrome.
Risk Factors For Preeclampsia
There are several risk factors that increase a mother’s risk of preeclampsia, including:
- Past history of preeclampsia in a prior pregnancy
- Chronic or longstanding high blood pressure (hypertension)
- Advanced maternal age (mother is 40 years old or older)
- Mother is obese
- Multiple fetuses (twins, triplets, etc.)
- Mother has lupus
- Mother is a smoker
- Mother has diabetes
Relationship between Preeclampsia and Hypoxic-Ischemic Encephalopathy and Cerebral Palsy
Cerebral palsy is the result of an injury to the baby’s brain caused by lack of oxygen – either hypoxia (lack of enough oxygen in the blood that comes to the baby from the mother) or ischemia (lack of enough blood flow reaching the baby). Lack of oxygen damages and destroys brain cells in critical parts of the baby’s brain causing hypoxic-ischemic encephalopathy (“HIE”), which is a brain injury that results in Cerebral Palsy.
In preeclampsia, the mother’s increased blood pressure causes decreased blood flow through the placenta to the baby and the end result is that, in many cases, the baby does not receive enough blood flow and oxygen resulting in hypoxic-ischemic encephalopathy and cerebral palsy.
Preeclampsia and Placental Abruption
Preeclampsia can also cause the premature separation of the placenta from the uterus, a very dangerous condition call placental abruption. When the placenta abrupts or separates from the wall of the uterus, this can slow or stop the flow of blood and oxygen to the baby. Placental abruption can cause severe bleeding and can endanger the lives of the mother and the baby. If the flow of blood and oxygen to the baby is disrupted by a placental abruption, the baby can suffer hypoxic-ischemic encephalopathy and cerebral palsy.
Preeclampsia and HELLP Syndrome
HELLP is an acronym that stands for:
H (“hemolysis” – breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)
HELLP syndrome is a life threatening complication of pregnancy that is similar to preeclampsia. This syndrome can lead to damage to the mother’s liver, destruction of her red blood cells, and a low platelet count.
How is Preeclampsia Diagnosed?
During pregnancy, the doctors and nurses should check the pregnant mother’s blood pressure and urine during each prenatal visit. In the doctor’s office, the mother gives a urine sample which is quickly tested for the presence of protein. The mother’s blood pressure is considered to be high if the blood pressure is 140/90 or higher, especially after the 20th week of the pregnancy. If that happens, there are more extensive lab tests to look for the extra protein in the urine, a condition called proteinuria, in the urine. There is a urine test for protein in the urine called a 24 hour test that is more specific than the urine dipstick test done in the doctor’s office. The doctors and nurses should also be watching for other symptoms of preeclampsia, including headaches, disturbances in vision, abdominal pain, swelling, etc.
There are different diagnostic criteria that are applied by health care providers. Some of those criteria define:
- Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either
- Urine with 0.3 or more grams of protein in a 24-hour specimen or
- Blood tests that show kidney or liver dysfunction
- Fluid in the lungs and difficulty breathing
- Visual impairments
When a pregnant woman has any of the following:
- Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest
- Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart
- Test results suggesting kidney or liver damage—for example, blood tests that reveal low numbers of platelets or high liver enzymes
- Severe, unexplained stomach pain that does not respond to medication
- Symptoms that include visual disturbances, difficulty breathing, or fluid buildup
Eclampsia happens when a pregnant women with preeclampsia develop seizures, which can happen before or during labor or after the baby is delivered.
Preeclampsia and Birth Injury
Preeclampsia, if untreated or improperly treated, can cause severe birth injuries, including hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. It is critically important for hospitals, doctors and nurses to recognize the signs and symptoms of preeclampsia and to carefully manage the pregnancy to be prepared to intervene to protect the mother and the baby. When medical providers fail to recognize the symptoms or fail to act timely to protect the mother and the baby, serious injuries can result.
If you have questions about whether your child’s injuries were preventable, we are available to help. At Birth Injury Safety, our birth injury attorneys welcome the opportunity to talk with you about what has happened to your child and about your legal rights. Consultations are free, so please contact us today by calling +1 (855) 925-1041.
- Preeclampsia Information from the U.S Department of Health and Human Services National Institutes of Health: read more.
- Preeclampsia Information from the Mayo Clinic: read more.
- Preeclampsia Information from the March of Dimes: read more.