pregnancy
Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest
August 25th, 2010Pre-Eclampsia-Definition and Background
Pre-Eclampsia is a medical condition that only affects women during pregnancy and post partum. It is characterized by 
high blood pressure and protein in the urine, subsequently creating a toxic physical environment for both mother and baby. It is frequently the reason a pregnant woman is prescribed bed rest. While it can occur anytime during pregnancy, it typically occurs after 20 weeks of pregnancy, in the late second or third trimester. Pre-Eclampsia occurs in 5-8% of all pregnancies globally and is the cause of some 76,000 maternal deaths and 500,000 infants annually.
Pre-Eclampsia can rapidly become a serious or even fatal medical condition. Women should know the signs and symptoms of pre-eclampsia and report any signs or symptoms they have to their health care provider immediately.
Major Signs and Symptoms of Pre-Eclampsia
None – The problem with Pre-Eclampsia, much like other hypertensive disorders, is that it often has no symptoms.
Hypertension is known as “the silent killer” and pre-eclampsia is no different. Bed rest has been shown to reduce blood pressure and frequently reduces the signs, symptoms and complications that may arise as a result of pre-eclampsia. Even though bed rest is inconvenient at best and quite uncomfortable and physically challenging at its worst, if your health care provider prescribes bed rest for pre-eclampsia, Please follow his or her directions, even if you feel fine.
Hypertension – Hypertension or high blood pressure is defined as two blood pressure readings over 140/90 at two different times at least six hours apart. However, pregnant women with normally low blood pressure, such as 110/65, may be diagnosed with pre-eclampsia prenatally or in the post partum period when their blood pressure rises to 135/80 and/or they develop signs and symptoms of pre-eclampsia.
In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:
In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.
For this reason, it is extremely important that women know what their baseline blood pressure readings are and at each prenatal visit they ask their providers what their blood pressure is. In this way, both health care provider and patient can be on the look out for blood pressure abnormalities and address them as soon as possible.
Swelling (Edema) – Swelling can be an insidious symptom of pre-eclampsia because so many women experience swelling of their hands and/or feet or even their faces when they are pregnant. However, when the swelling is significant enough to change your facial features, you should notify your health care provider immediately, advising them that you believe the swelling has become excessive. You may need to show them a photo of you prior to pregnancy, your driver’s license for example, to prove your point. In any event, if swelling concerns you, make sure it becomes a concern of your health care providers and that it is addressed.
Proteinuria – Proteinuria occurs when proteins, usually filtered by the kidneys and retained in the blood stream, leak into the urine because the small blood vessels in the kidneys have become damaged allowing the proteins to pass through. (This is usually due to your elevated blood pressure. Remember, pre-eclampsia creates a toxic physical environment to both mother and baby!)
Other Common Signs and Symptoms of Pre-Eclampsia
Sudden Weight Gain – Since weight gain is a hallmark of pregnancy, it’s often hard to discern between regular pregnancy weight gain and weight gain associated with Pre-Eclampsia. The rule of thumb is that if you start gaining more than 2 lbs per week or more than 6 lbs in a month, you should consult with your health care provider as this could be an indication of pre-eclampsia.
Headache – Severe, migraine-like headaches which are often one sided and dull and throbbing could be a warning that your blood pressure is dangerously high. Contact your health care provider immediately for evaluation.
Nausea or Vomiting – While nausea and/or vomiting is common in the first trimester, it usually abates during the second and third trimesters. If you have sudden onset of nausea and/or vomiting in the second or third trimester, contact your health care provider immediately for evaluation.
Changes in Vision – If you experience any sudden blurred vision, double vision, flashing spots, or sudden light sensitivity, this is another warning that your blood pressure may be dangerously high. Contact your health care provider immediately for evaluation.
Racing pulse, mental confusion, heightened anxiety, trouble catching your breath – While all of these symptoms can occur in pregnant women, when they suddenly occur from out of the blue and especially if they occur together, this is cause for concern. Contact your health care provider immediately.
Stomach or Right Shoulder Pain – I want to be a bit more specific here. The pain you may be experiencing here is right upper quadrant abdominal pain, specifically, liver pain. The pain may be “radiating” or “referred” to the right shoulder, but its origin is in the liver. This pain requires immediate attention as it is an indication that the liver is under stress and you may be suffering from HELLP (Hemolysis-bursting of red blood cells, Elevated Liver enzymes levels, and Low Platelet count) as serious obstetrical complication. It is imperative that you be evaluated immediately if you have symptoms of HELLP to avoid more serious complications or even death.
Lower back pain - Low back pain is so common in pregnancy that it is difficult to distinguish between the typical low back pain of pregnancy and low back pain associated with pre-eclampsia. If you are unsure, certainly consult your health care provider. But consult with your health care provider immediately if the low back pain is present with right upper quadrant abdominal pain as this may be another sign of pre-eclampsia.
This is a cursory overview of Pre-Eclampsia and we will delve into the subject with more depth in coming blog posts. Just remember that pre-eclampsia can have serious medical consequences for both you and your baby including death, so if you are concerned about symptoms, consult with your health care provider and have an immediate evaluation.
This list of signs and symptoms is edited and reprinted from the list presented on The Pre-Eclampsia Foundation website. This website is a holds a wealth of information on pre-eclampsia; current research and resources for more information and to get more help and/or support.
Did you have pre-eclampsia during your pregnancy? Are you a Mama on Bedrest now for pre-eclampsia? Share your story in our comments section below.
Angela Davids: Helping Mamas on Bedrest KeepEmCookin’!
August 9th, 2010
This month I am happy to feature someone who I now consider a good friend, Angela Davids. I actually met and got to know Angela on Twitter (@KeepEmCookin) as we are both passionate about supporting high risk pregnant women on bedrest. I knew from her website (www.keepemcookin.com) that Angela spent time on bed rest with both of her pregnancies, but when she told me what she went through with her second pregnancy, I knew that it was a story that needed to be shared. Angela developed severe pre-eclampsia following the birth of her son. What followed was nearly a fatal catastrophe. But I’m going to let Angela speak for herself. Here is Angela’s story.
Late in 2007, Just 5 weeks into my pregnancy, I discovered through ultrasound that I was pregnant with twins. My husband and I were shocked-yet we couldn’t have been happier. I had miscarried with our first pregnancy, so in a way it felt like we were making up for the baby we had lost.
At 17 weeks into the pregnancy, I begin having contractions.
At 19 weeks into the pregnancy, we had the regularly scheduled ultrasound where most people usually find out if they are having a girl or boy. Would we have one of each? Two boys? Two girls? February 28, 2008 was going to be one of the most exciting days of our lives!
At the ultrasound, we first found out we were having a boy. Bliss! And then the sonographer told us that the other baby had died in utero. I had just heard both heartbeats two weeks before and we had an ultrasound before that, where we saw their fingers and toes and adorable faces. Worry set in. Would the loss of one baby cause me to miscarry and lose both babies? My doctor said we would just need to wait to see if we would make it to 24 weeks, which is the earliest point of viability.
At 24 weeks and 1 day, I went into preterm labor and was placed on prescribed bed rest.
We were able to halt labor, and after nearly four months of bed rest and A LOT of medication, our Little Guy arrived safely at 39 weeks and 3 days on July 20, 2008. He was perfect, But I was in the worse shape of my life!
Immediately after delivery I was in agonizing pain, could barely think and couldn’t put my thoughts together enough to speak. Over the next couple of days I grew worse. I couldn’t walk and I could only hold my son if someone handed him to me because I was so weak. I couldn’t empty my bladder, so a catheter was placed. I cried and said I wasn’t ready to go home, but still, the doctors sent me home.
I called the hospital every day to describe my worsening symptoms; headaches, sudden swelling in my legs, extreme weakness, dangerously high blood pressure. Each time I spoke to a different doctor. Perhaps because I was so weak and my thoughts and speech were so confused, they couldn’t understand what I was saying. But on the fifth day home, I suddenly had chest pain and a nose bleed and my husband put me in the car and immediately drove me back to Labor and Delivery.
The doctors suspected preeclampsia, a condition characterized by often dangerously high blood pressure, extremity swelling and protein in the urine. It is treated with magnesium sulfate given intravenously to prevent seizure and stroke from the high blood pressure. It’s a horrible drug, with unbearable side effects for some, but it works. A few hours later when they tested my blood, they realized that the magnesium sulfate wasn’t leaving my body through my urine because I wasn’t urinating. It was trapped in my body because I was in acute kidney failure.
The pain was unreal and the thought of it still frightens me. Every moment was a struggle. The monitors sounded an alarm every time I shut my eyes because if I didn’t force myself to breathe, I stopped breathing. My sister was amazing, telling me, “Stay awake, Ang. You can get through this.” While doing her best to encourage and support me, she was running to the bathroom to throw up because she was so sick with worry. Meanwhile, my husband and my mom were at home with my newborn son and our two and a half year old, trying to maintain some kind of normalcy there.
After a week in the hospital, a blood transfusion and various IV fluids I was able to return home to my son. I was still very weak, but at least I was home.
When I thought of how lonely and frightened I was during my long months of bed rest, then to miss the first two weeks of my son’s life after all those hours waiting for him was almost unbearable. Part of me wanted to leave my experiences with bed rest and preeclampsia behind, to just move on. But I knew I was lucky to be alive. I had learned so much through my experience I decided to create a way for women on bed rest to reach out to one another online, to describe what they are experiencing and to help one another. That’s where the idea for KeepEmCookin.com came from.
Ladies, We can learn from one another and teach one another about high-risk pregnancy; what symptoms to look out for, how to care for ourselves and how to advocate for ourselves. We can share with one another the right questions to ask our doctors and how to make ourselves heard. Most importantly, We can do our part to guarantee that we have the healthiest pregnancies possible and keep our babies safely cookin’.
Gestational Diabetes: Often a Recurrent Problem for Mamas on or off Bedrest
August 2nd, 2010In January of this year I wrote “Gestational Diabetes: A Particular Problem for Mamas on Bedrest”. This post provided an overview of Gestational Diabetes, the diagnostic criteria for Gestational Diabetes and the complications and unfortunate outcomes that can occur if Gestational Diabetes is not treated.
What I didn’t mention at that time, and what has just come to my attention, is the fact that once a woman has had Gestational Diabetes in one pregnancy, she is at increased risk for developing Gestational Diabetes in her subsequent pregnancies.
In the July 12, 2010 issue of the American Journal of Obstetrics and Gynecology, lead author Darios Getahun, MD, MPH, from the Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena notes,
“Well-controlled gestational diabetes may prevent complications that result in fetal and maternal morbidity, such as high blood pressure during pregnancy, urinary tract infections, cesarean delivery, big babies, birth trauma, and a variety of other adverse outcomes, including future diabetes. Because of the silent nature of gestational diabetes, it is important to identify early those who are at risk and watch them closely during their prenatal care.”
Dr. Getahun and his colleagues reviewed obstetrical records from Kaiser Permanente in Southern California from 1991 to 2008 in an effort to determine of development of Gestational Diabetes was more prevalent in subsequent pregnancies. They also sought to determine if Gestational Diabetes is more prevalent among women of any particular race.
What Getahun and his colleagues found is that women who had Gestational Diabetes with their first pregnancies and had a second pregnancy had a 41.3% risk of developing Gestational Diabetes with their second pregnancy vs 4.2% risk in women who did not have Gestational Diabetes in their first pregnancies. Women who had Gestational Diabetes in their first two pregnancies had an even higher risk of developing Gestational Diabetes in their third pregnancies.
While the authors note that the study is limitied by the fact that the data used is analyzed retrospectively and there was no note of pre-pregnancy weights, pregnancy weight gain, what if any lifestyle interventions were implented or any other potentially confounding factors, based on the data reviewed, they are confident in reporting that women who develop Gestational Diabetes during their first pregnanies are at increased risk of developing Gestational Diabetes in subsequent pregnancies.
Dr. Getahun and his colleagues also noted that recurrence of Gestational Diabetes is more prevalent in Hispanic women and Asian/Pacific Islander women.
If you develop Gestational Diabetes during your first pregnancy, be sure that you and your obstetrician/midwife implement a plan to screen early in your subsequent pregnancies for Gestational Diabetes. If you do develop Gestational Diabetes in subsequent pregnancies , It is imperative that you Obstetrician/midwife monitor and manage your blood sugars with meticulous care so that you and your babies are at the lowest possible risk for complications.
For more information about Gestational Diabetes, check out our Resource Page. Gestational Diabetes is under the Pregnancy tab.
The full citation of Dr. Getahun’s paper can be found on the American Journal of Obstetrics and Gynecology website.
Please share your comments below.
