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As a labor nurse, there are a few things that scare my pants off when I admit a patient. One is feeling a cord in her vagina, and two is an out of control blood pressure reading. Ok, there is a tad more than those that scare me but for the sake of time, let’s talk about blood pressure. It’s the most common high-risk pregnancy issue I see, and it’s perilous — Life-Threatening.
As always, my mantra is this. EDUCATION IS KEY! Whether you have found yourself diagnosed with Preeclampsia during pregnancy or you are pregnant and researching, good for you! Head to my Instagram account Labor Nurse Mama or our motherhood blog, Habibi House, for daily pregnancy, birth, and motherhood education (added in with humor and real-life!)
What is Preeclampsia during Pregnancy?
Preeclampsia is a disorder that occurs during pregnancy and the postpartum period following the delivery. Girl, a lot of people are affected. In fact, according to the Preeclampsia Foundation, about 5-8% of all pregnancies end up preeclamptic. It usually occurs after the 20th week of pregnancy but can also rear its ugly head during the first six weeks of postpartum.
Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.Preeclampsia Foundation
Preeclampsia during pregnancy (or postpartum) is no joke. It’s severe. It and Hypertensive disorders of pregnancy are the leading cause of maternal AND infant illness/death in the world!!!
Preeclampsia is a multi-organ dysfunction that can only happen when a lovely placenta is involved, which means only someone whose pregnant or recently pregnant can get this monster. Your organs begin to experience reduced perfusion, which means they aren’t getting the blood they need, which means neither are your other body parts.
What causes it?
Ok, so what causes it? I’m glad you asked. Honestly, there is still so much research needed, because it is not a one and done answer. In other words, there are some thoughts but not concrete evidence.
But here are the risk factors:
- If you are pregnant with more than one baby!
- You’re a first-time preggo
- Your momma or sister had it.
- You are a baby still (less than 20 years old).
- You have diabetes.
- Kidney Disease or organ transplant.
- You already have Hypertension (Diagnosed before pregnancy)
- Being overweight, as in a BMI over 30, (think obesity, not the freshman 10!)
- Your first pregnancy with a new partner.
Sign and Symptoms of Preeclampsia during pregnancy
The signs and symptoms are as follows. However, it is essential to note that you may not have all of these or have typical signs. This is why regular appointments are so critical during pregnancy.
- High Blood Pressure takes the win. But don’t let numbers fool you. For instance, I usually am something like 97/60. I run low, very low. So if I were pregnant (and thank God I’m not), then a blood pressure above 127 or above diastolic (bottom number) of 75 could be considered high for me.
- They look for a rise in your systolic (top number) above 30 points and diastolic an increase of 15 or more points.Typically we look for anything above your norm or above 140s over the 90s. It’s also not a one-time thing. It has to high on two separate occasions at least four hours apart.
- BP should be taken when you are sitting down with the cuff on your left arm. Your arm should be at your heart level.
- Expert Tip: Know your average blood pressure. No one can advocate as you can. If you have someone who isn’t knowledgeable tell you your BP is fine, but you know it’s way higher than the norm, you can ask for a recheck.
This simply means protein in your urine. Hence, one of the reasons we dip your urine at every appointment. GO TO YOUR APPOINTMENTS!
Ask what your results are and know that trace protein can be normal. However, anything over 1+ protein is concerning and can (I SAID CAN NOT IS) be a sign that preeclampsia is coming, even with a normal BP.
Ok, this isn’t your normal, my feet are swollen kind of thing. This is a sudden and severe swelling, or swelling in weird places. If you notice that these areas are swollen; your face, around your lovely eyes, or in your hands, call your provider.
Expert tip: Take your finger and press hard into the swelling on your hands and feet. Hold it and count to 10, when you release the dip you made should immediately disappear. If it stays, then you have what is known as “pitting edema.” Notify your provider!
This type of headache is relentless. So if you have treated it with meds (safe for pregnancy meds) and it isn’t going away. This could be a sign of Preeclampsia during pregnancy. Guess what? Call your provider.
Not morning sickness, girl. This is when it comes back again after the first trimester. It could be connected to preeclampsia.
Sudden Weight Gain
This would be indicated by more than 3-5 pounds in a week.
Below are some of the most severe signs of Preeclampsia and can not be taken lightly.
This is the most serious sign and an indication that there is swelling on the brain. I’m not even going to say it, because surely you know who to call about this one. Now, not tomorrow morning.
- Seeing flashing lights
- You see spots
- seeing auras
- sensitivity to light
- blurry vision
You will probably hear this speel a few times during pregnancy. “Are you experiencing any headaches that won’t go away, pain in the upper right side of your stomach, or changes in vision?
The pain in your upper right side is particular to Preeclampsia during pregnancy. The pain will be under the right side of the ribs. This is a more severe sign/symptom of Preeclampsia and is related to Liver issues.
Shoulder pain will feel like someone is poking you along the bra strap area of your shoulder.
Back pain will be in the lower back and more like a sudden and deep pain. Not like normal pregnancy strain.
This one is gonna be a little more difficult for you to recognize. But basically, your reflexes, thing that little hammer thing below your knee, will be super strong and quick.
Shortness of Breath and anxiety
If you suddenly feel anxious and can’t catch a deep breath, this could also be a sign.
What is H.E.L.L.P. Syndrome?
It is a scary and life-threatening problem.
It stands for
- H: Hemolysis, which means your red blood cells are breaking down.
- EL: elevated liver enzymes
- LP: Low platelet count.
The mortality rate of HELLP syndrome is high, so this is why you and your provider need to be diligent and aggressive in monitoring and treating Preeclampsia.
How can you prevent it?
You probably can’t completely prevent (remember no one knows exactly why or what). But you can decrease your risk factors.
- Eat a healthy, well-balanced meal.
- Get moving. Exercise if approved by your provider.
- Decrease or nix salt intake.
- Drink a lot of water.
- Avoid caffeine if possible.
What can you expect when your OB thinks you may have Preeclampsia?
She is gonna order some tests for you momma.
- Duh, Take your BP more often.
- Check out your urine.
- Blood tests
- Monitor your weight.
- Watch your little nugget for signs of distress. Think more ultrasounds and stress tests.
What can you expect when your OB knows you have Preeclampsia?
Depending on how severe it is, will be the course of treatment you receive. The only foolproof end to it is to get the placenta and the baby out of dodge.
So if you are diagnosed with preeclampsia at 38 weeks, more than likely have a bag ready to go, cause you are getting induced.
If you are earlier, your treatment maybe includes one or all of the following:
- BP medications
- Magnesium Sulfate (you will be admitted for this one) It doesn’t do anything for your BP but protects you from having a seizure) It’s a real pain in the arse, and you will hate it. Sorry but it’s true. Ask for a bucket of ice, washcloths, and a fan.
- Monitor your urine output.
- If you are early in pregnancy, you may even get a steroid shot to help develop the baby’s lungs. This is wise in case we end up having to getting the baby out quickly.
How does preeclampsia during pregnancy affect your baby?
We have already talked about the havoc it can wreck on your body, but you are probably also wondering what’s happening to the little peep inside you.
Preeclampsia during your pregnancy can lead to IUGR. Which means, Intro-Uterine Growth Restriction, and means the baby will be small. It can also lead to having a Preterm baby. There can also be long term effects due to decreased oxygen supply to the baby.
Hence, why it is so serious, and delivery might likely be in your near future.
What does labor & Delivery look like for you?
If you have found yourself headed to the labor unit to be admitted for Preeclampsia diagnosis or to be monitored for a diagnosis, then here’s what it looks like.
- We admit you and ask you a ton of questions.
- We hook you up to the fetal monitor to watch the baby’s heart rate and pattern.
- We start an IV and draw a ton of labs (as mentioned above)
- You will need to give us a urine sample, so don’t stop to pee on the way.
- Depending on whether we are delivering you or watching you, we will do a 24-hour urine collection to monitor for protein levels.
- If your BP is through the roof, aka high, we have a set of big guns we bring out. (medications).
- You will most likely get Magnesium Sulfate through an IV during labor and for 24 hours afterward. Which means you stay in labor and delivery, hearing all the ruckus on the unit.
- We will turn your lights down low, decrease noise, and greatly encourage you to limit visitors.
Postpartum concerns for a Preeclampsic momma!
Girl, this party doesn’t end after delivery. Yes, it usually and I mean USUALLY gets better after delivery. However, you have to remain diligent in watching your signs and symptoms until your doctor clears you.
Expert tip: If for some reason you go to the ER for anything during the postpartum period, do this one thing. TELL THEM YOU HAD PREECLAMPSIA! This could save your life.
I want to remind you that although I am a labor and delivery nurse, I am not your provider. This article is solely to educate you but isn’t official medical advice.
Please, please follow up and voice concerns to your provider. Do not mess around with preeclampsia!
Let me know what you think, any questions you have, and what your experience with this beast called Preeclampsia has been.