Preeclampsia

Preeclampsia is a serious complication of pregnancy in which the woman develops elevated blood pressure and protein in the urine after the twentieth week of pregnancy. Other signs of preeclampsia include swelling of the hands and face, weight gain of more than two pounds per week, headache, vision problems and stomach pain. The cause of preeclampsia is not known, but genetic, dietary, vascular and autoimmune factors are among those currently being investigated. Higher risk for preeclampsia is associated with African-American race, first pregnancies, multiple pregnancies, older maternal age, and past history of high blood pressure, kidney disease or diabetes. Preeclampsia may develop into eclampsia, also known as toxemia with seizures, which occurs in one out of every 2000 to 3000 pregnancies.

The only cure for preeclampsia is to deliver the baby; if the fetus is less than 36 weeks old medical personnel may try to manage the condition until that gestational age is reached to improve the chances of delivering a healthy baby.

Women with preeclampsia are usually hospitalized, although cases may also be managed on an outpatient basis. Management of preeclampsia usually includes bed rest and monitoring of blood pressure, protein in the urine and weight.

If the mother has severe p;reeclampsia, labor may be induced to deliver the baby earlier than 36 weeks, although the probability of fetal survival is reduced [Page 1410]with a shorter gestational period, particularly if the fetus is less than 24 weeks.

According to data from the National Hospital Discharge Survey, the average annual incidence of preeclampsia in the United States in the years 19791986 was 26.1 per 1000 deliveries; there was little variation over those years, with the exception that the preeclampsia rate for African American and other minority women was higher in 1979 but decreased from by 1986 until it was approximately that of White women.

Women in the age group 30–34 years had the lowest rate (19.8 per 1000 deliveries), while women aged 15–17 years had the highest rate, 50.9 per 1000 deliveries. Unmarried women also had higher rates of preeclampsia, but there were no significant differences by geographic location or type of insurance.

The World Health Organization estimates that preeclampsia occurs in in 3.2 percent of live births annually, meaning that there are over 4 million cases worldwide every year. The case fatality rate is estimated at 1.7 percent, resulting in over 63,000 maternal deaths in 2000.

As with most maternal risk factors, risk is not evenly distributed but is much more common in developing countries than in industrialized countries. In fact, due to high standards of prenatal care and the availability of medical treatment, in the United States preeclampsia rarely results in maternal death, although fetal and or perinatal death are more common. However, preeclampsia remains the second leading cause of pregnancy-related death in the nited States (in part because pregnancy-related death is rare in the United States) and is the leading cause in many developing countries.

The World Health Organization estimates that worldwide, preeclampsia and eclampsia cause 12 percent of all maternal deaths.