What Is Preeclampsia? And Does It Still Kill Women In The US?

By Cara Kelly, USA TODAY

High blood pressure disorders, including pre-eclampsia and eclampsia, are among the leading preventable causes of death in childbirth in the U.S., often because hospitals fail to follow known safety measures, a USA TODAY investigation has found. 

Lady Sybil (Jessica Brown Findlay) and Tom Branson (Allen Leech) in 'Downton Abbey' after the birth of their daughter. 

[post_ads]That may come as a surprise to some, who may be most familiar with pre-eclampsia from the death of Lady Sybil Crawley in the PBS hit (and soon to be movie) "Downton Abbey." In the heartbreaking episode, the young mother's death seemed to be a result of antiquated medical care and a misogynistic physician who overlooked the symptoms.

However, pre-eclampsia, and doctors' failure to treat it, is not a thing of the past.

"Grey's Anatomy" fans may have guessed as much from the show's recent season, which spent a sizable chunk of time on maternal mortality. Though Karen Taylor's pre-eclampsia related death in Season 14's "Personal Jesus" had the added complexity of a love-triangle in classic Shonda Rhimes style, the complications addressed by Dr. Arizona Robbins can harm women in real life.

In South Carolina, YoLanda Mention was diagnosed with pre-eclampsia after giving birth in 2007 and was treated without incident. But with her last child a few years later, she was sent home with her newborn despite her dangerously high blood pressure. When she returned to the emergency room with even higher blood pressure and an excruciating headache, she was made to wait for hours without treatment, according to a lawsuit filed by her husband. She had a stroke while waiting and later died. 

And she is not alone.

Every year, more than 50,000 women suffer severe injuries or complications related to childbirth, and approximately 700 die. Of those caused by blood pressure and hemorrhage, about half could be prevented, experts say.
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There is no national tracking system for childbirth complications, but USA TODAY's years-long investigation included reviews of more than a half-million pages of internal hospital quality records and examinations of cases of more than 150 women whose deliveries went wrong. In the reviews, USA TODAY found a stunning lack of attention to safety recommendations and a widespread failure to protect new mothers. 

Cases like Mention's can often be treated, affordably and without high-tech equipment, when a hospital adheres to best safety practices. 

Here's what you need to know about the high blood pressure disorder.

What is pre-eclampsia?

Pre-eclampsia and eclampsia are part of the spectrum of high blood pressure disorders that can occur during pregnancy, according to the National Institute of Child Health and Human Development. The causes are unknown. 

[post_ads]Pre-eclampsia describes high blood pressure after 20 weeks of pregnancy, but according to the NICHHD, can include blood pressure at or greater than 140/90, increased swelling and protein in the urine. It is the leading cause of preterm birth. Pre-eclampsia severe enough to affect brain function and cause seizures or comas is called eclampsia.

Gestational hypertension is at the mild end of the spectrum, affecting women who develop high blood pressure when they are more than 20 weeks pregnant but then return to normal within 12 weeks of delivery. It typically causes no lasting harm, but severe gestational hypertension may be associated with early delivery and infants that are smaller than average.

What are the symptoms?

Part of the danger with pre-eclampsia is that many women don't feel sick, according to the Preeclampsia Foundation. Many of the signs are silent, while others resemble normal effects of pregnancy. 

• High blood pressure is the biggest red flag. But other symptoms may include:
• Proteinuria, or proteins in your urine that are normally filtered by your kidneys
• Swelling in the face, around the eyes and the hands (slight swelling, especially in the feet, is a common pregnancy issue and not necessarily cause for alarm)
• Headaches that won't go away even after medication
• Vision changes, including flashing lights, auras, light sensitivity or blurry vision
• Abdominal pain, particularly in the upper right quadrant
• Difficulty breathing, including shortness of breath, racing pulse and a heightened sense of anxiety

Symptoms of eclampsia, which are cause for immediate concern, include seizures, severe headaches, vision problems including temporary blindness, abdominal pain, nausea and vomiting, and small urine output. 

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How is it treated?

Health care providers should monitor blood pressure and lab tests that indicate the condition of the mother's kidneys, liver and ability of blood to clot.

A systolic blood pressure (the first number) of 160 or higher, or diastolic blood pressure (second number) of 110 or higher is dangerous – and needs urgent treatment. If your pressure is in either of these danger zones before or after delivery, nurses should retest you within 15 minutes. If it’s still too high, pressure-lowering medication should be given within an hour to prevent a stroke.

Magnesium sulfate can prevent seizures caused by high blood pressure. But moms need antihypertensive drugs to actually lower their pressure or they risk a stroke. The primary recommended drugs – considered safe for pregnant and recently delivered moms – are both delivered by IV: labetalol and hydralazine. A specific type of pill, called immediate-release oral nifedipine, can also be used.

What should you ask your doctor or hospital?

• If I need it, does the hospital have a policy to make sure I get the right medication fast?
• What is my blood pressure (during prenatal visits)?
• What are warning signs I should look out for?

See more at: USA TODAY