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What is Preeclampsia
Dr. Brennan Fitzpatrick explains the difference between preeclampsia and eclampsia, who is at risk, and how it affects pregnancy.
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Learn more about Brennan Fitzpatrick, MD, MBA, FACOG
Brennan Fitzpatrick, MD, MBA, FACOG
Brennan Fitzpatrick, MD, MBA, FACOG is the Director of Perinatal Medicine and Ultrasound, The Women's Hospital.Learn more about Brennan Fitzpatrick, MD, MBA, FACOG
Transcription:
Melanie Cole (Host): Welcome to podcast series from Deaconess The Women’s Hospital – A Place For All Your Life. I’m Melanie Cole and today, we’re discussing preeclampsia. Joining me, is Dr. Brennan Fitzpatrick. He’s the Director of the Perinatal Medicine and Ultrasound at The Women’s Hospital. Dr. Fitzpatrick, thank you so much for joining us today. Tell the listeners, just start with a little lesson. What is preeclampsia?
Brennan Fitzpatrick, MD, MBA, FACOG (Guest): Preeclampsia is one of what we call hypertensive disorders of pregnancy. It is a disease that is seen just during pregnancy. It is characterized typically by high blood pressure; however, patients with preeclampsia can have other issues. They can have issues with their kidney function, they can have issues with their liver function. They can have issues with their lung function. And they can even have issues with their brain including things like seizures and those types of things.
Host: Who is at risk for preeclampsia, Doctor? Tell us a little bit about if there’s a way to predict, you mentioned hypertension during pregnancy. Do you have some predictors?
Dr. Fitzpatrick: Absolutely. So, patients that are over the age of 35 are at higher risk. Patients with underlying chronic high blood pressure have an increased risk. Patients that have pregestational diabetes or diabetes that exists prior to pregnancy. Things like lupus, predisposition towards blood clots in the legs and in the lungs; those are all things that potentially can increase the probability of developing preeclampsia in pregnancy.
Host: So, then tell us the difference if you would between preeclampsia and eclampsia and we hear about things and toxemia; there’s all these terms being thrown around. Tell us what they mean.
Dr. Fitzpatrick: Toxemia is the way that we used to describe preeclampsia. So, those two words are essentially interchangeable. Preeclampsia and eclampsia are on the same spectrum; however, preeclampsia is typically a precursor to eclampsia, but it doesn’t always have to be a precursor to eclampsia. And eclampsia is essentially preeclampsia with seizures. So, that is the defining aspect of eclampsia is that there are seizures that occur. The way that we talk about preeclampsia to patients is that preeclampsia is a disease of the small blood vessels and we think that it is connected to the placenta and how the placenta functions but what happens is those small blood vessels spasm and when they spasm, that causes the blood pressure to go up. Over time as they spasm, they get damaged and when they get damaged, they get leaky and when they get leaky, they start leaking fluid and protein into places that they are not supposed to leak fluid and protein like the kidneys, the liver, sometimes the lungs, sometimes the brain.
And so that process of sort of swelling is what leads to the seizures that we see with eclampsia.
Host: So, then Dr. Fitzpatrick, when does preeclampsia occur during pregnancy and how does it affect the pregnancy? Because this must be very scary for women.
Dr. Fitzpatrick: Absolutely. And it is a very serious disease. It can come on quickly. A lot of times, with patients not being fully aware that they are developing the disease, a lot of times we find patients come in and maybe they don’t feel all that great and they are having headaches and sparkling lights in their vision, those types of things. And then we check their blood pressure and their blood pressure is elevated; we dip their urine and there’s protein in the urine. It is typically a disease that presents in the third trimester of pregnancy. It can present earlier but typically, it’s in the third trimester. A significant proportion of patients actually can present in the immediate post-partum period.
Host: So, if this is something that you suspect or you even realize is going on; how is it treated and how do you stop it from becoming eclampsia, if you can?
Dr. Fitzpatrick: Well unfortunately, the best treatment for it is delivery. And that is not as big of a deal if you are talking a patient that presents at term with preeclampsia. But in patients that are preterm, and particularly early preterm patients; you sometimes are in a position where the only treatment that you have is to deliver them. Typically speaking, what we tell patients is that when we suspect preeclampsia, we will admit them to the hospital. Once they are in the hospital, we will evaluate their kidney function and their liver function. We’ll monitor their blood pressures. We’ll collect a 24 hour urine to look at the protein in the urine and if they are having complaints like a headache or we check their reflexes and those reflexes are brisk; then sometimes we’ll put patients on a medicine called magnesium sulfate. Magnesium sulfate is preventative treatment to prevent seizures in patients that have preeclampsia or are at risk for eclampsia.
So, in that sense, it really becomes about keeping patients in the hospital. There are sort of two different severity levels of preeclampsia. There’s preeclampsia and then there’s something that we call preeclampsia with severe features. And those severe features can be blood pressures that are greater than 160/110. We talked about fluid in the lungs. We talked about liver dysfunction. We talked about kidney dysfunction. All of those things could potentially be characterized as severe features. The furthest that we let a patient go when she develops preeclampsia with severe features is 34 weeks gestation. So, we deliver them preterm because we’re trying to reduce the risk for both mom and baby.
In patients that have essentially mild preeclampsia, or preeclampsia those patients can be managed in the hospital all the way up to 37 weeks and then delivered at that time. If a patient develops eclampsia, we deliver that patient at the time that the patient develops eclampsia. So, in other words, if a patient is 26 or 27 or 28 weeks and they develop eclampsia, we will deliver them at that time.
Host: How does it affect the baby?
Dr. Fitzpatrick: We think that the origins of preeclampsia have to do with how the placenta implants and the placenta is the hook up between mom and baby. So, at baseline, you can see what we call placental dysfunction so, a lot of times we’ll see babies that are small. We can see issues with respect to something called placental abruption which is a separation of the placenta off the uterine wall. We can see issues with respect to an increased risk for fetal demise. So, there are unquestionably increased risks as it relates to the baby in patients that have preeclampsia.
Host: So, Doctor, can it happen after the baby is born? As you’ve said that if it’s eclampsia or even pre and sometimes you might have to deliver right then; can it then happen as well?
Dr. Fitzpatrick: Yeah so, essentially when we talk to patients and once, they are delivered, we talk to patients that a significant proportion of them will have persistent or recurrent symptoms after they deliver. The majority of patients will go ahead and resolve. However, we do see patients that in the postpartum period will continue to have issues. Those issues can linger up to a couple of weeks. Occasionally, you’ll see them have issues as far as six weeks postpartum. But typically, by two weeks postpartum, you tend not to see it as much. And it’s just a matter of watching those patients closely. We do a lot of times, restart that magnesium sulfate. As I said it’s a preventative against eclampsia or seizures, but it also sort of stabilizes vascular membranes or blood vessel membranes and sort of stops that spasm that we were talking about earlier.
Host: If a woman is at risk or does come up with preeclampsia and she gets pregnant again; is she now at risk for this again?
Dr. Fitzpatrick: There’s no question. So, we talk about recurrence risk being as high as 65% and ultimately there are things that patients can do to reduce that risk. Baby aspirin is probably the most significant that we talk about. Patients that have a history of preeclampsia or risk factors for preeclampsia and we talked about some of those; chronic high blood pressure, pregestational diabetes. Patients can take low dose aspirin and reduce the risk of preeclampsia by up to 70%. So, there are treatments that can reduce the risk, however, we can’t always prevent it from happening again in a subsequent pregnancy.
Host: Please wrap it up for us Dr. Fitzpatrick. It’s such an interesting topic. Please tell women what you’d like them to know about preeclampsia and eclampsia and what you can do for them at Deaconess The Women’s Hospital.
Dr. Fitzpatrick: Well I think the important thing to remember is again, that it is a serious issue that occurs during pregnancy. It is something that your general OB-GYN is trained to evaluate for and detect. If patients are having issues with their blood pressure, it’s something that needs to be taken very, very seriously. Because as I said, it can progress quickly and a lot of times unbeknownst to the patient. From our perspective at The Women’s Hospital, we have an outstanding team that’s very, very capable of handling even the sickest patients with preeclampsia. We have a full compliment of Maternal Fetal Medicine physicians who are specialists in treating this specific disease. And certainly The Women’s Hospital is very well equipped to take care of again, even the sickest patients.
Host: Thank you so much Dr. Fitzpatrick for coming on and sharing your incredible expertise with us today. That concludes this episode of the podcast series from Deaconess the Women’s Hospital – A Place For All Your Life. To schedule an appointment or to learn more about high risk pregnancy and Tri State Perinatology at The Women’s Hospital please visit our website at www.deaconess.com/TSP to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Deaconess Women’s Hospital podcasts. I’m Melanie Cole.
Melanie Cole (Host): Welcome to podcast series from Deaconess The Women’s Hospital – A Place For All Your Life. I’m Melanie Cole and today, we’re discussing preeclampsia. Joining me, is Dr. Brennan Fitzpatrick. He’s the Director of the Perinatal Medicine and Ultrasound at The Women’s Hospital. Dr. Fitzpatrick, thank you so much for joining us today. Tell the listeners, just start with a little lesson. What is preeclampsia?
Brennan Fitzpatrick, MD, MBA, FACOG (Guest): Preeclampsia is one of what we call hypertensive disorders of pregnancy. It is a disease that is seen just during pregnancy. It is characterized typically by high blood pressure; however, patients with preeclampsia can have other issues. They can have issues with their kidney function, they can have issues with their liver function. They can have issues with their lung function. And they can even have issues with their brain including things like seizures and those types of things.
Host: Who is at risk for preeclampsia, Doctor? Tell us a little bit about if there’s a way to predict, you mentioned hypertension during pregnancy. Do you have some predictors?
Dr. Fitzpatrick: Absolutely. So, patients that are over the age of 35 are at higher risk. Patients with underlying chronic high blood pressure have an increased risk. Patients that have pregestational diabetes or diabetes that exists prior to pregnancy. Things like lupus, predisposition towards blood clots in the legs and in the lungs; those are all things that potentially can increase the probability of developing preeclampsia in pregnancy.
Host: So, then tell us the difference if you would between preeclampsia and eclampsia and we hear about things and toxemia; there’s all these terms being thrown around. Tell us what they mean.
Dr. Fitzpatrick: Toxemia is the way that we used to describe preeclampsia. So, those two words are essentially interchangeable. Preeclampsia and eclampsia are on the same spectrum; however, preeclampsia is typically a precursor to eclampsia, but it doesn’t always have to be a precursor to eclampsia. And eclampsia is essentially preeclampsia with seizures. So, that is the defining aspect of eclampsia is that there are seizures that occur. The way that we talk about preeclampsia to patients is that preeclampsia is a disease of the small blood vessels and we think that it is connected to the placenta and how the placenta functions but what happens is those small blood vessels spasm and when they spasm, that causes the blood pressure to go up. Over time as they spasm, they get damaged and when they get damaged, they get leaky and when they get leaky, they start leaking fluid and protein into places that they are not supposed to leak fluid and protein like the kidneys, the liver, sometimes the lungs, sometimes the brain.
And so that process of sort of swelling is what leads to the seizures that we see with eclampsia.
Host: So, then Dr. Fitzpatrick, when does preeclampsia occur during pregnancy and how does it affect the pregnancy? Because this must be very scary for women.
Dr. Fitzpatrick: Absolutely. And it is a very serious disease. It can come on quickly. A lot of times, with patients not being fully aware that they are developing the disease, a lot of times we find patients come in and maybe they don’t feel all that great and they are having headaches and sparkling lights in their vision, those types of things. And then we check their blood pressure and their blood pressure is elevated; we dip their urine and there’s protein in the urine. It is typically a disease that presents in the third trimester of pregnancy. It can present earlier but typically, it’s in the third trimester. A significant proportion of patients actually can present in the immediate post-partum period.
Host: So, if this is something that you suspect or you even realize is going on; how is it treated and how do you stop it from becoming eclampsia, if you can?
Dr. Fitzpatrick: Well unfortunately, the best treatment for it is delivery. And that is not as big of a deal if you are talking a patient that presents at term with preeclampsia. But in patients that are preterm, and particularly early preterm patients; you sometimes are in a position where the only treatment that you have is to deliver them. Typically speaking, what we tell patients is that when we suspect preeclampsia, we will admit them to the hospital. Once they are in the hospital, we will evaluate their kidney function and their liver function. We’ll monitor their blood pressures. We’ll collect a 24 hour urine to look at the protein in the urine and if they are having complaints like a headache or we check their reflexes and those reflexes are brisk; then sometimes we’ll put patients on a medicine called magnesium sulfate. Magnesium sulfate is preventative treatment to prevent seizures in patients that have preeclampsia or are at risk for eclampsia.
So, in that sense, it really becomes about keeping patients in the hospital. There are sort of two different severity levels of preeclampsia. There’s preeclampsia and then there’s something that we call preeclampsia with severe features. And those severe features can be blood pressures that are greater than 160/110. We talked about fluid in the lungs. We talked about liver dysfunction. We talked about kidney dysfunction. All of those things could potentially be characterized as severe features. The furthest that we let a patient go when she develops preeclampsia with severe features is 34 weeks gestation. So, we deliver them preterm because we’re trying to reduce the risk for both mom and baby.
In patients that have essentially mild preeclampsia, or preeclampsia those patients can be managed in the hospital all the way up to 37 weeks and then delivered at that time. If a patient develops eclampsia, we deliver that patient at the time that the patient develops eclampsia. So, in other words, if a patient is 26 or 27 or 28 weeks and they develop eclampsia, we will deliver them at that time.
Host: How does it affect the baby?
Dr. Fitzpatrick: We think that the origins of preeclampsia have to do with how the placenta implants and the placenta is the hook up between mom and baby. So, at baseline, you can see what we call placental dysfunction so, a lot of times we’ll see babies that are small. We can see issues with respect to something called placental abruption which is a separation of the placenta off the uterine wall. We can see issues with respect to an increased risk for fetal demise. So, there are unquestionably increased risks as it relates to the baby in patients that have preeclampsia.
Host: So, Doctor, can it happen after the baby is born? As you’ve said that if it’s eclampsia or even pre and sometimes you might have to deliver right then; can it then happen as well?
Dr. Fitzpatrick: Yeah so, essentially when we talk to patients and once, they are delivered, we talk to patients that a significant proportion of them will have persistent or recurrent symptoms after they deliver. The majority of patients will go ahead and resolve. However, we do see patients that in the postpartum period will continue to have issues. Those issues can linger up to a couple of weeks. Occasionally, you’ll see them have issues as far as six weeks postpartum. But typically, by two weeks postpartum, you tend not to see it as much. And it’s just a matter of watching those patients closely. We do a lot of times, restart that magnesium sulfate. As I said it’s a preventative against eclampsia or seizures, but it also sort of stabilizes vascular membranes or blood vessel membranes and sort of stops that spasm that we were talking about earlier.
Host: If a woman is at risk or does come up with preeclampsia and she gets pregnant again; is she now at risk for this again?
Dr. Fitzpatrick: There’s no question. So, we talk about recurrence risk being as high as 65% and ultimately there are things that patients can do to reduce that risk. Baby aspirin is probably the most significant that we talk about. Patients that have a history of preeclampsia or risk factors for preeclampsia and we talked about some of those; chronic high blood pressure, pregestational diabetes. Patients can take low dose aspirin and reduce the risk of preeclampsia by up to 70%. So, there are treatments that can reduce the risk, however, we can’t always prevent it from happening again in a subsequent pregnancy.
Host: Please wrap it up for us Dr. Fitzpatrick. It’s such an interesting topic. Please tell women what you’d like them to know about preeclampsia and eclampsia and what you can do for them at Deaconess The Women’s Hospital.
Dr. Fitzpatrick: Well I think the important thing to remember is again, that it is a serious issue that occurs during pregnancy. It is something that your general OB-GYN is trained to evaluate for and detect. If patients are having issues with their blood pressure, it’s something that needs to be taken very, very seriously. Because as I said, it can progress quickly and a lot of times unbeknownst to the patient. From our perspective at The Women’s Hospital, we have an outstanding team that’s very, very capable of handling even the sickest patients with preeclampsia. We have a full compliment of Maternal Fetal Medicine physicians who are specialists in treating this specific disease. And certainly The Women’s Hospital is very well equipped to take care of again, even the sickest patients.
Host: Thank you so much Dr. Fitzpatrick for coming on and sharing your incredible expertise with us today. That concludes this episode of the podcast series from Deaconess the Women’s Hospital – A Place For All Your Life. To schedule an appointment or to learn more about high risk pregnancy and Tri State Perinatology at The Women’s Hospital please visit our website at www.deaconess.com/TSP to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Deaconess Women’s Hospital podcasts. I’m Melanie Cole.