Preeclampsia Diagnosis

Preeclampsia, a potentially life threatening complication of pregnancy, is characterized by an elevated blood pressure. Slightest increase in blood pressure after the 20th week of pregnancy along with the signs of organ damage (mostly kidneys) may indicate the development of preeclampsia. If left untreated, it can result in serious consequences and even prove to be fatal for both mother and baby. Hence timely preeclampsia diagnosis is extremely important and its only cure is delivery.

When to Diagnose for Preeclampsia

To determine if you need preeclampsia diagnosis, the first step is to know if you have symptoms of preeclampsia. Symptoms may completely be absent and blood pressure may shoot up suddenly. Blood pressure monitoring is an integral part of antenatal care, and a pressure of 140/90mmHg or above, if recorded at 2 separate occasions at least 4 hours apart, shouldn't be ignored. Other signs that indicate you have preeclampsia include:

  • Excess protein in urine or additional signs of kidney problems
  • Vision changes, like temporary vision loss, blurring of vision and light sensitivity
  • Severe headaches
  • Abdominal pain in the upper quadrants, mostly on the right side
  • Nausea and vomiting
  • Reduced urinary output
  • Thrombocytopenia (reduced platelets)
  • Impaired liver function
  • Breathlessness due to fluid in lungs
  • Sudden weight gain
  • Swelling in hands and face

But you need to visit a doctor and get tested if you experience:

  • Severe headaches
  • Severe abdominal pain
  • Blurring of vision
  • Severe breathlessness

Note: While these signs and symptoms often accompany preeclampsia, they are not reliable indicators because some of them like nausea and vomiting are normal during pregnancy, especially during the first month. If you have a hard time to differentiate them, just contact your doctor and get diagnosed.

How to Perform Preeclampsia Diagnosis

A single elevated blood pressure is not enough to determine that you have preeclampsia. Your doctor may order the following diagnosis:

1. Blood Tests

Blood tests give a complete picture of the cells and platelets (fragments playing part in blood clotting) and help in assessing kidney and liver function. Specifically blood tests are done to check:

  • Uric acid, a waste product formed as a result of protein and cell break down, is usually elevated in preeclampsia, indicating kidney damage, which is responsible for its filtration. This is often the earliest lab finding in pre-eclampsia.
  • Hematocrit is a value that tells us about the percentage of RBCs in the blood. For example, a value of 40 means 40% of blood is made up of RBCs. In non-pregnant state, this ranges between 36 and 44, but during pregnancy there is an increase in plasma, making red blood cells less concentrated and reducing hematocrit values. But preeclampsia causes plasma to be absorbed and raises hematocrit value abnormally.
  • Platelets number can be reduced abnormally due to preeclampsia.
  • Partial thromboplastin time (PTT) is the time required for blood to clot, which may be increased in preeclampsia, since it disturbs clotting process.
  • Body electrolyte levels may change if preeclampsia causes kidney damage or blood vessel fluid leakage. Important electrolytes include sodium, potassium, chloride, magnesium and calcium.
  • Kidney function: Blood urea nitrogen, creatinine and certain substances cleared from the blood by kidney can be checked to assess kidney function. Preeclampsia causes kidney damage and prevents the removal of these waste products, resulting in their increase in blood.
  • Liver function: Certain enzymes can be investigated to assess liver function as well.

2. Urinalysis

The second preeclampsia diagnosis method is urinalysis. It can be used to diagnose preeclampsia by measuring protein to creatinine ratio. Besides, collecting urine over a period of 24 hours and assessing the quantity of protein lost in urine can be used to determine the severity of preeclampsia.

3. Fetal Ultrasound

Regular ultrasounds help in keeping a tab on baby’s growth, which allow the doctor to make an estimation of the amount of amniotic fluid present in the cavity as well as the weight of the baby.

4. Biophysical Profile

Also called a nonstress test, it checks baby’s heart rate on movement. When combined with the finding of an ultrasound, it can provide more information about baby’s tone, movement, breathing and amniotic fluid volume in the uterus.

How to Treat Preeclampsia

Once preeclampsia diagnosis is made, its treatments should follow immediately. Options include:

1. Medication

Medicines that can be given in this condition are:

  • Antihypertensives: Although blood pressure of 140/90 mmHg doesn’t fall in the category where treatment is required, dangerously high blood pressure should be treated with antihypertensive drugs to lower blood pressure. While not all such medicines are safe during pregnancy, make sure you consult your doctor to check if you need them or not.
  • Corticosteroids tend to improve platelet and liver function, and prolong pregnancy in severe preeclampsia. It also helps in fetus lung maturation within 48 hours to aid in preparing baby for life outside of the womb after premature delivery.
  • Anticonvulsants, like magnesium sulfate, may help in preventing seizures in severe cases.

2. Hospitalization

In severe cases of preeclampsia, you may have to live in the hospital for some time, so your doctor can perform regular tests to monitor your baby's health and the amount of your amniotic fluid volume. An insufficient of this fluid may indicate the poor blood supply to your baby.

3. Delivery

Delivery is the ultimate solution for preeclampsia.

  • If preeclampsia develops towards the end of your pregnancy, doctor may suggest inducing labor. But the assessment of cervix readiness (dilation, effacement and its softness) also plays a role in this process.  In severe cases, your doctor will induce labor or arrange a C-section directly without any assessment. Anticonvulsant is given intravenously during the process.
  • Blood pressure returns to normal within 12 weeks after delivery and painkillers approved by the doctor may also be taken. NSAIDS, like ibuprofen and naproxen sodium, tend to increase your blood pressure and should be avoided, but acetaminophen is a safe option.
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