Understanding Preeclampsia

A preeclampsia diagnosis can leave you worried about your health, your baby’s well-being, and whether important warning signs were addressed. This page can help your family understand the condition, the care it may require, and when questions about prenatal, delivery, or postpartum treatment may deserve a closer review.

What is preeclampsia?

Preeclampsia is a pregnancy-related high blood pressure disorder that most often develops after 20 weeks of pregnancy, although it can also begin after delivery. It is diagnosed when new-onset hypertension occurs with protein in the urine or other signs that organs such as the brain, liver, kidneys, blood, or lungs may be affected.

Protein in the urine is not present in every case. Some patients have no noticeable symptoms and are diagnosed through routine blood pressure checks, urine testing, laboratory studies, or fetal monitoring. Because the condition can progress, careful evaluation and follow-up are important even when a patient initially feels well.

Signs and symptoms

Preeclampsia may be discovered during a prenatal or postpartum visit before symptoms appear. When warning signs do occur, they can develop gradually or begin suddenly and should be reported promptly.

• A severe or persistent headache that does not improve
• Blurred vision, seeing spots, light sensitivity, or temporary vision changes
• Pain in the upper right abdomen, upper abdomen, or shoulder
• Nausea or vomiting later in pregnancy
• Shortness of breath or difficulty breathing
• Sudden or pronounced swelling of the face or hands
• Rapid weight gain associated with fluid retention
• Reduced urination
• Elevated blood pressure, protein in the urine, or abnormal blood test results identified by the medical team

Symptoms can also begin after delivery, including after a patient has returned home. A persistent headache, vision changes, breathing difficulty, upper abdominal pain, or other concerning symptoms during the postpartum period require prompt medical evaluation.

What causes preeclampsia?

The exact cause of preeclampsia is not fully understood. Current evidence links the condition to the placenta and to widespread changes in how blood vessels develop, signal, and function during pregnancy.

Biological processes believed to contribute may include:

• Abnormal development or remodeling of blood vessels that supply the placenta
• Reduced or irregular blood flow between the uterus and placenta
• Placental signals that affect blood vessels throughout the mother’s body
• Inflammation and dysfunction in the inner lining of blood vessels
• Immune, genetic, and metabolic factors that may influence placental and vascular health

A prior history of preeclampsia, chronic high blood pressure, kidney disease, diabetes, autoimmune disease, a multiple pregnancy, a first pregnancy, in vitro fertilization, obesity, older maternal age, and a family history of preeclampsia are among the factors associated with higher risk. These factors do not mean preeclampsia was inevitable, and the condition can occur without an obvious risk pattern.

When preeclampsia may be medical malpractice

Not every case of preeclampsia is caused by medical malpractice. The condition can arise or worsen despite appropriate prenatal and postpartum care. However, the following circumstances may point to negligence when a provider’s failure to meet accepted standards contributes to preventable harm:

• Failing to measure, document, repeat, or respond to elevated blood pressure readings
• Dismissing severe headaches, vision changes, upper abdominal pain, breathing difficulty, sudden swelling, or other warning symptoms
• Failing to order or properly interpret urine protein testing, platelet counts, liver or kidney studies, or other appropriate assessments
• Failing to recognize preeclampsia when diagnostic findings or severe features are present
• Inadequately monitoring the mother or baby after concerning symptoms, blood pressure readings, or test results
• Failing to assess fetal growth, placental function, or fetal well-being when clinically indicated
• Delaying treatment for persistent severe hypertension
• Failing to administer magnesium sulfate when clinically indicated to reduce the risk of seizures
• Delaying hospitalization, specialist consultation, transfer, stabilization, or delivery when the mother’s or baby’s condition requires escalation
• Providing inadequate postpartum monitoring, discharge instructions, blood pressure follow-up, or evaluation of new symptoms

Wais, Vogelstein, Forman, Koch & Norman, LLC works with qualified medical experts to review prenatal, labor and delivery, and postpartum records and determine whether the care met accepted standards.

Treatment and long-term outlook

Treatment depends on the severity of the condition, the gestational age of the pregnancy, and the health of the mother and baby. Preeclampsia without severe features may sometimes be managed with close outpatient or hospital monitoring, including frequent blood pressure checks, blood and urine testing, fetal growth assessments, and fetal heart rate monitoring.

Preeclampsia with severe features generally requires hospital evaluation and careful observation. Treatment may include medication for persistent severe hypertension, magnesium sulfate to reduce the risk of eclamptic seizures, and corticosteroids when preterm delivery is anticipated and additional fetal lung development may be beneficial. Delivery is the definitive treatment, but the timing and method depend on the clinical situation and whether continued pregnancy presents greater risks than delivery.

Many patients recover after delivery, but symptoms can persist or first appear during the postpartum period. Preeclampsia can be associated with eclampsia, stroke, organ injury, placental abruption, fetal growth restriction, and preterm birth. Patients who have had preeclampsia also need ongoing medical follow-up because the condition is associated with a higher future risk of chronic high blood pressure and cardiovascular disease. A baby born early or affected by placental problems may need neonatal and developmental follow-up based on the complications experienced.