With a long family history of premature babies, my major concern during my first pregnancy was preterm labor. Once I made it to nearly 40 weeks with a relatively easy pregnancy (minus the whole “throwing up every day for four months” thing), I felt like I was in the clear. So when I went in for an appointment at 39.5 weeks, I was shocked to be sent straight to the hospital because of high blood pressure and proteinuria (protein in my urine), telltale signs of preeclampsia.
The next afternoon, the verdict was in: I had preeclampsia, and they planned to induce labor the following morning.
After a nonstress test indicated my daughter was still healthy and thriving in utero, the doctors started a 24-hour urine collection to measure my protein levels. The next afternoon, the verdict was in: I had preeclampsia, and they planned to induce labor the following morning. (This was in 2011, and protocols have since changed; elevated protein levels are no longer required for a preeclampsia diagnosis.)
In a nutshell, preeclampsia is the development of hypertension, or high blood pressure (two readings of 140/90 or higher, at least four hours apart), after 20 weeks of pregnancy, along with other complications and often accompanied by proteinuria. It occurs in approximately 3–4 percent of pregnancies in the United States, with 90 percent of cases occurring after 34 weeks, and most at full term (37+ weeks). Though more rare, preeclampsia can also develop in the days and weeks after delivery.
Preeclampsia can lead to serious complications like fetal growth restriction, preterm birth, placental abruption, HELLP syndrome, eclampsia (preeclampsia with seizures), organ damage, and cardiovascular disease. It’s nothing to mess around with and can be deadly if not recognized and treated. According to the Centers for Disease Control, between 2011 and 2016, hypertensive disorders of pregnancy caused nearly 7 percent of maternal deaths.
This is why regular prenatal checkups are so vital: Because of my lack of reportable symptoms, which is quite common with preeclampsia, the only way my providers caught it was because of my office visit.
I remembered briefly learning about preeclampsia during maternal health classes, but my diagnosis surprised me, because other than the joys of being enormously pregnant, I felt fine. The nurses ran through a list of questions. Had I experienced any headaches, vomiting, or extreme or sudden swelling of my hands, feet, or face? What about visual disturbances, shortness of breath, or pain in my upper abdomen? I answered no across the board, but despite that, my blood pressure was high, my protein levels were through the roof, and my platelets were low.
This is why regular prenatal checkups are so vital: Because of my lack of reportable symptoms, which is quite common with preeclampsia, the only way my providers caught it was because of my office visit. If I had missed that appointment, things could have been much worse. The next morning, I was induced, and three and a half hours later my daughter was placed in my arms. My blood pressure remained elevated after leaving the hospital, and I had to take a low dose of blood pressure medication for a few months postpartum until it resolved.
The only “cure” for preeclampsia is delivery of the baby.
While experts believe preeclampsia starts with the placenta and the blood vessels that are formed during its development (which is why low-dose aspirin is now often recommended for individuals at risk), we still don’t have concrete answers on why it happens, why certain women develop it and not others, or how to prevent it. The only “cure” for preeclampsia is delivery of the baby.
Five and a half years later, I became pregnant with my second daughter. At the time, I had some elevated risk: my history of preeclampsia and new paternity. In the intervening years, my first husband had died from brain cancer, and my new partner and I were shocked to learn that each pregnancy with a new father puts one at higher risk for preeclampsia than a subsequent pregnancy with the same father. Overall, although my doctors determined that while I was at greater risk than the general population, other than having me start a low-dose aspirin regimen, they decided to continue treating my pregnancy as “normal” risk until there was reason not to.
As with my first, other than vomiting regularly for the first four months, my second pregnancy progressed without complications. Around 38 weeks, I had a sudden and unexplained bout of vomiting one evening. On high alert for preeclampsia symptoms, I called my OB. At the hospital, my blood pressure was good, I had no more episodes of vomiting, and I passed my 24-hour urine collection by the skin of my teeth, so after an overnight stay I was allowed to go home.
Knowing my history, my doctors are monitoring me closely and have considered me high-risk from day one.
Four days later, I went into labor in the middle of the night. I felt fine, but in the few days since my last evaluation, I had developed full-blown preeclampsia, and by the time we arrived at the hospital, I was in a hypertensive crisis. My blood pressures were consistently reading 200+/120+. With those numbers, I was at high risk for having a stroke, and my daughter and I were both at increased risk for other dangerous complications.
As my labor progressed rapidly, a nurse administered IV meds to lower my blood pressure. Fifty minutes after we arrived, my second daughter was born. While I cradled her to my chest, my team worked around me, starting a magnesium drip to prevent seizures and monitoring my blood pressure to make sure it was coming down. I stayed in the hospital for four days while my blood pressure stabilized, and by a week after discharge, my blood pressure had returned to normal.
I’m now pregnant with my third daughter. Knowing my history, my doctors are monitoring me closely and have considered me high-risk from day one. I take a low-dose aspirin every day, and now that I’m past 20 weeks, I also frequently check my blood pressure at home. I know what symptoms to keep an eye out for: severe headache, vision changes, pain in the upper abdomen, nausea and vomiting, and sudden shortness of breath can all indicate possible preeclampsia. Sudden weight gain and swelling can also be signs, but they are less reliable, as they also happen in healthy pregnancies.
While the thought of developing preeclampsia again is still a little frightening, my husband and I are both well versed in what we need to watch for (and what might be hiding under the surface) as my due date approaches.
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