Severe Preeclampsia Case Study
This was JC's first pregnancy. She was eight weeks from her due date when she came to the office for a visit. When I came into the room, I was immediately alarmed. She had gained eight pounds in one week, her blood pressure was 150/105 and she had a significant amount of protein in her urine. She told me she had been having headaches for the last couple days and was feeling lousy.

The diagnosis of eclampsia was apparent to me even though her blood pressure hadn't reached the magic 160/110. I admitted her to the hospital where lab tests confirmed my suspicion. Her platelets (which help prevent you from bleeding) were very low and her liver tests were moderately elevated.)

In this situation, there was no question what had to be done. Both mother and baby were in danger. JC could develop seizures. She could hemorrhage from her low platelet count. Meanwhile her baby was living in a hostile environment due to the elevated blood pressure. There was a reduced level of blood flowing to the baby, which meant that less oxygen and food were reaching the baby. This situation could be lethal to the baby if left untreated.

After doing a vaginal exam, I discovered that JC was not ready for labor and would take many hours to be successfully induced. Due to the risk of hemorrhage, a cesarean section was the safest, quickest way to treat the condition. I treated JC prior to delivery with a medication called magnesium sulfate to prevent seizures and performed a cesarean section.

JC's preeclampsia resolved over the next several days and her lab test reverted back to normal. The baby required several weeks of hospitalization before going home. Both mother and baby are doing well now.

This case represents a dramatic example of severe preeclampsia. Not all cases are this challenging nor do they all require cesarean sections. Let's take the same case and modify the findings ever so slightly.

JC has all the same findings except her platelet count is just marginally low. In this case, she still needs to be delivered but is not at high risk of hemorrhaging. She can undergo induction of labor with the drug pitocin and have a vaginal delivery. Her baby will still need the same extra hospital care and JC's preeclampsia will resolve the same way as with the cesarean section.

Mild Preeclampsia Case Study
In mild forms, we can be more conservative in our treatment depending on the situation. If the woman's blood pressure rises and she is close to her due date, we will opt to induce her. If she is many weeks from her due date, we will treat her with bed rest and careful monitoring. The following case illustrates this situation:

LM was seven weeks from her due date when her blood pressure was noted to be 145/95. She had a small amount of protein in her urine and had noted a five-pound weight gain over the past several weeks. She didn't have any other signs of preeclampsia. Her blood tests came back normal. We ordered an ultrasound to check on the baby's growth, and a fetal heart monitoring study to ensure the baby was getting enough oxygen. All the tests indicated that the baby was growing.

We put LM on bed rest and continued to watch her carefully over the ensuing weeks by repeating many of the tests. When she was four weeks from her due date, her blood pressure began to rise and we found more protein in her urine. It was time for LM to deliver. We gave her magnesium to prevent seizures and pitocin to initiate labor.

LM had a healthy six-pound daughter who was able to go home with her mom on the second post-delivery day.

This case illustrates the concept of conservative management. Careful observation is an acceptable management plan with mild preeclampsia. It is a poor plan if severe preeclampsia is present.

Summary

Preeclampsia is a very common medical condition during pregnancy. Properly identifying the disease enables your physician to make important decisions, which will affect the outcome of your pregnancy. If you have any worrisome symptoms during your pregnancy, pick up the phone and call your doctor.

Craig L. Bissinger, MD is a board certified Obstetrician/Gynecologist practicing in Parsippany, NJ. Dr. Bissinger is vice-chairman of the Department of OB/GYN at Morristown Memorial Hospital where is is also actively involved in teaching medical students and residents. Dr. Bissinger is a frequent speaker on a host of women's health topics and a member of the Eli Lilly Speakers Bureau.