Growing Pressure: The Ins and Outs of Pregnancy Induced Hypertension

When Karen Klein started to swell up, she thought it was a normal part of her pregnancy. Four weeks later, she was in the delivery room suffering from preeclampsia.

By Naomi Mendelsohn

Twenty-nine weeks into her pregnancy, Karen Klein started to swell up.

"The doctors didn’t think anything of it. It was kind of normal," says Karen, the mother of twins. "We just assumed that it was the babies pressing on my diaphragm."

But by 33 weeks, there was a lot more swelling. Karen’s feet and ankles got larger. Her toes looked like sausages.

"At 34 weeks, I went in for a regular visit," explains Karen. "My blood pressure was high, not sky high, but higher than it should be. Plus, there was more protein in my urine."

With an abnormally high blood pressure reading of 140/90 and an unusual protein count of plus two, it was clear that Karen was suffering from preeclampsia, a form of pregnancy induced hypertension that is severely dangerous to the mother and child.

"The doctor sent me to labor and delivery. She wanted them to take a look at me."

An hour later, the doctors induced labor.

The most common form of hypertensive disorder affecting pregnant women, preeclampsia affects three to five percent of all pregnancies.

"Pregnancy induced hypertension is one of the most common medical complications of pregnancy," explains Arianna Sholes-Douglas, M.D., perinatologist and director of the Antenatal Diagnostic Center at Mercy Medical Center in Baltimore (MD). "A lot of the complications due to preeclampsia are the reasons why women die during pregnancy. But this is not typical."

What is typical, according to Dr. Douglas, is an increase in blood pressure, swelling and headaches.

"For the typical person, the doctor will recognize the symptoms, put her on bed-rest and induce delivery sooner," says Dr. Douglas. "We usually wouldn’t just let it go to term. Because being pregnant is causing the problems, we look to ending the pregnancy earlier than usual."

This is exactly what happened to Karen.

"They tried to induce me, because preeclampsia is really serious."

Karen stresses the word "tried". For her, this is just when things took a turn for the worse.

"I was taking all these IV fluids. It was all going in, but nothing was coming out. My blood pressure was getting higher. This went on for 24 hours. I was just getting bigger and bigger, like a Botero painting. I just kept thinking, ‘How long are they going to let this go on?’"

After 24 hours spent trying to induce labor, the doctors decided to break Karen’s water, a fail-proof method to induce.

"They thought I’d have three hours to sleep, but 20 minutes later, the babies were descending," Karen says, still sounding shocked. "It was out of nowhere. All of a sudden the doctors were warning, ‘If there are any calls you need to make, make them now.’"

The trouble with preeclampsia is that it can rapidly evolve into eclampsia, a severe and often fatal condition that is characterized by blurry vision and seizures. Fortunately, preeclampsia usually develops late in the third trimester when the babies are developed enough to survive. At this point, delivery can usually occur without too many hitches.

The big trouble, however, occurs when preeclampsia develops before the third trimester.

"The earlier it [preeclampsia] starts manifesting itself, the more severe it is," explains Dr. Douglas. "The more severe it is, the more complicated the pregnancy can be."

These complications are quite dangerous for both mother and child.

"At six months, you’ll have a very premature baby," explains Patricia Robertson, M.D., a perinatologist at UC San Francisco. "The problem is whether you deliver the baby or keep her pregnant. At six months, the baby’s only going to be a pound and a half at birth. But there are complications for the mother: seizure, stress on the kidneys so the kidneys shut down. She might not be clotting her blood. There can even be a stroke if the blood pressure is too high."

The problematic choice to induce labor is in the hands of physicians.

For most women, delivery is a perfect cure.

"Over 99 percent [of preeclampsia cases] are going to resolve after delivery," explains Dr. Douglas. "It just goes away. "

Most women’s blood pressure drops within a week and they are out of the danger zone.

For other women, however, a range of problems may ensue. This was the case for Karen.

"I went home after five days thinking I was going to be sore but fine," recalls Karen. "When I got home from the hospital I was constantly hyperventilating. The doctor checked my lungs which sounded fine, but I was getting worse. My blood pressure was 170/110. This was almost stroke level and I already had the babies."

And Karen still wasn’t losing weight.

"Normally, I weigh 125. When I checked in to the hospital to have the babies, I weighed 199. I thought I’d be so much lighter after the babies. But when I got home I still weighed 195. Three or four days later, it still wasn’t going away."

Eventually, Karen’s doctors had to give her a diuretic and hypertension medicine.

"In the last three days, I went from 194 pounds to 170 pounds, I have much farther to go, but with this medication it should go a lot faster."

Preeclampsia is most common among new mothers. But, if you get it once, you’re more likely to get it again.

"The earlier you get it, the more likely you are to get it again, " explains Dr. Douglas. "And to get it earlier in your next pregnancy."

Preeclampsia commonly affects women of extreme ages — the very young and women over 35. It is also more prevalent in African-American women and women who suffer from an underlying disease such as renal disease, chronic hypertension, lupus or diabetes.

The good news, however, is that doctors are on the lookout for pregnancy induced hypertension throughout the nine months. And at the slightest sign of trouble, they begin a vigilant watch including twice weekly visits and very close monitoring.

Once diagnosed, preeclampsia is pretty easily taken care of.

"In a way, I’m not sorry I had the experience," says Karen. "It’s interesting. And the more women I talk to, the more I realize there are a lot of women I know who have preeclampsia and everyone says the same things."

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