Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest

August 25th, 2010

Pre-Eclampsia-Definition and Background

Pre-Eclampsia is a medical condition that only affects women during pregnancy and post partum. It is characterized by high blood pressure and protein in the urine, subsequently creating a toxic physical environment for both mother and baby. It is frequently the reason a pregnant woman is prescribed bed rest. While it can occur anytime during pregnancy, it typically occurs after 20 weeks of pregnancy, in the late second or third trimester. Pre-Eclampsia occurs in 5-8% of all pregnancies globally and is the cause of some 76,000 maternal deaths and 500,000 infants annually.

Pre-Eclampsia can rapidly become a serious or even fatal medical condition. Women should know the signs and symptoms of pre-eclampsia and report any signs or symptoms they have to their health care provider immediately.

Major Signs and Symptoms of Pre-Eclampsia

None – The problem with Pre-Eclampsia, much like other hypertensive disorders, is that it often has no symptoms.
Hypertension is known as “the silent killer” and pre-eclampsia is no different. Bed rest has been shown to reduce blood pressure and frequently reduces the signs, symptoms and complications that may arise as a result of pre-eclampsia. Even though bed rest is inconvenient at best and quite uncomfortable and physically challenging at its worst, if your health care provider prescribes bed rest for pre-eclampsia, Please follow his or her directions, even if you feel fine.

Hypertension – Hypertension or high blood pressure is defined as two blood pressure readings over 140/90 at two different times at least six hours apart. However, pregnant women with normally low blood pressure, such as 110/65, may be diagnosed with pre-eclampsia prenatally or in the post partum period when their blood pressure rises to 135/80 and/or they develop signs and symptoms of pre-eclampsia.

In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:

In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.

For this reason, it is extremely important that women know what their baseline blood pressure readings are and at each prenatal visit they ask their providers what their blood pressure is. In this way, both health care provider and patient can be on the look out for blood pressure abnormalities and address them as soon as possible.

Swelling (Edema) – Swelling can be an insidious symptom of pre-eclampsia because so many women experience swelling of their hands and/or feet or even their faces when they are pregnant. However, when the swelling is significant enough to change your facial features, you should notify your health care provider immediately, advising them that you believe the swelling has become excessive. You may need to show them a photo of you prior to pregnancy, your driver’s license for example, to prove your point. In any event, if swelling concerns you, make sure it becomes a concern of your health care providers and that it is addressed.

Proteinuria – Proteinuria occurs when proteins, usually filtered by the kidneys and retained in the blood stream, leak into the urine because the small blood vessels in the kidneys have become damaged allowing the proteins to pass through. (This is usually due to your elevated blood pressure. Remember, pre-eclampsia creates a toxic physical environment to both mother and baby!)

Other Common Signs and Symptoms of Pre-Eclampsia

Sudden Weight Gain – Since weight gain is a hallmark of pregnancy, it’s often hard to discern between regular pregnancy weight gain and weight gain associated with Pre-Eclampsia. The rule of thumb is that if you start gaining more than 2 lbs per week or more than 6 lbs in a month, you should consult with your health care provider as this could be an indication of pre-eclampsia.

Headache – Severe, migraine-like headaches which are often one sided and dull and throbbing could be a warning that your blood pressure is dangerously high. Contact your health care provider immediately for evaluation.

Nausea or Vomiting – While nausea and/or vomiting is common in the first trimester, it usually abates during the second and third trimesters. If you have sudden onset of nausea and/or vomiting in the second or third trimester, contact your health care provider immediately for evaluation.

Changes in Vision – If you experience any sudden blurred vision, double vision, flashing spots, or sudden light sensitivity, this is another warning that your blood pressure may be dangerously high.  Contact your health care provider immediately for evaluation.

Racing pulse, mental confusion, heightened anxiety, trouble catching your breath – While all of these symptoms can occur in pregnant women, when they suddenly occur from out of the blue and especially if they occur together, this is cause for concern. Contact your health care provider immediately.
Stomach or Right Shoulder Pain – I want to be a bit more specific here. The pain you may be experiencing here is right upper quadrant abdominal pain, specifically, liver pain. The pain may be “radiating” or “referred” to the right shoulder, but its origin is in the liver. This pain requires immediate attention as it is an indication that the liver is under stress and you may be suffering from HELLP (Hemolysis-bursting of red blood cells, Elevated Liver enzymes levels, and Low Platelet count) as serious obstetrical complication. It is imperative that you be evaluated immediately if you have symptoms of HELLP to avoid more serious complications or even death.

Lower back pain – Low back pain is so common in pregnancy that it is difficult to distinguish between the typical low back pain of pregnancy and low back pain associated with pre-eclampsia. If you are unsure, certainly consult your health care provider. But consult with your health care provider immediately if the low back pain is present with right upper quadrant abdominal pain as this may be another sign of pre-eclampsia.

This is a cursory overview of Pre-Eclampsia and we will delve into the subject with more depth in coming blog posts. Just remember that pre-eclampsia can have serious medical consequences for both you and your baby including death, so if you are concerned about symptoms, consult with your health care provider and have an immediate evaluation.

This list of signs and symptoms is edited and reprinted from the list presented on The Pre-Eclampsia Foundation website. This website is a holds a wealth of information on pre-eclampsia; current research and resources for more information and to get more help and/or support.

Did you have pre-eclampsia during your pregnancy? Are you a Mama on Bedrest now for pre-eclampsia? Share your story in our comments section below.

22 responses to “Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest”

  1. carmela robinson says:

    i have a history of preeclampsia with both my children. i am experiencing high blood pressures 140s/90s-100s, there was 200mg protein in my urine and have experienced some swelling. also i am experiencing upper back pain between my shoulder blades when i lay back in a chair or anything in that nature. i am in the marine corps and they dont seem to worried about it at this time. im not on bed rest or anything and feel that i am developing early stages of preeclampsia and need advise. please and thank you!

  2. Darline says:

    While I can’t give medical advice, I can say this. Get yourself another evaluation-if not by an OB provided by the Marine Corps, then by another obstetrician-immediately! What you are describing is, by definition, pre-eclampsia and if left unchecked can have serious negative effects not only on your health but on the health of your baby. You are at risk for developing a stroke, HELLP syndrome or worse. While it may not be life threatening now, your condition could change quickly. This can be avoided. Get checked out ASAP!!! Let us us know how you are doing and if we can help further.

  3. carmela robinson says:

    thank you so much for your advise… i went back to my OB and they are going to talk amongst each other about putting me on bedrest because my previous 2 pregnancies i delivered 28 weeks and 25 weeks and im 24 now.. they keep telling my my bp today was ok and it was 140/95. but thank you again and ill keep u informed

  4. carmela robinson says:

    well the finally put me on bedrest till i deliver.. but my bp levels arent stablilizing and im in and out of the hospital which i guess is a good thing since they are watching me more closlely now.. 🙂

  5. Darline says:

    Carmela,
    While I never want to wish bed rest on anyone, I am glad that they are watching your BP more closely. Has it flucutated much? If it is staying around 140/95, that is better than if it is jumping to 190/100 and then back. Do you have a BP cuff at home. BP fluctuates at different times in the day. It would interesting to perhaps track what your blood pressure does first thing in the morning before you get up, midday and then in the evening. Keeping a log can help detect trends. Just a thought to talk over with your OB’s. You can get a BP monitor at a drug store pretty inexpensively. See what your OB’s think and keep me posted. If you need anything, do let me know.
    Darline

  6. carmela robinson says:

    thank you so much.. i had to have my daughter 14 weeks early. she weighed 1lb 4oz. she is doing pretty good. she is in the nicu until may her original due date. i had to deliver due to my bp and growth retarded umbilical cord…

  7. Sharon says:

    My daughter in law is being checked for preclamsia. bedrest what does bedrest actually mean? She wants to try and work (teacher) and I told her I don’t think a good idea.

  8. Darline says:

    Sharon, bed rest is a treatment used to try to quell signs and symptoms of preterm labor and/or any symptoms that may put a mama or baby’s life in danger. Bed rest can range from modification of daily activities to full restriction of activity and confinement in bed (on your left side).

    Pre-Eclampsia is a common reason that women are prescribed bed rest. In Pre-eclampsia, a woman develops (dangerously) high blood pressure, spills protein into her urine, develops (severe) swelling in her hands, feet and face and in severe cases develops kidney failure, seizures, could have a stroke or even die. Bed rest is prescribed in an effort to lower a woman’s blood pressure, reduce swelling, reduce protein in the urine and to avoid progression to the more serious complications.

    I understand your daughter in law’s desire to continue working. For many women, the prospect of bed rest is daunting, most especially for financial reasons. She may have also read that there is no evidence that bed rest is effective as a treatment for high risk pregnancy symptoms. However, bed rest does seem to buy some women time so that their obstetricians can administer various medications and treatments that actually have a positive effect on their pregnancies.

    The best recommendation that I can give to you and your daughter in law is for her to have a very frank discussion about her pregnancy with her obstetrician. She needs to find out exactly how high her blood pressure is and if it is going higher, going up and down or what. She also needs to know if she has protein in her urine. Is she swelling? Has she had any other signs or symptoms of pre-eclampsia? How does her obstetrician intend to treat her symptoms? What is his/her expected outcome? Is your daughter in law being prescribed full bed rest or modified activity? She should ask for very specific instructions. If she still has questions, she should consider getting a second opinion, perhaps from a Maternal/Fetal Medicine specialist (perinatologist).

    Pre-Eclampsia is nothing to play with. At its best, it can require modifications to daily activities. At its worse, it can be deadly for both mother and baby. Your daughter in law needs to get very clear advice from her obstetrician and heed it.

  9. Yvonne says:

    I am on bed rest as of today 35 weeks and I don’t do much but go to bathroom and take dog out for a minute and get my self food and water to drink. Otherwise I can’t do anything docs say nothing or o will be in hospital. So I am taking this real serious and trying to rest ASAP. I have a great family who has helped me today do dishes and go grocery shopping thanks to my sister and mom. I hope I don’t get or have preclampias. I pray that all my resting will reduce my chances. Pray for ,me.

  10. Darline says:

    Yvonne,
    Thanks for your comment. We will most certainly keep you in our thoughts and prayers. May I suggest you hop on over to our Facebook Page, Facebook.com/mamasonbedrestandbeyond? Our community is really warm and supportive and can really relate to where you are right now. I also invite you to our free teleseminar mixer Friday, feb 22 at noon ET. It’s a free call and the call in info is on today’s blog, “Mamas Mattress Mambo-Promo video”. Be well and let us know how we can support your and keep your spirits up!!!

  11. Hina says:

    Hi, I was diagnosed with hyperechoic bowel, placentomology ,UA showing flow reversal(IUGR) during my first pregnancy last year . My bp shooted to 135/85 during 4th month ,started havin swelling n my tummy never showed till6th month .gynae till now didn’t diagnosed anything on every ultrasound she wid say it’s fine .at the beginning of 6th month I changed the gynae and was diagnosed with all the problems but then it was too late she suggested abortion. As artries started reversal flow n the baby may die on its own she said . Now again I m pregnant n its my 4th month . I had nft ultrasound done n the result was ‘both artries showing high resistance flow, she has suggested me full bed rest. Are these all symptoms of pre eclampsia n should take. It seriously .also I’m taking Ex hep inj everyday .please guide me .wud this pregnancy remain safe .

  12. Darline says:

    Hello H,
    You are extremely high risk. That being said, nothing is impossible. I can’t tell where you are writing from, but if they
    Have maternal fetal medicine specialists, I highly suggest you consult with one. Also, given your vascular (artery) and blood pressure issues, you should have a cardiologist on your healthcare team as well. While the odds may not be in your favor, a strong healthcare team will definitely optimize your chances. Not knowing your full history and seeing you clinically I am in no position to make medical judgments. If you want this baby and I believe that you do, continue seeking the best, most skilled medical care possible. Know that it will likely take several different physicians, each with different expertise, to see you through. The cornerstone will be a strong OB/GYN coordinating your care & communicating w/all the specialists making sure everyone is on the same treatment page. Good luck and do let us know how you are doing.

  13. Hina says:

    Hi ,thnx for your reply ,I am writing from India ,city Chandigarh ,I am being diagnosed here from one of the best gynae .i am not aware wat is going inside me as she just suggested bed rest after seeing the u/s report. Tmrw I ‘ll have the triple test n show her the reports. Am I suffering from pre eclampsia. Or is it IUGR ?

  14. Darline says:

    Hina,
    It sounds like you are still in the discovery phases. I know it’s frustrating, but you are going to have to ride this wave, have all your tests and evaluations and then allow your OB the time s/he needs to analyze all that is going on and give you a diagnosis. Sounds like you’ve got a really good provider, so there isn’t a thing that I would add except to try to be patient and to stay calm. I know how frantic this must be, but soon enough you will have a definitive diagnosis and you’ll be able to plan and prepare accordingly. We are keeping you in our thoughts and prayers and hoping you and your little one are just fine. Do keep us posted and thanks for letting us take this journey with you.

  15. hal says:

    Hi, im 22weeks pregant and my bp is high its about 152/108 or sometimes 140/100 or 148/90 and ive been put on labetanol 100mg to take twice a day but now ive been told to take 200mg twice a day..!(my bp before pregancy was high but nothing was done about it as i was already on alot of medication for other illnesses) im also factor v leiden hetroz.. Basically my uric acid is high it was first 377, then onna another day 379 and on another day taking labetanol it was 321 and on another day again continuing labetanol it was 353 but preeclampsia was negative and protein was +1.. Should i be worrying?? Thank you

  16. Darline says:

    Hello Hali557
    First and foremost I don’t worry! Worrying about all of this is quite possibly the worst thing that you could do at this point and quite frankly will likely drive your blood pressure up and cause other disruptions to your system. Now, are your BP’s and other problems cause for concern? Yes! But the one thing that is encouraging to me is that it seems that you are being tightly followed by your health care provider. But if you want to keep track of your own progress, I would suggest getting a home blood pressure system and monitoring your blood pressure, say, every morning when you first wake up and then perhaps late in the day around 3-5 pm. I would also take your BP anytime your feel stressed; i.e. if you get stressful news/lab results, family stress, etc…You can take your BP up to 3 times a day, but I think you may then be driving yourself crazy. Record your BP’s and note when you are going up, when you have taken your medications,and what is happening. This way you may be able to notice trends. Sometimes there is no pattern and the pregnancy is simply causing your blood pressure to rise. But sometimes there are subtle triggers and if you can identitfy these, then you can address them and help yourself.

    As for the elevated uric acid, has anyone ever suggested a low purine diet? It is not curative but it can help. Here is a good link that I found. Hope this helps and let me know how you are doing.

  17. katlynn says:

    Hello, at 24 weeks and 27 weeks my BP measured at 136/76 and then 142/82 and since then they’ve found significant amounts of protein in my urine. They don’t seem concerned with bedrest or changing anything in my regular routine but of course I want what is best for me and baby. I need a second opinion because personally I thought avoiding work and stressful situations would increase my chances of keeping her in the womb until 37 weeks but they don’t seem concerned.

  18. Darline says:

    Katlynn,
    Your symptoms are concerning, potentially indicating the development of pre-eclampsia. The latest research doesn’t really support bed rest as a treatment for pre-eclampsia unless mama’s condition becomes unstable (i.e.uncontrolled elevated blood pressure, kidney failure). Now according to what you have written, your lab results are rising slightly. Has your OB started any sort of treatment? What is his/her treatment plan for you? In these cases the literature supports medication to lower blood pressure and reduce the protein in the urine. Bedrest will accomplish neither of these. If your OB is able to manage your blood pressure and proteinuria with you as an outpatient, keeping them from wide fluctuations and from rising, then it’s actually better for you to avoid bed rest. As you may have read, bed rest has its own associated problems. So if you can be managed without full activity restriction, then its a good thing. Your OB is going to have to be the final call on this, though.

    I would suggest that you have a very frank talk with your OB. Ask him/her their thoughts on your blood pressure and proteinuria, and what their plan is for your pregnancy going forward? Ask if you need to be on bed rest and if not, at what point do they see bed rest as necessary? Ask them at what point (lab values or symptoms) they will intervene (i.e. induce labor or do a c-section) and what should you be looking out for? What can you do to optimize your own health and the health of your baby? Keep asking questions until you get answers that you understand and that make sense to you. If you can’t get the information that you desire, by all means, get a second opinion-preferably from a Maternal Fetal Health Specialist, or at the very least, an obstetrician who has handled many cases of pre-eclampsia.

    I realize this is really stressful, but as much as possible, try not to stress. More and more OB’s are moving away from the bed rest prescription because it has not been shown to be effective. However, do make sure that they are addressing your health concerns; the rising blood pressure and the proteinuria. Your job is to do your best to remain calm and take exquisite care of yourself; eating nutrient dense foods, getting lots of rest, walking (if it is not contraindicated).

    Do let us know how your discussion with your OB goes and if you get your questions answered to your satisfaction.

  19. Annie says:

    Hi, I am 14 wks with our 3rd child, I am chronic with hypertension, have a history of preeclampsia, and I hemmoraged with our 2nd child. In your experience, will I likely be put on bedrest & are there any effective ways to prevent bedrest (our kids are 3 & 16 months so still needing hands on care). I have cut all white sugar & some other sweeteners out of my diet to strive to prevent preeclampsia by natural weight loss. Gained no weight in the 1st trimester. Any suggestions appreciated.

  20. Darline says:

    Annie,
    While weight management will be helpful, if you have chronic hypertension, it should be managed medically. Given your history of hypertension, pre-eclampsia and intra-partum hemorrhage, you are high risk for complications. That being said, there is, at least at this moment, no clear indication for you to be on bedrest. Now remember, I have not seen your medical chart, taken a history or done any sort of examination, so I AM NOT IMPARTING ANY SORT OF MEDICAL ADVICE!!!! If you have concerns, you must discuss them with your obstetrician. At this juncture, watching and careful monitoring are indicated. I am sure that your obstetrician is doing this. In the event that your status/situation changes, the he/she will evaluate whether or not bed rest is warranted. Bedrest is (should be) used in cases where Mama’s or baby’s health is unstable and medical professionals are trying to get the unstable situation under control. Once the situation is under control, then mama should not be restricted. However, your obstetrician is the one best able to determine if your situation warrants bedrest. PLEASE DON’T TRY TO SELF TREAT!!!

    Don’t restrict your weigh gain as that may be detrimental to you child. You need to be consuming an additional 300-500 calories daily and experiencing slow, steady weight gain up to 25 lbs at term. (more if you started your pregnancy underweight, less if you started overweight. Again, consult with your OB on weight management during pregnancy.) If your situation is not limited by your obstetrician, you can engage in low intensity exercise. Again, this must all be dictated by your health status and if your blood pressure is up, you are bleeding or signs of pre-eclampsia present, then your OB must do everything necessary to manage the situation and that may include activity restriction.

    I’m sorry that I cannot offer more, but this platform is not one for offering individual medical advice. We present general information and answer general questions. For specific questions and situations such as yours, your best option is to schedule an appointment with your OB and ask specifics about your situation. All the best to you and please keep us posted!!

  21. Shanay317 says:

    Hi I am on my second pregnancy is my 12th week. My protein level was 532 so I have to take another 24hr urine. My pressures have been amazing. Today it was 107/69. It never usually spikes unless I have a migraine. I had preeclampsia with my first child and now they want my to see a kidney specialist. Could I possibly be on the verge of it again even though my pressures are low? Should I be resting more?

  22. Darline says:

    Hello Shanay,
    Yes, it is possible that you are developing Pre-Eclampsia again. You may also have something going on with your kidneys that is unrelated. Sounds like your OB is on top of the situation. Let us know how things turn out.

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