Which condition in a pregnant patient with severe preeclampsia is an indication?

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Prematurity

Worldwide, preeclampsia is responsible for up to 20% of the 13 million preterm births each year.

A baby is considered premature if he or she is born before 37 weeks, but more severe issues occur when a baby is born earlier than 32 weeks. Babies born later than 32 weeks in developing countries may have more severe problems than babies born in high resource countries since those countries often lack the resources that preemies need.

The effects of being born early can vary widely. Some babies may spend only a day or two under close observations while others may spend the first months of their life in the Neonatal Intensive Care Unit (NICU). Some babies may also have lifelong problems such as learning disorders, cerebral palsy, epilepsy, blindness, and deafness.

Having a premature baby can also mean a great deal of emotional and financial stress for a family.

Intrauterine Growth Restriction (IUGR)

Preeclampsia can cause reduced blood flow to the mother's placenta, restricting the supply of food to her baby. As a result, the baby may become malnourished and be small for its gestational age. Ultrasounds can help identify IUGR.

Many babies who suffer from IUGR can catch up on their growth within a few months, although recent research suggests that growth restricted infants are more prone to adult diseases including diabetes, congestive heart failure and hypertension.

Of the 30 million IUGR infants born worldwide each year, 15% (4.5 million) are associated with preeclampsia.

Mother’s shouldn’t blame themselves or poor nutrition for IUGR, because it is caused by a failing placenta and not the mother’s diet. You could be eating all of the right things, but if the placenta is not capable of passing nutrients along, your baby’s growth will suffer.

Acidosis

The baby survives in the womb by receiving nutrients and oxygen through the placenta. Preeclampsia compromises the placenta and the baby’s body begins to restrict blood flow to its limbs, kidney and stomach in an effort to preserve the vital supply to the brain and heart. Should the baby’s oxygen reserve become depleted, (as the placenta detaches or dies) the baby’s body may produce too much lactic acid. If too much lactic acid builds up, the baby will develop “acidosis” and become unconscious and stop moving. Delivery is essential at this point, even if the baby is premature.

Death

Infant death is one of the most devastating consequences of preeclampsia. In the U.S., approximately 10,500 babies die from preeclampsia each year and an estimated half a million worldwide. Many countries do not have the means to keep a premature baby alive, so the rate of neonatal death in these countries is therefore much higher.

Stillbirths from preeclampsia (babies that die in utero after 20 weeks of gestation) number between 1,000 and 2,200 in the U.S. Stillbirths are much more likely to occur with severe preeclampsia, HELLP syndrome or preeclampsia superimposed on chronic hypertension.

Preeclampsia can appear and progress very quickly. Please err on the side of caution and contact your doctor or midwife immediately if you experience warning signs of preeclampsia.

An integrated system of maternal and newborn care can reduce some of these deaths. This includes diagnosing preeclampsia early, monitoring the baby’s condition, using magnesium sulfate to prevent maternal seizures and possibly confer neurological protection on the baby, administering steroids for the baby's lung development, safely managing early delivery when needed, and providing specialized care for pre-term newborns. However, we ultimately need more research. We need to find a cure.

Ongoing life challenges

Preeclampsia has been linked to a host of lifelong challenges for infants born prematurely, among them learning disorders, cerebral palsy, epilepsy, blindness and deafness. With prematurity also comes the risk of extended hospitalization, small gestational size and the interruption of valuable bonding time for families. Prematurity stresses a family unit, and this stress is compounded when the mother is also ill.

An integrated system of maternal and newborn care can reduce some of these deaths. This includes diagnosing preeclampsia early, monitors the baby’s condition, using magnesium sulfate to prevent maternal seizures and possibly confer neurological protection on the baby, safely managing early delivery when needed, and providing needed care for pre-term newborns. However, we ultimately need more research. We need to find a cure.

What are indicators for severe preeclampsia?

What are indications that preeclampsia has progressed?

What is the most common complication of preeclampsia?