Preeclampsia

What is preeclampsia?

Preeclampsia is a pregnancy complication marked by new high blood pressure (hypertension) that develops after 20 weeks, usually alongside signs that the mother’s organs are under strain: most classically protein in the urine, but also affected liver, kidney, blood, or brain function. It affects roughly 1 in 25 pregnancies in the United States and is one of the leading causes of serious illness and death for mothers and babies worldwide. Caught and managed on time, most pregnancies with preeclampsia end well; missed or ignored, it can escalate quickly into a medical emergency.

Preeclampsia is thought to begin with a problem in how the placenta implants and forms its blood supply early in pregnancy. The result is a cascade that raises blood pressure and, over time, injures the mother’s blood vessels and organs. Because the only definitive cure is delivery of the baby and placenta, the central job of prenatal care is to detect preeclampsia early, judge how severe it is, and time delivery so that neither mother nor baby is put at unnecessary risk.

Warning signs and symptoms

Early preeclampsia often causes no symptoms a mother would notice, which is exactly why blood-pressure checks and urine tests at every prenatal visit matter. As it progresses, warning signs can include:

• A severe or persistent headache that does not ease with usual measures
• Vision changes: blurring, flashing lights, spots, or temporary loss of vision
• Pain in the upper-right abdomen or below the ribs (a sign of liver involvement)
• Sudden swelling of the face, hands, or feet
• Rapid weight gain over a few days
• Nausea or vomiting that begins in the second half of pregnancy
• Shortness of breath from fluid on the lungs
• Reduced urination

These symptoms in the second half of pregnancy are a reason to be evaluated the same day, not at the next scheduled visit. They can also appear for the first time after delivery: postpartum preeclampsia is real and is easy to miss once a mother is home.

How preeclampsia is diagnosed and monitored

Diagnosis rests on measurements, not guesswork, and the standard of care is built around catching those measurements early. The core tests:

Under current guidance, preeclampsia can be diagnosed even without protein in the urine if high blood pressure is joined by low platelets, impaired liver or kidney function, fluid on the lungs, or new brain or vision symptoms. Once diagnosed, monitoring intensifies: more frequent blood-pressure checks, repeat bloodwork, and fetal surveillance (ultrasounds for growth, amniotic fluid checks, and non-stress tests), because the same placental problem that harms the mother can starve the baby of nutrients and oxygen.

HELLP syndrome

HELLP syndrome is a severe variant of preeclampsia named for its three features: Hemolysis (breakdown of red blood cells), Elevated Liver enzymes, and Low Platelets. It is dangerous partly because it can develop with blood pressure that is only mildly elevated (or, in some women, without much hypertension at all), so it is missed when clinicians anchor on blood pressure alone. Upper-abdominal or right-shoulder pain, nausea, and a general sense of being unwell are common. HELLP can progress to liver rupture, dangerous bleeding, and organ failure, and it usually calls for prompt delivery regardless of gestational age.

Eclampsia

Eclampsia is the onset of seizures in a woman with preeclampsia, and it is a life-threatening obstetric emergency. The seizures can cause the mother to lose oxygen and can cut the baby’s oxygen supply during the event. Eclampsia is largely preventable: magnesium sulfate given to women with severe preeclampsia sharply reduces the risk of seizures, and it is a standard-of-care medication precisely because it works. When a mother with warning signs of severe disease is not started on magnesium and then seizes, that gap is one of the failures a records review examines.

Risks to mother and baby

For the mother, uncontrolled preeclampsia can cause stroke, seizures, HELLP syndrome, placental abruption, liver and kidney failure, fluid on the lungs, and bleeding problems. For the baby, the injured placenta can restrict growth (fetal growth restriction) and reduce oxygen, and the need to deliver early is a leading driver of prematurity and its complications. When the baby’s oxygen supply is compromised around delivery, the result can be asphyxia around delivery and hypoxic-ischemic encephalopathy (HIE), a brain injury that can lead to lasting disability including cerebral palsy. This is why timing is everything: delivering too early exposes the baby to prematurity, while waiting too long exposes both mother and baby to the disease.

Treatment and standard of care

The only cure is delivery, but management before delivery matters enormously. The standard of care generally includes:

• Blood-pressure control. Severe-range readings (≥160/110) are treated urgently with medication to prevent stroke; within an hour is the widely taught benchmark.
• Magnesium sulfate to prevent or treat seizures in severe preeclampsia and eclampsia.
• Corticosteroids before an anticipated early delivery to mature the baby’s lungs.
• Timing of delivery based on severity and gestational age: generally by 37 weeks for preeclampsia without severe features, and sooner (often immediately) for severe disease, HELLP, or eclampsia.
• Close surveillance of mother and baby until delivery, and continued vigilance postpartum.

Low-dose aspirin started in the late first trimester is recommended for women at higher risk, and failing to offer it to a clearly high-risk patient can itself fall below the standard.

Was the harm preventable?

Not every case of preeclampsia, and not every bad outcome, is the result of negligence. Preeclampsia can develop and progress despite excellent care. But much of the harm it causes is preventable, because the disease announces itself in numbers (blood pressure, urine protein, platelets, liver enzymes) that a prenatal team is supposed to be checking and acting on. The failures that lead to injury tend to be recognizable: rising blood pressure that was not worked up, protein in the urine that was not followed, severe-range readings left untreated, magnesium not started, or a delivery that should have happened days earlier. Our dedicated page on the failure to diagnose preeclampsia walks through exactly what prenatal care is supposed to catch.

Legal options for families

A preeclampsia claim is a medical-negligence claim. It asks whether your providers monitored for the disease, recognized its warning signs, and responded as the standard of care required, and whether a failure to do so injured you or your baby. Where a baby suffered lasting brain injury, compensation may need to cover a lifetime of care; our HIE settlements page explains how those cases are valued. Filing deadlines (statutes of limitations) vary by state and can be short for a mother’s own injury claim, so it is worth confirming them early.

Where your case would be handled depends on where the care happened. Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey. Everywhere else, the alliance connects families with its vetted network of local birth injury attorneys. Special rules apply to care delivered at military or federally funded hospitals.

Frequently asked questions

What blood pressure is considered preeclampsia?

A reading of 140/90 mmHg or higher, confirmed on two occasions at least four hours apart after 20 weeks of pregnancy, meets the blood-pressure threshold. Readings of 160/110 or higher are “severe range” and are treated as an urgent situation requiring blood-pressure medication, usually within an hour.

Can you have preeclampsia without protein in your urine?

Yes. Current guidelines allow a diagnosis of preeclampsia when high blood pressure is accompanied by low platelets, impaired liver or kidney function, fluid on the lungs, or new brain or vision symptoms, even if urine protein is normal. This is an important change, because anchoring only on urine protein can delay diagnosis.

What is the difference between preeclampsia, HELLP, and eclampsia?

Preeclampsia is high blood pressure with signs of organ strain after 20 weeks. HELLP syndrome is a severe form involving red-blood-cell breakdown, elevated liver enzymes, and low platelets. Eclampsia is the development of seizures. HELLP and eclampsia are both medical emergencies that usually require prompt delivery.

Can preeclampsia hurt the baby?

It can. The placental problem behind preeclampsia can restrict the baby’s growth and oxygen supply, and severe disease often forces an early delivery, making prematurity a common consequence. When oxygen is compromised around birth, the baby can suffer asphyxia and brain injury, so careful monitoring of both mother and baby is essential.

Does preeclampsia go away after delivery?

Usually it resolves in the days to weeks after delivery, but not always immediately, and it can appear for the first time postpartum. Postpartum preeclampsia causes the same dangers, including seizures and stroke, so warning signs after going home should be taken just as seriously.

Sources

This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your physician about medical concerns.