Toxemia of Pregnancy

Toxemia of Pregnancy is a condition involving high blood pressure, fluid retention, and protein in the urine. When it occurs, it happens during the last trimester of pregnancy. Toxemia that is mild to moderate is also called pre-eclampsia. Toxemia that becomes severe is an emergency condition and is called eclampsia. Severe toxemia may include seizures, fluid in the lungs, abnormal liver function, and failure of fetal growth.

Causes

The cause of toxemia is unknown. Possible causes may include:
  • Genetic factors
  • Dietary factors
  • Problems with blood vessel function
  • An autoimmune disorder

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Inadequate prenatal care
  • Toxemia in a previous pregnancy
  • First pregnancy
  • Multiple fetuses (for example, twins)
  • Obesity
  • Age: under 18 years old or older than 40 years old
  • Race: Black
  • Chronic high blood pressure
  • Kidney disease
  • Blood vessel disorders
  • Autoimmune disorders
  • Diabetes
  • Disease involving the placenta

Symptoms

Women with toxemia may have symptoms or they may feel fine, especially if the toxemia is mild. It is very important to see your doctor regularly during pregnancy to detect toxemia early.
Symptoms may include:
  • Headaches
  • Bloating or water retention
  • Noticeably swollen ankles or feet (Some mild swelling during pregnancy may be normal.)
  • Swelling of the face and upper body when waking up
  • Blurred vision or sensitivity to light
  • Upper abdominal pain
  • Nausea or vomiting
  • Seizures or convulsions

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
Measurement of Blood Pressure
A blood pressure reading of 140/90 or higher is considered high whether or not a woman is pregnant. During pregnancy, blood pressure in the third trimester is compared with blood pressure before pregnancy or during the beginning of the second trimester. Blood pressure is elevated during pregnancy if:
  • The first number in your blood pressure reading has risen 30 mmHg or more or
  • The second number has risen 15 mmHg or more
Assessment of Fluid Retention
Sometimes fluid retention is obvious during the physical exam. Fluid retention may cause weight gain of more than 5 pounds in one week. Sudden weight gain over one or two days is almost certainly due to fluid retention.
Urine Test
Under normal circumstances there is no measurable protein in urine. In pre-eclampsia protein appears in the urine.
Blood Tests
Blood test include checking:
  • Complete blood count
  • Clotting factors
  • Electrolytes
  • Kidney and liver function

Treatment

Treating pre-eclampsia early can prevent its progression to eclampsia. The only way to cure toxemia is to deliver the baby.
Treatment may include:
Early Delivery of the Baby

If the pregnancy has progressed 36 weeks or more, your doctor may recommend that labor be induced.
Drugs, Diet and Rest

Mild toxemia can often be managed until 36 weeks gestation with medication, a low-salt diet, and plenty of rest.
Home Treatment
If your home situation is stable, and you live close to the hospital, your doctor may treat you at home. Home treatment may include:
  • Frequent blood pressure readings
  • Plenty of rest
  • Help preparing meals, doing housework and caring for family members
Admission to the Hospital
If toxemia is moderate, or your home situation is not stable, the doctor may admit you to the hospital. Treatment may include:
  • Lowering your blood pressure
  • Eliminating extra fluid
  • Monitoring your baby's condition
  • Making sure you get enough rest
Severe Toxemia
If the toxemia is severe, labor can be induced as early as 28 weeks. Early delivery poses a risk to the fetus, but allowing severe toxemia to continue is extremely risky for the mother.

Prevention

There are no reliable guidelines for preventing toxemia. However, the following actions may help prevent toxemia or other problems related to pregnancy:
  • Get early and regular prenatal care. Early treatment of pre-eclampsia may prevent eclampsia.
  • If you have chronic high blood pressure, keep it under control during pregnancy.
  • Get your doctors approval before taking any prescription or over-the-counter medicines.
  • Do not smoke or drink alcohol during pregnancy.
  • Eat regular, healthful meals and take prenatal vitamins.