Toxemia
Toxemia, also known as preeclampsia or eclampsia, is a pregnancy-related condition that typically arises after the 20th week of gestation, characterized by high blood pressure and protein in the urine. While the exact cause remains unknown, several risk factors have been identified, including first-time pregnancy, multiple gestations, a family history of the condition, diabetes, and chronic health issues such as hypertension and renal disease. Diagnosis is based on specific measurements of blood pressure and urine protein levels, and patients may experience additional symptoms like facial swelling, headaches, and visual disturbances.
In severe cases, toxemia can lead to life-threatening complications, including seizures and fetal growth restrictions. Treatment is contingent on the severity of the condition and the gestational age of the fetus. Management may include medications to control blood pressure, bed rest, and careful monitoring of both the mother and fetus. The definitive treatment for toxemia is the delivery of the baby and placenta. In preterm cases, healthcare providers must weigh the risks and benefits of early delivery, often utilizing additional interventions to ensure the safety and health of both the mother and the baby.
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Subject Terms
Toxemia
Also known as: Preeclampsia, eclampsia, pregnancy-induced hypertension (PIH), gestational hypertension
Anatomy or system affected: Blood vessels, circulatory system, reproductive system
Definition: A common disorder of pregnancy characterized by hypertension and proteinuria (protein in the urine). When severe, toxemia can affect multiple organ systems and even lead to seizures
Causes: Unknown; risk factors include first pregnancy, more than one fetus, family history of toxemia, diabetes, antiphospholipid syndrome, chronic hypertension, renal disease
Symptoms: Elevated blood pressure and facial edema; in severe cases, headache, visual changes, upper abdominal pain, decreased urine output, overactive reflexes, fluid in lungs
Duration: Chronic during pregnancy
Treatments: Depends on severity and gestational age of fetus; may include blood pressure medications (hydralazine, labetalol), bed rest, delivery of baby
Causes and Symptoms
The precise cause of toxemia, also called preeclampsia or eclampsia, is unknown. Multiple theories exist, the leading ones pointing to an immunologic or vascular cause. Toxemia occurs after twenty weeks of gestation and is associated with a number of risk factors, including nulliparity, twin gestation, family history of toxemia, diabetes, antiphospholipid syndrome, chronic hypertension, and renal disease.
Symptoms and signs that are required for a diagnosis of toxemia are systolic blood pressure over 140 and diastolic blood pressure over 90 across a span of six hours and urine with protein in excess of 300 milligrams over twenty-four hours. Other symptoms may be present, such as facial edema. In severe cases, headache, visual changes, upper abdominal pain, decreased urine output, hyperreflexia (overactive reflexes), or fluid in the lungs may be present. These symptoms may be accompanied by laboratory abnormalities indicating liver, kidney, red blood cell, or platelet disorders. Toxemia may also manifest as seizures, with the risk of concomitant stroke, which is termed eclampsia. In women with prolonged preeclampsia, uteroplacental insufficiency (decreased blood supply to the fetus) may occur, leading to oligohydramnios (too little amniotic fluid) and/or restriction in fetal growth.
Treatment and Therapy
The treatment of toxemia depends on the severity of the disease and the gestational age of the fetus. High blood pressure can be controlled with medications such as hydralazine or labetalol. The patient is placed on bed rest, and the patient’s fluid status is monitored. Delivery of the infant and placenta is curative. While this is the treatment of choice when the infant is full term, the treatment plan in preterm pregnancies is more complex.
In a preterm pregnancy, ultrasonography and fetal heart tone monitoring are carried out to check for any adverse effects of toxemia on the fetus. If toxemia becomes severe or there is evidence of fetal compromise, then the decision for delivery may be made, even if the infant is preterm. If delivery is anticipated, then the patient will receive intravenous magnesium to decrease the risk of seizures. If the fetus is less than thirty-four weeks of gestation, then the patient also receives steroid injections to facilitate fetal lung maturity. If seizures occur, a bolus of magnesium can be given to stop the seizures, and stabilization measures are taken to maximize maternal and fetal safety.
Bibliography
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