Toxemia of Pregnancy: Symptoms, Risks, Complications, and Treatment
Toxemia normally occurs in the second half of pregnancy and the mother will recover completely after giving birth. If there's a re-infection during childbirth or bleeding, the mother will die. This infection is one of the top three reasons why pregnant women die. If she has toxemia, the possibility of premature delivery or giving birth to a stillborn is very high. So the pregnant mother must take extra care of herself. If she's extremely careful and has been taking care of herself since the first trimester, there will not be any big issues. Total prevention is the best prevention.
What is Toxemia?
Toxemia refers to the condition which edema (swelling caused by accumulation of fluid in the tissues), proteinuria (a condition characterized by the presence of greater than normal amounts of protein in the urine) and high blood pressure occurs after the 20th week of pregnancy. Among pregnant women who have passed on, about 20% die of toxemia. So it's a very serious condition and the only way to prevent it is prevention.
One to two cases of toxemia in every 20 expectant mothers
Toxemia is usually accompanied by serious bleeding and infections. It's one of the top three causes of death in pregnant women. The fetus will die as well and the rate of having pregnancy complications is extremely high. Between five and eight percent of pregnant women can be infected with this infection, that is one to two women in every 20 expectant mothers. That makes this infection a very common condition among pregnant women. The issue is, not much is known about toxemia. So it's very difficult to treat toxemia patients properly.
There are many hypotheses about the causes of toxemia. Among them, immunology provides the most convincing and widely accepted explanation. From the way that this infection disappears completely without any treatment after childbirth, it can be said that the disease is a condition caused by the antibody response of the mother's body when she's pregnant. The mother's body deduced that the placenta is a foreign body and so produces antibodies which lead to toxemia.
The mother passes toxemia to her daughter
Toxemia is highly hereditary. If a mother had this infection, the possibility of her daughter having the same disease is eight times more than the average expectant woman. It's the same between sisters. If the elder sister had toxemia, the younger sister will most likely develop the same condition as well. Therefore, if there's a family history of toxemia, the pregnant woman must tell the doctor about it during her antenatal checkups so that prevention methods can be put in place.
Toxemia worsens after the 34th week of pregnancy
Toxemia usually appears around 6 months pregnancy, particularly after the 20th week. After 9 months pregnancy, particularly the 34th week, it'll worsen. The earlier symptoms such as edema and proteinuria appear, the slimmer the chance of recovery after childbirth. If the pregnant mother only has very mild toxemia, she can choose to rest at home and only go to the hospital to checkup on her condition every one or two weeks. If resting at home, blood pressure must be measured twice daily and healthy lifestyle habits must be maintained. If toxemia is serious, she must be hospitalized.
Proteinuria as an indication of toxemia
After the 20th week of pregnancy, the expectant mother can test for the presence of toxemia via the proteinuria index of a urine test. One of the main indicators of toxemia is proteinuria. If there's no inflammation in the kidneys, ureter (a tube that carries urine from the kidney to the urinary bladder) or bladder but proteinuria is present in the urine, there's a possibility of developing toxemia. A person with proteinuria will experience tiredness, loss of appetite, a decrease in volume of urine and has dry throat. As there's no way for the expectant mother to determine on her own whether or not she has proteinuria; she has to go to the hospital for a checkup. If protein is detected in the urine, it's sent for an abnormality analysis. If the level of protein in urine is higher than normal, then it can be confirmed that the mother has proteinuria.
Serious toxemia causes convulsions
Toxemia damages the liver, kidneys and blood circulation, causing more fatigue than usual. If the condition deteriorates, representative symptoms such as life-threatening convulsions, pain in the upper abdomen, headaches and abnormal vision will appear. Pain in the upper abdomen refers to the affliction in the precordium (the region over the heart and lower thorax) or the upper right-hand side of the abdomen. There are also instances of damaged blood vessels hurting the liver. The pregnant woman will feel heavy and giddy in the head and vision will be darkened and blurred, making things in front of her appear dark and dusty. If these three symptoms are present in addition to dangerous convulsions, consult the doctor-in-charge immediately.
Fetus and mother are endangered when convulsions arise
Epilepsy, together with high blood pressure, proteinuria and edema will give rise to convulsions, with seizures happening once or more than once daily. Epilepsy during pregnancy gravely endangers the mother. Cerebral hemorrhage (uncontrolled bleeding in the brain) causing the person to trip unexpectedly will increase in those with high blood pressure and is fatal for pregnant women. There's also the possibility of biting the tongue and hurting the lips, fractures in the ribs or backbones or retinal detachment. If epilepsy can be thoroughly treated, the mother will recover within 24 hours.
When there's an epileptic seizure, both the mother and fetus will be highly endangered. If the placenta is unable to supply enough nutrients and oxygen, the fetus' development will be stunted. It could be prematurely delivered or even die.
Deliver baby immediately if symptoms are very serious
The only way to cure toxemia is emergency childbirth. If the baby is due, give birth at once. If the baby is premature, decide to operate at once or wait and observe depending on the mother's condition. Even if the fetus could only stay in its mother's tummy for just another day, it's always better to let it be that way. However, if the mother's life is threatened, even if the fetus is only seven or eight months old, premature delivery has to go ahead. If the fetus and mother are not in any danger, delay childbirth as much as possible and wait for an opportunity to deliver.
High blood pressure, proteinuria or edema will subside after the fetus and placenta are out of the mother's body. The mother will recover naturally within one month of delivery. If her blood pressure doesn't drop and still has proteinuria after a month, she has to continue with the regular checkups to prevent any difficult-to-cure complications.
If temporary blindness occurs due to complications, vision will be completely restored one week after childbirth. However, if there's kidney damage, a transplant is necessary. If cerebral hemorrhage arises, even if the mother manages to survive, she'll be partially paralyzed.
Top Three Symptoms of Toxemia
Representative symptoms of toxemia are high blood pressure, proteinuria and edema. If there's a sudden sharp increase in body weight and the neck becomes frozen, the pregnant mother has to be extra careful.
The easiest symptom to detect in toxemia is edema. Pregnant women with edema will have very swollen hands and legs. With adequate rest and sleep, the swelling will subside.
If swelling persists even with adequate rest and if the swollen area doesn't bounce back immediately after pressing on it, the possibility of toxemia is very high.
Edema is the condition in which too much fluid is accumulated in the body. If there's proteinuria, it's 100% guaranteed that edema will follow. The face will definitely be swollen and when the swelling in the limbs is at its most serious, even the abdominal wall and perineum (the area of skin located below the anus) will be swollen as well. If body weight increases more than one kilogram weekly or more than three kilograms monthly, the possibility of toxemia skyrockets. Even if there are no other symptoms, go to the hospital for a checkup immediately.
Only having edema is still inconclusive of whether a pregnant woman has proteinuria. In the test for proteinuria, a urine examination to determine the proteinuria index and the increase of blood pressure must be done before a conclusion can be made. If the woman has been enjoying a normal pregnant process, proteinuria can also be detected at the late pregnancy stage. However, the proteinuria index in expectant mothers with toxemia is way higher than proteinuria detected during late pregnancy.
High blood pressure
High blood pressure is the most important indicator for determining toxemia. The highest blood pressure during a 20-week pregnancy is 140mmHg and above. If the lowest blood pressure is 90mmHg and above, the expectant mother has to be wary of developing toxemia, and has to keep tabs of changes in her blood pressure.
General Knowledge in a Box: The Beginnings of Toxemia
Sudden increase in body weight
Between 7 and 9 months into pregnancy, body weight will increase by one kilogram or more. If weight increase exceeds more than three kilograms in a month, that's a warning sign of toxemia. While a monthly increase of 0.5kg is normal, however, if the cardiac functions weaken and there's an increase in fluids in the body, weight gain is immediate.
The ring tightens and cannot be removed
If a pregnant woman feels that her ring has suddenly tightened and it's very difficult to remove it, this means her body has swollen. If the body is still swollen after a night's rest and the swollen area doesn't bounce back immediately after she presses on it, she has to be careful because these symptoms could be toxemia.
Frozen in the back of neck
Her blood pressure is high and she feels frozen in the back of her neck. High blood pressure is the most dangerous symptom in toxemia, so the pregnant woman must go to the hospital at once and check for blood pressure abnormality.
Symptoms of Severe Toxemia
It's classified as severe toxemia if the following symptoms appear: severe swelling, kidney damage and adverse effects on the placenta. In a serious condition like this, both mother and fetus will die. During an emergency, the fetus must be delivered within 72 hours.
• When the systolic blood pressure (the amount of pressure that blood exerts on vessels while the heart is beating) is at 160mmHg and diastolic pressure (pressure exerted on vessels when the heart is resting, represented by the bottom number in a blood pressure reading) is at 110mmHg and above
• When more than five grams of proteinuria is discharged a day
• When there's convulsions and epilepsy
• Daily urine volume less than 500 cubic centimeters
• When every 1 cubic centimeter has a platelet count less than 100,000
• Compared to the average gestational age of a normal pregnancy, the fetus development is slower by 5%
• Having symptoms such as lasting severe headaches, severe vision impairment, unconsciousness and signs of irritation in the central nervous system
If the above symptoms appear and the pregnant woman cannot use medication to lower her blood pressure, have convulsions, scarcity of amniotic fluid or placenta abruption, she must give birth within 72 hours.
Pregnant Women belonging to the Toxemia High-risk Group
If there's a family history of toxemia or the pregnant woman is of an advanced age, carrying twins, has high blood pressure or diabetes, she'll be more prone to having the infection. Do a self-check first on the probability of having this infection and prevent it as much as possible.
Be extra careful if there's a family history of toxemia
The pregnant mother should find out if anyone in the family had toxemia before if she has almost no self-awareness of the disease in the beginning of pregnancy. Be extra careful in daily life. If she has illnesses such as kidney or heart diseases and diabetes, she should go for checkups more frequently to prevent falling sick suddenly. If there's a sudden sharp increase in body weight, even though there may be no swelling, she should check for toxemia.
Pregnant women in the high-risk group should pay attention in their daily lives
Toxemia doesn't only happen to women who have high blood pressure before pregnancy. If the expectant mother's body has difficulty getting used to the state of being pregnant, toxemia may happen as well. Generally, blood pressure will fall a little during 5 or 7 months pregnancy, return to a normal level in the 9th or 10th month and then increases slightly during childbirth. However, the blood pressure of pregnant women with toxemia will be in the range of 140mmHg and 90mmHG and above. Below are people in the toxemia high-risk group:
Family history of toxemia
If the mothers or sisters in the family have the disease before, the pregnant woman will also likely develop toxemia during her pregnancy.
Pregnant women of an advanced age
Compared to women who have given birth two or more times, women who are giving birth for the first time and are above the age of 35 are more prone to toxemia. That's because the more advanced the age, the more blood vessels aging there is, so it's very easy to have high blood pressure or kidney diseases.
Women pregnant with twins
Expectant mothers carrying twins are two or three times more likely to develop toxemia than normal pregnant women.
Pregnant women with high blood pressure
If women have high blood pressure before pregnancy, one out of three of such women are likely to have toxemia during pregnancy. Women who doesn't have toxemia but has a family history of deaths due to high blood pressure or cerebral hemorrhage are also likely to have the disease.
Diabetic pregnant women
During pregnancy, even a healthy woman can develop toxemia easily. Especially overweight pregnant women, the tendency of developing toxemia is very high. If you're diabetic, the fetus will easily become a gigantic baby. Moreover, with diabetes, the heart and kidneys will have to bear a heavier load, so the possibility of toxemia is extremely high.
Overweight pregnant women
Blood pressure will increase if the body is made to bear the burden of a lot of weight. Hence, overweight pregnant women are more prone to toxemia than normal-weight pregnant women.
Pregnant women with kidney diseases
Women with kidney diseases prior to pregnancy have to be aware that their kidney conditions will get worse after pregnancy. As toxemia is very closely related to kidney diseases, pregnant women with kidney diseases are much more likely to develop toxemia.
Women with toxemia before and have given birth two or more times
Women who have given birth two or more times and contracted toxemia in the early stages of pregnancy have a 50% possibility of being infected with the condition again.
Expectant mothers under a lot of stress
A pregnant mother should maintain a relaxed mind and body as much as possible. Women who are under a lot of stress are extremely likely to be under the threat of toxemia.
Complications more Dangerous than Toxemia
If toxemia is dangerous, that's because of its deadly complications. Toxemia at its most serious state can lead to death in both the mother and fetus. What types of complications will arise from toxemia then?
Severe toxemia will lead to the fetus not being able to develop fully. If the mother's blood pressure increases, blood vessels will become narrower and blood flow to the placenta will be restricted. This will cause the placenta to lose its functionality and totally suffocate the fetus' ability to grow. The fetus will now suffer the slow torture of oxygen deprivation and malnutrition. The mother's body will induce labor due to danger. Thus, the fetus could be born prematurely and with cerebral palsy (a group of disorders affecting a person’s ability to move). In more severe cases, the fetus could be stillborn.
If blood vessels connecting the placenta and uterus weaken and the uterus detaches, this is placenta abruption (a serious condition in which the placenta partially or completely separates from the uterus before the baby is born). If the abruption is big, the fetus would die of suffocation. If bleeding occurs, the mother will also be endangered. If this becomes toxemia, there will be edema, brain edema (brain swelling), high blood pressure and poor blood circulation. Moreover, there will also be whole-body convulsions and when that develops into epilepsy, it's best to find a suitable time to deliver the baby as soon as possible.
Mother and fetus will die
If toxemia is ignored and not treated, the mother will have uremia, a serious complication of chronic kidney disease and acute kidney injury which causes kidney failure. When toxemia deteriorates into uremia, there will be frequent and severe headaches, retinal detachment (a separation of the light-sensitive retina in the back of the eye from its supporting layers) and disorder of consciousness (a state where consciousness is affected by brain injury). There will even be pulmonary edema (a condition caused by excess fluid in the lungs) leading to breathing difficulty. Six in 1000 pregnant women with toxemia die of pulmonary edema which causes difficulty in breathing, kidney failure or breathing difficulty caused by convulsions. The fetus' death rate is higher than that of its mother's, with 50 dying in 1000 fetuses.
The only cure for toxemia is childbirth. The best way is prevention as well as taking care of blood pressure and swellings. If a pregnant mother follows these guidelines, she can completely avoid toxemia.
Avoid being overweight and exercise strict weight control
An overweight pregnant woman, especially those whose age is advanced, the possibility of developing toxemia is very high. To avoid excessive weight gain during pregnancy, it's important to control the diet and get appropriate exercise. Light and relaxed exercises promote blood circulation and prevent swelling.
Early detection and regular checkups
This is the best way of preventing toxemia. If epilepsy symptoms such as high blood pressure, proteinuria and swelling appear, seek treatment immediately.
Don't accumulate exhaustion and stress
Nothing is more important than maintaining a relaxed mind and body when a woman is expecting. That's because the blood pressure drops when she's resting, blood supply to the placenta and kidneys will be gentle and the swelling will disappear, greatly benefiting the body. If she feels tired during the day, try to lie down and rest as much as possible.
Limit salt intake to less than 10 grams daily
Having too much salt is the cause of swelling and will burden the kidneys and increase blood pressure. Besides salt, tomatoes and condiments such as soya sauce, chili paste or broad bean paste, pickled vegetables, instant food, biscuits and bread are all high in salt content. So it's best to consume this food cautiously.
Avoid high-calorie food
Though it may be unreasonable to limit the intake of meat, there's every reason to limit the intake of high-calorie food. Calcium helps to get rid of salt, so it's good to consume more calcium. Fruits and vegetables are rich in calcium, so pile on the goodies. If the pregnant mother is preparing her own food, go easy on the salt.
General Knowledge in a Box: The Baby who Survives
If the mother has toxemia, it's very likely that the baby will be underweight. However, underweight babies are different from the average premature babies as the survival rates of these tiny warriors are very high. Their lungs are more developed than premature babies, so they can grow very quickly. It's generally assumed that babies whose mothers have toxemia grow up in a tough environment, thus this gives them a head start when it comes to building up their resistance.
So much for the information a pregnant woman need to know regarding toxemia.