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| |    The Evaluation of Pre-Eclampsia by Elisa Ross, MD reviewed by Laura Jana, M.D., F.A.A.P. and Marjorie Greenfield, M.D. Making the diagnosis A pregnant woman may have progressing symptoms for some time before she is actually diagnosed with pre-eclampsia . In order to actually have pre-eclampsia, you must have high blood pressure, and either protein in your urine or swelling in places other than your legs. If your blood pressure has been only slightly high, your doctor or midwife may tell you to rest on your left side and have frequent blood pressure checks until the condition "declares" itself. Bedrest may also be prescribed if the pressure is high but there was neither protein in your urine, nor swelling, nor changes in certain blood tests (see below). In addition to rechecking your blood pressure, your practitioner may check for changes in the following areas to confirm the diagnosis of pre-eclampsia and determine its severity: Kidney function Kidney function may be decreased in pre-eclampsia, resulting in lower urine output. Protein may also escape into the urine. A dipstick may be used in the office to detect the presence of protein. You may also be asked to collect your urine in a jug for 24 hours. This gives a more accurate picture of your kidney function. There are also some blood tests (uric acid, blood urea nitrogen or BUN, and creatinine), which measure kidney function. Swelling Daily weights will give an idea of how fast a woman with pre-eclampsia is retaining fluid. A weight gain of five pounds or more in a week may be worrisome. Liver function In some cases, the pre-eclampsia leads to temporary liver damage, which can lead to changes in red blood cells and platelets (another component of blood). This is known as HELLP syndrome. In general, women at risk for pre-eclampsia should report any upper abdominal pain, especially on the right, as this may indicate liver involvement. Headaches and neurological symptoms A woman at risk for pre-eclampsia should report visual disturbances like persistent spots before her eyes, or any severe headache, especially if it does not respond to Tylenol®. She may also be evaluated for the briskness of her reflexes. In very rare, unpredictable cases, temporary seizures can occur. This is called eclampsia. One reason we treat pre-eclampsia is to prevent seizures. Fetal Well-Being When a woman is evaluated for high blood pressure or other symptoms, her baby will probably be evaluated, too. The baby's heart rate will be monitored. The mother is typically asked to keep track of the baby's movements. We expect babies to move at least four times, three times each day. If further reassurance is needed, the baby may be evaluated by ultrasound, looking for activity, also known as a Biophysical Profile . Fetal growth and amniotic fluid volume may also be measured. If some of the above tests are seriously different than expected, it may be necessary to deliver the baby early.
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