Information for you

Published in August 2010 (next review date: 2014)

An ectopic pregnancy
What is an ectopic pregnancy?
An ectopic pregnancy is when a pregnancy starts to grow outside the
uterus (womb). In the UK, one in 90
(just over 1%) pregnancies is an ectopic pregnancy.
When you become pregnant, the sperm and egg meet in the fallopian
tube (the tube that carries the egg
from the ovary to the uterus). Usually, the fertilised egg moves into the
uterus for the pregnancy to grow
and develop. If this does not happen, an ectopic pregnancy may start
to develop in a fallopian tube
(sometimes known as a tubal pregnancy). An ectopic pregnancy can
occur in places other than a fallopian
tube, such as in the ovary (rarely) or inside the abdomen (very rarely).
This information is about an ectopic pregnancy in the fallopian tube. A
pregnancy
cannot survive in this situation and sadly cannot lead to the birth of
a baby.
This is because as the pregnancy gets bigger it can:

run out of space to grow in the fallopian tube

rupture (burst) the fallopian tube, causing severe pain and internal
bleeding. This is a potentially life-threatening situation for you.
What is an ectopic pregnancy?
An ectopic pregnancy is when a pregnancy starts to grow outside
the uterus
(womb). In the UK, one in 90 (just over 1%) pregnancies is an
ectopic
pregnancy.
When you become pregnant, the sperm and egg meet in the
fallopian tube (the
tube that carries the egg from the ovary to the uterus). Usually,
the fertilised egg
moves into the uterus for the pregnancy to grow and develop. If
this does not
happen, an ectopic pregnancy may start to develop in a fallopian
tube
(sometimes known as a tubal pregnancy). An ectopic pregnancy
can occur in
places other than a fallopian tube, such as in the ovary (rarely) or
inside the
abdomen (very rarely).
This information is about an ectopic pregnancy in the fallopian
tube. A
pregnancy cannot survive in this situation and sadly cannot
lead to the birth
of a baby. This is because as the pregnancy gets bigger it can:

run out of space to grow in the fallopian tube

rupture (burst) the fallopian tube, causing severe pain and internal
bleeding. This is a potentially life-threatening situation for you.
1

An ectopic pregnancy
Information for you
Published August 2010
2
What are the symptoms of an ectopic
pregnancy?
Most women get physical symptoms in the sixth week of pregnancy
about two weeks after a missed
period. You may or may not be aware you are pregnant if your periods
are irregular or if the contraception
you are using has failed.
Each woman is affected differently by an ectopic pregnancy. Some
women have no symptoms, some have
a few symptoms while others have many symptoms. Because
symptoms vary so much, it is not always
straightforward to make a diagnosis of an ectopic pregnancy. The
symptoms of an ectopic pregnancy
may include:
Abnormal bleeding
You may have some spotting or bleeding that is different from your
normal period. The bleeding may be
lighter or heavier than normal. The blood may be darker and more
watery.
Pain in your lower abdomen
This may develop suddenly for no apparent reason or may come on
gradually over several days. It may be
on one side only.
Pain in the tip of your shoulder
This occurs due to blood leaking into the abdomen. This pain is there
all the time and may be worse when
you are lying down. It is not helped by movement and may not be
relieved by painkillers.
Upset tummy
You may have diarrhoea or pain on opening your bowels.
Severe pain/collapse
If the fallopian tube ruptures and causes internal bleeding, you may
develop intense pain or you may
collapse. This is an emergency situation. In rare instances, collapse is
the first sign of an ectopic pregnancy.
Should I seek medical advice immediately?
Yes! An ectopic pregnancy can pose a serious risk to your health. If
you have had sex within the last 3 to
4 months (even if you have used contraception) and are experiencing
these symptoms, get medical help
immediately. Seek advice even if you do not think you could be
pregnant.
You can get medical advice from:

your general practitioner or midwife

the A&E department at your local hospital

an Early Pregnancy Unit (details of the unit nearest to you can be

found at
www.earlypregnancy.
org.uk/FindUsMap.asp
)

N H S o n 111 .
3
Am I at increased risk of an ectopic
pregnancy?
Any woman of childbearing age who is having sex could have an
ectopic pregnancy. You are at an increased
risk of an ectopic pregnancy if:

you have had a previous ectopic pregnancy

you have a damaged fallopian tube. The main causes of damage are:
{
{
previous surgery to your fallopian tubes, including sterilisation
{
{
previous infection in your fallopian tubes (see RCOG patient
information
Acute pelvic
inflammatory disease: tests and treatment
)

you become pregnant when you have an intrauterine device (IUD/coil)

or if you are on the
progesterone-only contraceptive pill (mini-pill)

your pregnancy is an in vitro fertilisation (IVF) or intracytoplasmic

sperm injection (ICSI)
pregnancy

you are over 40 years old

you smoke.
How do I get a diagnosis?
Most ectopic pregnancies are suspected between 6 and 10 weeks of
pregnancy. Sometimes the diagnosis is
made quickly, but if you are in the early stages of pregnancy, it can
take longer (a week or more) to make a
diagnosis of an ectopic pregnancy.
Your diagnosis will be confirmed by the following:
Consultation and examination
The doctor will ask about your medical history and symptoms. The
doctor will examine your abdomen
and may also do a vaginal (internal) examination. You should be
offered a female chaperone (someone to
accompany you) for this. You may also wish to bring someone to
support you during your examination.
If you have not already had a positive pregnancy test, you will be
asked for a urine sample so this can be
tested for pregnancy. If the pregnancy test is negative, it is very
unlikely that your symptoms are due to an
ectopic pregnancy.
Ultrasound scan
Most women are offered a transvaginal scan (where a probe is gently
inserted into your vagina) to look
at the uterus, ovaries and fallopian tubes. If you are in the early stages
of pregnancy, you may be offered
another scan after a few days when it may be easier to see the
pregnancy.
Blood tests

A test for the level of the pregnancy hormone human chorionic

gonadotrophin (hCG) or a change
in this level every few days may help to give a diagnosis.

A test for the level of the hormone progesterone may be taken.

Laparoscopy
If the diagnosis is still unclear, an operation called a laparoscopy may
be necessary. This operation takes
place under a general anaesthetic. The doctor uses a small telescope
to look at your pelvis by making a tiny
cut usually into the umbilicus (tummy button). This is also called
keyhole surgery.
If an ectopic pregnancy is detected, treatment may take place during
the same operation.
4
What are the options for treatment?
Because an ectopic pregnancy cannot lead to the birth of a baby, all
options end the pregnancy in order to
reduce the risks to your own health. Your options depend on:

how many weeks pregnant you are

your symptoms

if there has been a lot of bleeding inside your abdomen

the level of hCG

your scan result

your general health

your personal views and preferences this should involve a

discussion about your future
pregnancy plans

the options available at your local hospital.

The options for treatment are listed below not all will be suitable for
you.
Expectant management (wait and see)
Ectopic pregnancies sometimes end on their own similar to a
miscarriage. Depending on your situation, it
may be possible to monitor the hCG levels with blood tests every few
days until these are back to normal
(see
Follow-up appointments: what happens next?
). Although you do not have to stay in hospital,
you should go back to hospital if you get any symptoms. You should
be given a direct contact number for
the emergency or gynaecology ward at your hospital.
Expectant management is not an option for all women. It is usually
only possible when the pregnancy is still
in the early stages and when you have a few or no symptoms. Up to
29 in 100 (29%) women undergoing
expectant management may require additional medical or surgical
management.
Medical treatment
In certain circumstances, an ectopic pregnancy may be treated by
medication (drugs). The fallopian tube
is not removed. A drug (methotrexate) prevents the pregnancy from
developing and so the ectopic
pregnancy gradually disappears. The drug is given as an injection. If
your pregnancy is beyond the very
early stages or the hCG level is high, methotrexate is less likely to
succeed. Many women experience some
pain in the first few days, but this usually settles with paracetamol or
similar pain relief. Although long-term
treatment with methotrexate for other illnesses can cause significant
side effects, this is rarely the case with
one or two injections to treat ectopic pregnancy.
You may need to stay in hospital overnight and then return to the clinic
or ward a few days later. It may
be sooner if you have any symptoms. It is very important that you
attend your follow-up appointments
(see
Follow-up appointments: what happens next?
).

Fifteen in 100 (15%) women need to have a second injection of

methotrexate.

Seven in 100 (7%) women will need surgery, even after medical
treatment.
Surgery
The aim of surgery is to remove the ectopic pregnancy. The type of
operation you have will depend on
your wishes or plans for a future pregnancy and what your surgeon
finds during the operation (laparoscopy).
To have the best chance of a future pregnancy inside your uterus, and
to reduce the risk of having another
ectopic pregnancy, you will usually be advised to have your fallopian
tube removed (salpingectomy).
5
If you only have one tube or your other tube does not look healthy, this
already affects your chances of
getting pregnant. In this circumstance, you may be advised to have a
different operation (salpingotomy).
This operation aims to remove the pregnancy without removing the
tube. It carries a higher risk of a future
ectopic pregnancy but means you retain the possibility of a pregnancy
in the uterus in the future. Some
women may need to have a further operation to remove the tube later
if the pregnancy has not been
completely removed.
An operation to remove the ectopic pregnancy will involve a general
anaesthetic. The surgery will be either:

Laparoscopy the stay in hospital is about 1 to 2 days and the

recovery is about 2 to 4 weeks
(see RCOG patient information
Recovering Well: information for you after a laparoscopy
).

Open surgery known as a laparotomy is performed through a

larger cut in your lower
abdomen. It is usually done if severe internal bleeding is suspected.
You will need to stay in
hospital for 2 to 4 days. It usually takes about 4 to 6 weeks to recover.
There are risks associated with any operation. This may be due to the
use of an anaesthetic or the
operation itself. Your surgeon and anaesthetist will discuss these with
you.
What do I need to know to make an informed
decision?
When an ectopic pregnancy is confirmed, and if the fallopian tube has
not ruptured, your doctor should
discuss your options with you.
Make sure you:

fully understand all your options

ask for more information if there is something you do not understand

raise your concerns

understand what each option means for your fertility (see

What about future pregnancies?
)

have enough time to make your decision.

In an emergency situation
If the fallopian tube has ruptured, emergency surgery is needed to
stop the bleeding. This is achieved by
removing the ruptured fallopian tube and pregnancy. This operation is
often life-saving. Your doctors will
need to act quickly and this may mean that they have to make a
decision on your behalf to operate. In this
situation you may need a blood transfusion (see RCOG patient
information
Blood transfusion, pregnancy
and birth
).
Follow-up appointments: what happens next?
It is important that you attend your follow-up appointments. The check-
ups and tests you have will depend
on the treatment you received.
Expectant management
Your doctor will need to check your blood levels of hCG every few
days until normal levels are reached.
This is to ensure that the pregnancy has completely ended. You may
need further ultrasound scans.
Medical management
You will need to return twice in the first week and then once a week to
check your blood levels of
hCG. It may take a few weeks to ensure the pregnancy has
completely ended and you may need further
ultrasound scans. During this time, you should not have sex. You
should avoid getting pregnant by using
reliable contraception for at least 3 months.
6
Surgical management
You may be offered a follow-up appointment with your gynaecologist,
particularly if you have had an
emergency operation. If you have not had your fallopian tube
removed, you will need to have your hCG
level checked until this is back to normal.
What about future pregnancies?
For most women an ectopic pregnancy occurs as a one off event
and does not occur again. The chance of
having a successful pregnancy in the future is good.
Even if you have only one fallopian tube, your chance of conceiving is
only slightly reduced. The overall
chance of having an ectopic pregnancy next time is between 7 and 10
in 100 (710%). However, this
depends on the type of surgery you had and any underlying damage
to the remaining tube(s).
In a future pregnancy, you may be offered an ultrasound scan at 6 to 8
weeks to confirm that the
pregnancy is developing in the womb.
If you do not want to become pregnant, seek further advice from your
doctor or family planning clinic as
some forms of contraception may be more suitable after an ectopic
pregnancy.
How will I feel afterwards?
The impact of an ectopic pregnancy can be very significant. It can
mean coming to terms with the loss of a
baby, with the potential impact on future fertility or with the fact you
could have lost your life. Each woman
copes in her own way an ectopic pregnancy is a very personal
experience. This experience may affect
your partner and others in your family as well as close friends.
It is important to remember that the pregnancy could not have
continued without causing a serious risk to
your health.
Before trying for another baby, it is important to wait until you feel
ready emotionally and physically.
However traumatic your experience of an ectopic pregnancy has
been, it may help to know that the
possibility of a normal pregnancy next time is much greater than the
possibility of having another ectopic
pregnancy. If you have any questions, make sure you speak with your
midwife, general practitioner
or gynaecologist.
7
7
Sources and acknowledgements
This information is based on the Royal College of Obstetricians and
Gynaecologists (RCOG) guideline
The
Management of Tubal Pregnancy
(published by the RCOG in 2010). This information will also be
reviewed,
and updated if necessary, once the guideline has been reviewed. The
guideline contains a full list of the
sources of evidence we have used. You can find it online at:
www.rcog.org.uk/womens-health/clinical-
guidance/management-tubal-pregnancy-21-may-2004
.
The RCOG produces guidelines as an educational aid to good clinical
practice. They present recognised
methods and techniques of clinical practice, based on published
evidence, for consideration by obstetricians and
gynaecologists and other relevant health professionals. This means that
RCOG guidelines are unlike protocols
or guidelines issued by employers, as they are not intended to be
prescriptive directions defining a single course
of management.
This information has been reviewed before publication by women
attending clinics in Kilmarnock, London
and Wrexham.
A glossary of all medical terms is available on the RCOG website at
http://www.rcog.org.uk/womens-health/
patient-information/medical-terms-explained
.
A final note
The Royal College of Obstetricians and Gynaecologists produces patient
information for the public. The
ultimate judgement regarding a particular clinical procedure or treatment plan
must be made by the doctor or
other attendant in the light of the clinical data presented and the diagnostic
and treatment options available.
Departure from the local prescriptive protocols or guidelines should be fully
documented in the patients case
notes at the time the relevant decision is taken.
All RCOG guidelines are subject to review and both minor and major
amendments on an ongoing basis. Please
always visit
www.rcog.org.uk
for the most up-to-date version of this guideline.
Royal College of Obstetricians and Gynaecologists 2010

Ectopic Pregnancy Clinical Presentation

Updated: Jul 05, 2016
 Author: Vicken P Sepilian, MD, MSc; Chief Editor: Michel E Rivlin, MD more...

History
The classic clinical triad of ectopic pregnancy is pain, amenorrhea, and vaginal bleeding;
unfortunately, only about 50% of patients present with all 3 symptoms. About 40-50% of patients
with an ectopic pregnancy present with vaginal bleeding, 50% have a palpable adnexal mass, and
75% may have abdominal tenderness. In one case series of ectopic pregnancies, abdominal pain
presented in 98.6% of patients, amenorrhea in 74.1% of them, and irregular vaginal bleeding in
56.4% of patients. [48]

These symptoms overlap with those of spontaneous abortion; a prospective, consecutive case
series found no statistically significant differences in the presenting symptoms of patients with
unruptured ectopic pregnancies versus those with intrauterine pregnancies. [49]

In first-trimester symptomatic patients, pain as the presenting symptom is associated with an

odds ratio of 1.42, and moderate to severe vaginal bleeding at presentation is associated with an
odds ratio of 1.42 for ectopic pregnancy. [50] In one study, 9% of patients with ectopic pregnancy
presented with painless vaginal bleeding. [51] As a result, almost 50% of cases of ectopic
pregnancy are not diagnosed at the first prenatal visit.

Patients may present with other symptoms common to early pregnancy, including nausea, breast
fullness, fatigue, low abdominal pain, heavy cramping, shoulder pain, and recent dyspareunia.
Painful fetal movements (in the case of advanced abdominal pregnancy), dizziness or weakness,
fever, flulike symptoms, vomiting, syncope, or cardiac arrest have also been reported. Shoulder
pain may be reflective of peritoneal irritation.

Astute clinicians should have a high index of suspicion for ectopic pregnancy in any woman who
presents with these symptoms and who presents with physical findings of pelvic tenderness,
enlarged uterus, adnexal mass, or tenderness.

Approximately 20% of patients with ectopic pregnancies are hemodynamically compromised at

initial presentation, which is highly suggestive of rupture. Fortunately, using modern diagnostic
techniques, most ectopic pregnancies may be diagnosed before rupture.

Physical Examination
The physical examination of patients with ectopic pregnancy is highly variable and often
unhelpful. Patients frequently present with benign examination findings, and adnexal masses are
rarely found. Patients in hemorrhagic shock from ruptured ectopic may not be tachycardic. [52]

Some physical findings that have been found to be predictive (although not diagnostic) for
ectopic pregnancy include the following:
 Presence of peritoneal signs

Cervical motion tenderness

Unilateral or bilateral abdominal or pelvic tenderness - Usually much worse on the

affected side

Abdominal rigidity, involuntary guarding, and severe tenderness, as well as evidence of

hypovolemic shock, such as orthostatic blood pressure changes and tachycardia, should alert the
clinician to a surgical emergency; this may occur in up to 20% of cases. However, midline
abdominal tenderness or a uterine size of greater than 8 weeks on pelvic examination decreases
the risk of ectopic pregnancy. [53]

On pelvic examination, the uterus may be slightly enlarged and soft, and uterine or cervical
motion tenderness may suggest peritoneal inflammation. An adnexal mass may be palpated but is
usually difficult to differentiate from the ipsilateral ovary.

The presence of uterine contents in the vagina, which can be caused by shedding of endometrial
lining stimulated by an ectopic pregnancy, may lead to a misdiagnosis of an incomplete or
complete abortion and therefore a delayed or missed diagnosis of ectopic pregnancy.

Management of Preeclampsia During

Delivery
Symptoms

Complications

Outlook

Prevention
What Is Preeclampsia?
Preeclampsia is a problem that arises during pregnancy and is characterized by high blood
pressure and damage to other organs, such as the kidneys. Preeclampsia is considered a serious
condition that can lead to dangerous complications for you and your baby. The exact cause,
however, isnt known. Researchers suspect that it may involve problems with the blood vessel
development in the fetus, which in turn causes a dysfunctional reaction in the mothers blood
vessels.

SYMPTOMS

What Are the Symptoms of Preeclampsia?

Preeclampsia usually begins after week 20 of pregnancy. The condition can occur in women who
previously had normal blood pressure. The first sign of preeclampsia is an abnormal rise in blood
pressure. This is defined as a rise in blood pressure to greater than 140/90 millimeters of mercury
that persists for more than just a few hours. Your doctor will check your blood pressure at every
pregnancy checkup, so that if preeclampsia is suspected, your doctor can run the proper tests to
confirm and treat the diagnosis.

Other symptoms of preeclampsia include:

severe headaches

excess protein in the urine, which is a sign of kidney problems

dizziness

nausea

vomiting

blurry vision

a temporary loss of vision

upper abdominal pain

decreased urine output

swelling of the face and hands

Preeclampsia occurs in about 2 to 8 percent of pregnancies, according to the National Institutes

of Health (NIH). The only way to cure preeclampsia is to deliver your baby. Since preeclampsia
can be life-threatening, your doctor will likely choose to deliver your baby early to prevent
further complications.

AD V E RTISE ME N T

COMPLICATIONS

What Complications Can Arise During

Delivery?
If you are diagnosed with preeclampsia, your doctor may decide to induce your labor. Youll
likely deliver vaginally. If youre less than 30 weeks into your pregnancy, youll have to deliver
your baby by a cesarean section, or C-section, instead because the cervix will not be ready to
dilate.

If the hypertension gets worse, it can lead to several life-threatening complications.

Complications that could arise for the mother during a delivery include:

bleeding in the brain, or hemorrhagic stroke

seizures

coma

HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelets), which can
cause permanent damage to your nervous system, lungs, and kidneys

When preeclampsia causes seizures, its called eclampsia.

About one in every 50 women who experience seizures, or eclampsia, will die from the
condition, according to the United Kingdoms National Health Services (NHS). Unborn babies
can suffocate during the mothers seizure, and about one in every 14 of these babies may die.
Additionally, mothers who experience a stroke due to preeclampsia may have permanent brain
damage.

Severe cases of preeclampsia can also affect your baby, especially during the stressful process of
delivery. Complications that could arise for the baby during delivery include:

impairment of blood and oxygen flow

the placenta detaching from the uterus too early, or placental abruption

other complications associated with prematurity, such as breathing problems due to

underdeveloped lungs
 death

OUTLOOK

What Is the Outlook for People with

Preeclampsia?
Preeclampsia is the third leading cause of death for mothers during pregnancy, according to
research in the International Journal of Womens Health. The risk of death is lower in developed
countries like the United States. The risk of death or brain damage is also lower the earlier the
preeclampsia is diagnosed Being closely monitored in a hospital and given medications also
lowers the risk of death or brain damage. Having early and regular prenatal care is the most
important thing you can do to minimize the risk of complications for you and your baby.

Babies that were born prematurely due to preeclampsia may also experience numerous long-term
health issues depending on how early they were born. These include:

learning disorders

physical disabilities

cerebral palsy

epilepsy

deafness

blindness

Delivery of the baby is the only available cure for preeclampsia. After delivery, your blood
pressure should go back to normal within a few hours to a few days. Sometimes, it can take up to
six weeks to reach a normal level.

AD V E RTISE ME N T

PREVENTION

How Can Complications Be Prevented?

If your preeclampsia is severe, the first step to preventing complications is to deliver the baby as
soon as possible. A drug known as oxytocin is typically used to start labor. It works by
stimulating the uterus to contract. An epidural anesthesia or other types of analgesic drugs can be
given to control pain. However, women with low platelet counts caused by the preeclampsia may
not be able to have an epidural. Your doctor will help you decide which pain medication is best
for you.
During labor, management of preeclampsia involves medications that help to stabilize your blood
pressure and prevent seizures. Intravenous magnesium sulfate is given to prevent seizures. The
hospital staff will continually monitor your knee reflexes after you receive magnesium sulfate.
Loss of knee reflexes is the first sign of hypermagnesemia, or elevated magnesium levels in the
blood, which can lead to respiratory paralysis and cardiac arrest if its not monitored. Anti-
hypertension drugs such as hydralazine (Apresoline) and labetalol (Normodyne, Trandate) are
given to lower blood pressure gradually. Oxygen is also given.

You and your babys condition will be monitored closely. If you begin to experience severe
bleeding, anemia, or low platelet levels, you might need a blood transfusion.

Was this article helpful?

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Medically Reviewed by University of Illinois-Chicago, College of

Medicine on12 February 2016 Written by Jacquelyn Cafasso
AD V E RTISE ME N T

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Preeclampsia
Although the exact pathophysiologic mechanism is not clearly understood,
preeclampsia is primarily a disorder of placental dysfunction leading to a
syndrome of endothelial dysfunction with associated vasospasm. In most
cases, pathology evaluation demonstrates evidence of placental insufficiency
with associated abnormalities such as diffuse placental thrombosis, an
inflammatory placental decidual vasculopathy, and/or abnormal trophoblastic
invasion of the endometrium. These findings support abnormal placental
development or placental damage from diffuse microthrombosis as being
central to the development of this disorder. There is also evidence to indicate
an altered maternal immune response to fetal/placental tissue may contribute
to the development of preeclampsia.
The widespread endothelial dysfunction may manifest as a maternal
syndrome, fetal syndrome, or both. The pregnant woman may manifest
dysfunction of multiple organ systems, including the central nervous, hepatic,
pulmonary, renal, and hematologic systems. Endothelial damage leads to
pathologic capillary leak that can present in the mother as rapid weight gain,
nondependent edema (face or hands), pulmonary edema, hemoconcentration,
or a combination thereof. The diseased placenta can also affect the fetus via
decreased uteroplacental blood flow. This decrease in perfusion can manifest
clinically as nonreassuring fetal heart rate testing, low scores on a biophysical
profile, oligohydramnios, or as fetal growth restriction.
The hypertension occurring in preeclampsia is due primarily to vasospasm,
with arterial constriction and relatively reduced intravascular volume
compared with that of a normal pregnancy. The vasculature of normal
pregnant women typically demonstrates decreased responsiveness to
vasoactive peptides such as angiotensin-II and epinephrine.
In contrast, women who develop preeclampsia typically show a
hyperresponsiveness to these hormones, an alteration that may be seen even
before the hypertension and other manifestations of preeclampsia become
apparent. In addition, blood pressures in preeclampsia are labile, and the
normal circadian blood pressure rhythms may be blunted or reversed. One
study found increased arterial stiffness in women with preeclampsia, as well
as in those with gestational hypertension, compared with normotensive
controls; treatment with alpha methyldopa significantly improved the vascular
stiffness in preeclampsia but did not normalize it. [6]
Risk factors
Preeclampsia is more common at the extremes of maternal age (< 18 y or >35
y). The increased prevalence of chronic hypertension and other comorbid
medical illnesses in women older than 35 years may explain the increased
frequency of preeclampsia among older gravidas. In addition, black women
have higher rates of preeclampsia complicating their pregnancies compared
with other racial groups, mainly because they have a greater prevalence of
underlying chronic hypertension. Among women aged 30-39 years, chronic
hypertension is present in 22.3% of black persons, 4.6% of non-Hispanic
white persons, and 6.2% of Mexican Americans. Hispanic women generally
have blood pressure levels that are the same as or lower than those of non-
Hispanic white women.
Women who develop preeclampsia during pregnancy have an increased risk
of recurrent preeclampsia during subsequent pregnancies. The overall risk is
about 18%. The risk is higher (50%) in women who develop severe early
preeclampsia (ie, before 27 weeks' gestation). These women are also at
increased risk for cardiovascular disease later in life. Whether the
preeclampsia increases cardiovascular risk or the 2 conditions share a
common underlying cause remains unclear. [7]
Maternal personal risk factors for preeclampsia
The following are maternal personal risk factors for preeclampsia:
First pregnancy
New partner/paternity
Age younger than 18 years or older than 35 years
History of preeclampsia
Family history of preeclampsia in a first-degree relative
Black race
Obesity (BMI 30)
Interpregnancy interval less than 2 years or longer than 10 years
Maternal medical risk factors for preeclampsia
The following are maternal medical risk factors for preeclampsia:
Chronic hypertension, especially when secondary to such disorders as
hypercortisolism, hyperaldosteronism, pheochromocytoma, or renal artery
stenosis
Preexisting diabetes ( type 1 or type 2), especially with microvascular
disease
Renal disease
Systemic lupus erythematosus
Obesity
Thrombophilia
History of migraine [8]
Use of selective serotonin uptake inhibitor antidepressants (SSRIs)
beyond the first trimester [9]
Placental/fetal risk factors for preeclampsia
The following are placental/fetal risk factors for preeclampsia:
Multiple gestations
Hydrops fetalis
Gestational trophoblastic disease
Triploidy
Next: Gestational Hypertension

What to Read Next on Medscape

Diagnostic Overview
Determining whether elevated blood pressure identified during pregnancy is
due to chronic hypertension or to preeclampsia is sometimes a challenge,
especially if no recorded blood pressures from the first half of the gestation
are available. Clinical characteristics obtained via history, physical
examination, and certain laboratory investigations may be used to help clarify
the diagnosis. Fetal well-being must also be considered with the workup of the
mother.
Preeclampsia is rare before the third trimester, and the diagnosis of severe
hypertension or preeclampsia in the first or early second trimester
necessitates exclusion of gestational trophoblastic disease and/or molar
pregnancy. Mild lower extremity edema is common in normal pregnancy, but
rapidly increasing or nondependent edema may be a signal of developing
preeclampsia. However, edema is no longer included among the criteria for
the diagnosis of preeclampsia.
New seizures in pregnancy suggest preeclampsia-eclampsia, but primary
neurologic disorders must be excluded.
Hyperaldosteronism and hypercortisolism are difficult to diagnose during
pregnancy due to the high levels of progesterone and the normal increase in
endogenous cortisol output.
Next: Routine Tests

What to Read Next on Medscape

Definition of Oligohydramnios

Oligohydramnios is a condition where the amniotic fluid less than normal, which is less than 500 cc.

Cause of Oligohydramnios

Cause of oligohydramnions can not be fully understood. The majority of pregnant women who are not sure
what causes it. Cause of oligohydramnions that has been detected is the fetal congenital defects and leaking
pouches / membrane of the amniotic fluid surrounding the fetus in the womb. Approximately 7% of infants
of women who experienced oligohydramnions, suffered congenital defects, such as the kidney and urinary
tract disorders, because the amount of urine produced by the fetus is reduced.

Other health problems are also associated with oligohydramnios is high blood pressure, diabetes, SLE, and
problems with the placenta. Women who've had chronic high blood pressure should consult a health care
professional before planning a pregnancy to ensure that their blood pressure remains well supervised and
medications that they take are safe during their pregnancy.
Epidemiology of Oligohydramnios

Approximately 8% of pregnant women have too little amniotic fluid. Oligohydramnios can occur anytime
during pregnancy, although in general often occurs in the last trimester of pregnancy. Approximately 12% of
women whose pregnancies beyond the limits of the approximate time of birth (gestational age 42 weeks)
was also oligohydramnios, because the amount of amniotic fluid was reduced by almost half of the normal
amount during pregnancy at 42 weeks.

Risk Factors of Oligohydramnios

Women with these conditions have a high incidence of oligohydramnios:

1. Congenital anomalies.

2. Intrauterine growth restriction (IUGR).

3. Premature rupture of membranes (PROM) (24-26 weeks).

4. Post-maturity syndrome.

Clinical Manifestations of Oligohydramnios

1. Uterus looks smaller than gestational age and no ballottement.

2. Pregnant women feel pain in the stomach at every movement of the fetus.

3. Often ends with parturition prematurus.

4. Fetal heart sound was heard starting in the fifth and heard more clearly.

5. Labor longer than usual.

6. When uterine contraction will be painful.

7. When the membranes rupture, amniotic fluid very little, even no one came out.

Nursing Diagnosis may appear:

1. Acute pain r / t movements of the baby

2. Impaired sleep pattern r / t pain

3. Risk of injury: the fetus r / t reduction in amniotic fluid

 4. Anxiety

5. Knowledge deficit r / t do not know information

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