Preeclampsia is a serious condition that can develop during pregnancy, typically after 20 weeks of gestation. It involves high blood pressure and signs of damage to other organ systems, most often the liver and kidneys. When preeclampsia is diagnosed or managed at 34 weeks gestation, it presents specific considerations for both the pregnant individual and the baby.
Preeclampsia at 34 Weeks
Preeclampsia is characterized by new-onset hypertension, defined as blood pressure readings of 140/90 mmHg or higher, on two occasions at least four hours apart, after 20 weeks of pregnancy. This condition often includes proteinuria, the presence of excess protein in the urine, indicating kidney involvement. While proteinuria was once a requirement for diagnosis, its absence does not rule out preeclampsia if other signs of organ dysfunction are present.
Diagnosis at 34 weeks falls within the “late preterm” period, making it a significant point for clinical decisions regarding management and potential delivery. Some individuals may have preeclampsia without noticeable symptoms, making regular prenatal checks for blood pressure and urine protein important.
Common signs and symptoms include:
Severe headaches that do not improve with pain relievers.
Visual disturbances, such as blurred vision or flashing lights.
Upper abdominal pain, particularly under the ribs on the right side.
Sudden, significant swelling in the face, hands, or feet.
Rapid weight gain due to fluid retention.
Impact on Mother and Baby
Preeclampsia at 34 weeks can lead to several complications for the birthing parent. Eclampsia involves the onset of seizures. HELLP syndrome, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count, is another serious complication.
Other risks for the birthing parent include:
Stroke, from uncontrolled high blood pressure.
Acute kidney injury.
Pulmonary edema, where fluid fills the lungs.
Placental abruption, where the placenta separates from the uterus before birth, causing severe bleeding.
For the baby, birth at 34 weeks due to preeclampsia presents challenges of prematurity. Preterm birth complications include respiratory distress syndrome, feeding difficulties, and challenges with maintaining a stable body temperature.
Intrauterine growth restriction (IUGR) can occur when the placenta is not functioning optimally, limiting the baby’s growth. Babies with IUGR may be smaller than expected. Many babies born at 34 weeks, especially with preeclampsia complications, will require Neonatal Intensive Care Unit (NICU) care.
Navigating Care and Treatment
Medical management involves close monitoring of both the birthing parent and the baby. Monitoring includes:
Regular blood pressure checks.
Blood tests for liver enzymes, kidney function, and platelet counts.
Urine samples for protein.
Fetal well-being is assessed through:
Non-stress tests, evaluating the baby’s heart rate.
Biophysical profiles, using ultrasound to assess fetal breathing, movement, muscle tone, and amniotic fluid volume.
Ultrasounds, to check fetal growth and amniotic fluid levels.
Medications may be prescribed to manage symptoms and prevent complications. Antihypertensive medications, like labetalol or nifedipine, control high blood pressure and reduce stroke risk. Magnesium sulfate is often administered to prevent seizures in severe preeclampsia or eclampsia.
The healthcare team carefully decides the timing of delivery, balancing the risks of continuing the pregnancy with those of preterm birth. This decision considers the severity of preeclampsia and the health of both parent and baby. For severe preeclampsia at or beyond 34 weeks, immediate delivery is often recommended.
What to Expect for Delivery and Beyond
Delivery is often considered the definitive resolution for preeclampsia at 34 weeks. Labor may be induced to encourage vaginal birth. A Cesarean section (C-section) may also be necessary, particularly if the birthing parent’s or baby’s condition rapidly worsens or if other obstetric complications arise.
Immediately after delivery, the birthing parent continues to be closely monitored. Blood pressure is regularly checked, and blood tests are repeated to ensure improving organ function and normalizing platelet counts.
While delivery typically resolves preeclampsia symptoms, it can take days or weeks for blood pressure to normalize and organ dysfunction to fully resolve. Many individuals remain in the hospital for a few days postpartum for observation.
Postpartum preeclampsia can occur, sometimes weeks after delivery, with symptoms similar to those during pregnancy, such as headaches or swelling. Follow-up care after discharge is important, involving regular appointments to monitor blood pressure and ensure complete recovery.