Toxemia

Toxemia is a historical term used to describe a state in which toxins are present in the bloodstream and cause systemic illness. In obstetrics, it has been used to refer to a pregnancy‑related syndrome marked by hypertension and often proteinuria, historically called toxemia of pregnancy. Today, clinicians typically distinguish preeclampsia, eclampsia, and gestational hypertension, recognizing that the underlying issues involve placental dysfunction and endothelial inflammation rather than a single toxin.

In toxemia of pregnancy, abnormal placentation leads to release of antiangiogenic factors, widespread endothelial dysfunction, vasospasm, and organ hypoperfusion. This can affect the liver, kidneys, brain, and hematologic system, producing a range of signs from persistent hypertension and edema to elevated liver enzymes, low platelets, or seizures in severe cases (eclampsia). Risk factors include first pregnancy, obesity, preexisting hypertension or diabetes, autoimmune disorders, and advanced maternal age.

Diagnosis relies on clinical and laboratory findings. After 20 weeks of gestation, persistent high blood pressure (typically ≥140 systolic or ≥90 diastolic) plus proteinuria confirms preeclampsia in many cases; absence of proteinuria but with signs of organ dysfunction can also establish the diagnosis. Additional tests assess liver and kidney function, platelet count, and fetal status. HELLP syndrome is a related severe variant with hemolysis, elevated liver enzymes, and low platelets.

Management depends on gestational age and severity. Stabilization, close monitoring, and timely delivery are central. Antihypertensive therapy may be used to control blood pressure, and magnesium sulfate is commonly given for seizure prophylaxis in preeclampsia or eclampsia. Corticosteroids may be used to promote fetal lung maturity when early delivery is anticipated.

Prognosis improves with appropriate management, but toxemia of pregnancy remains a leading cause of maternal and perinatal morbidity. Historically, the term toxemia has broader usage, but contemporary practice favors specific diagnoses such as preeclampsia and eclampsia.