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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Pre-eclampsia and Eclampsia

Medical Codes

	ICD-9-CM:
	642.40 -	Preeclampsia and Eclampsia, Mild or Unspecified, Unspecified as to Episode of Care or Not Applicable
	642.41 -	Preeclampsia and Eclampsia, Mild or Unspecified, Delivered, with or without Mention of Antepartum Condition
	642.42 -	Preeclampsia and Eclampsia, Mild or Unspecified, Delivered, with Mention of Postpartum Condition
	642.43 -	Preeclampsia and Eclampsia, Mild or Unspecified, Antepartum Condition or Complication
	642.44 -	Preeclampsia and Eclampsia, Mild or Unspecified, Postpartum Condition or Complication
	642.50 -	Preeclampsia, Severe, Unspecified as to Episode of Care or Not Applicable
	642.51 -	Preeclampsia, Severe, Delivered, with or without Mention of Antepartum Condition
	642.52 -	Preeclampsia, Severe, Delivered, with Mention of Postpartum Condition
	642.53 -	Preeclampsia, Severe, Antepartum Condition or Complication
	642.54 -	Preeclampsia, Severe, Postpartum Condition or Complication
	642.60 -	Eclampsia, Unspecified as to Episode of Care or Not Applicable
	642.61 -	Eclampsia, Delivered, with or without Mention of Antepartum Condition
	642.62 -	Eclampsia, Delivered, with Mention of Postpartum Condition
	642.63 -	Eclampsia, Antepartum Condition or Complication
	642.64 -	Eclampsia, Postpartum Condition or Complication
	642.70 -	Pre-eclampsia or Eclampsia or Superimposed on Pre-existing Hypertension; Unspecified as to Episode of Care or Not
	642.71 -	Pre-eclampsia or Eclampsia or Superimposed on Pre-existing Hypertension; Delivered, with Mention or Without Mention of Antepartum Condition
	642.72 -	Pre-eclampsia or Eclampsia or Superimposed on Pre-existing Hypertension; Delivered, with Mention of Postpartum Complication
	642.73 -	Pre-eclampsia or Eclampsia or Superimposed on Pre-existing Hypertension; Antepartum Condition or Complication
	642.74 -	Pre-eclampsia or Eclampsia or Superimposed on Pre-existing Hypertension; Postpartum Condition or Complication

Related Terms

Toxemia of Pregnancy

Overview

Preeclampsia is a serious metabolic disturbance (toxemia) of pregnancy that occurs most often following the twentieth week of pregnancy. Preeclampsia involves a systemic malfunction of the tissue lining the blood vessels (vascular endothelium) and is characterized by high blood pressure (hypertension), swelling (edema), and high amounts of protein in the urine (proteinuria). It is one of a group of disorders that appear to be progressive steps in a single process that includes gestational hypertension (blood pressure of 140/90 or greater), mild and severe preeclampsia, and eclampsia. Eclampsia is a severe progression of preeclampsia characterized by one or more convulsions (seizures) not associated with epilepsy, brain hemorrhage, and coma. Most cases of eclampsia develop in the third trimester of pregnancy with seizures occurring within 2 days after delivery in 80% of cases (Ross).

The precise cause of preeclampsia is unknown. Some theories include immune system dysfunction, genetic factors, placental abnormalities or premature placental detachment from the uterine wall (abruptio placentae), and low antitoxic protective mechanisms due to low protein (albumin) levels in the blood. It is believed to start with endothelial cell injury resulting in constriction of blood vessels and a reduced blood supply (reduced vascular perfusion) in the placenta (placental hypoperfusion), although it remains unclear exactly why this occurs. Organ systems including the brain, liver, and kidneys also are affected. The process may begin without symptoms and become apparent only after hypertension has developed.

HELLP syndrome, named for the symptoms associated with the condition—hemolysis, elevated liver enzymes, and low platelet count—may be a progression of preeclampsia but some researchers suggest it has a different etiology.

Incidence and Prevalence: In the US, preeclampsia affects roughly 5% of all pregnancies, and the incidence is 23.6 cases in 1,000 births (Erogul).

In developed countries, the incidence of preeclampsia is 4% to 18% (Lim). The incidence of eclampsia in developed countries varies from 1 in 1,000 pregnancies to 1 in 3,448 pregnancies (Ross).

Source: Medical Disability Advisor

Causation and Known Risk Factors

Preeclampsia is more common with first pregnancies, in women with previously diagnosed high blood pressure, and in those who have a family history of the condition. Middle-aged mothers (>40 years) are at increased risk of developing preeclampsia and eclampsia, and the risk ratio for blacks compared to whites is 1.5 to 1 (Lim). Failure to receive adequate prenatal care also is associated with an increased frequency of eclampsia (Ross). Risk appears to be greater in women who have a history of preeclampsia, preterm delivery, multiple gestations, or chronic hypertension. Other risk factors include obesity and chronic medical conditions such as diabetes, kidney disease, or antiphospholipid syndrome.

Source: Medical Disability Advisor

Diagnosis

History: Individuals with preeclampsia may report edema of the hands, face, and ankles, weight gain in excess of 2 pounds (1 kg) per week, or particularly sudden weight gain over 1 to 2 days. Other symptoms may include severe headache, rapid heartbeat (tachycardia), dizziness, nausea, ringing or buzzing in the ears, double or blurred vision, irritability, drowsiness, vomiting, abdominal pain, and decrease in urinary output.

Eclampsia includes symptoms of mild preeclampsia in 25% of cases prior to the occurrence of seizures; however, eclampsia may occur without hypertension and proteinuria. Hypertension was reported to be absent in 16% of cases studied in the US (Ross). Women with severe preeclampsia are more likely to progress to seizures (Ross). Before the onset of a seizure, the woman may experience severe headache, confusion, blurred vision, or upper abdominal pain. The seizures consist of violent, rhythmic, jerking movements of the limbs. Breathing may be difficult due to the constriction of the muscles of the voice box (larynx). Coma may follow.

Physical exam: An initial exam includes blood pressure measurement, evaluation of the pregnancy, and a complete physical exam to evaluate possible organ system dysfunction if preeclampsia is suspected. Monitoring of blood pressure, edema, and proteinuria is then done at each subsequent physician visit. Hypertension is the most important standard for judging preeclampsia. Mild preeclampsia involves borderline hypertension (140/90). Any significant blood pressure increase during the second trimester is a warning signal.

Abdominal pain in severe eclampsia may be caused by an enlarged liver, which may be detected by pressing on the upper right abdomen with the hand (palpation). Examination of the eyes (ophthalmic exam) may show the arteries of the eyes in spasm, causing the blurred vision. Women may show neurological signs such as increased reflexes (hyperreflexia), loss of vision, confusion, and sometimes unconsciousness or coma if eclampsia has already developed.

Tests: No single test can diagnose preeclampsia. Urinalysis may reveal proteinuria. If preeclampsia is suspected because of elevated blood pressure, a complete blood count with peripheral smear is done, as well as a blood chemistry profile, including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, lactate dehydrogenase (LDH), indirect bilirubin, and uric acid. In severe preeclampsia, blood tests may reveal elevated levels of hemoglobin and hematocrit indicating increased blood viscosity and hemoconcentration. Coagulation tests (prothrombin time [PT], partial thromboplastin time [PTT], and fibrinogen) may be abnormal, and platelet counts may be decreased. Elevated uric acid and serum creatinine indicate kidney dysfunction. Liver function tests may be abnormal; alkaline phosphatase may increase 2 to 3 times the normal level due to liver injury. Neurological studies that may be useful include brain computed tomography (CT) or magnetic resonance imaging (MRI) with transcranial Doppler to rule out intracranial bleeding and identify central nervous system lesions that are sometimes responsible for seizures. An ultrasound scan of the abdomen can be done to eliminate other etiologies of abdominal pain and to evaluate the status of the pregnancy.

No test or group of symptoms reliably predicts which woman will develop eclampsia other than having a prior diagnosis of preeclampsia.

Source: Medical Disability Advisor

Treatment

Delivery of the fetus is the only cure for preeclampsia. Early detection is key to management and involves careful monitoring of both mother and fetus. Preeclampsia and eclampsia usually do not respond to diuretics, a low-salt diet, or any other preventive strategies that have been investigated. Blood pressure may be decreased through bed rest or antihypertensive medication. In some cases, hospitalization may be necessary for constant monitoring. Lying on the left side while resting increases uterine flow and takes weight off the large blood vessels, helping to improve the oxygen supply to the fetus. Some doctors may treat with magnesium sulfate during labor and for a few days after delivery to help prevent eclampsia.

When preterm preeclampsia does not resolve, the individual usually is hospitalized. If preeclampsia still persists and worsens, the fetus may be delivered prematurely. If HELLP syndrome is diagnosed, immediate delivery is recommended.

For eclampsia, anticonvulsant and antihypertensive drugs may be given to control seizures and reduce blood pressure. As soon as the mother is stable, labor is induced or the infant is delivered by cesarean section. Following delivery, the mother is closely monitored for further signs of eclampsia. If eclampsia develops after the delivery the treatment is the same as before delivery.

Regular prenatal visits to a physician or maternity clinic are essential for a healthy, safe pregnancy, delivery, and postpartum period.

Source: Medical Disability Advisor

Prognosis

Although the infant mortality rate with preeclampsia is nearly double that of babies born to mothers with normal blood pressure and no signs of preeclampsia, the majority of women with preeclampsia deliver healthy babies (Erogul). Proteinuria usually resolves within 6 weeks after delivery. Preeclampsia usually does not cause permanent damage or adversely affect the long-term health of the mother, but risk of preeclampsia and eclampsia is greater in subsequent pregnancies. Preeclampsia in the US is associated with higher than normal mortality and morbidity for mothers and newborns (neonates) and has been shown to be responsible for 15% of premature births and 17.6% of pregnancy-related maternal deaths (Lim).

Eclampsia is a much more significant complication of pregnancy, with a high potential for maternal death, particularly if it develops before delivery; the pre-delivery (perinatal) maternal mortality rate is 5.6% to 11.8% in the US and UK (Ross). Approximately 50,000 maternal deaths due to eclampsia are reported annually worldwide, with death occurring more often in women older than age 30 and in women who have had no prenatal care (Ross). Babies born to women with eclampsia are at increased risk of morbidity and mortality due to prematurity, low birth weight, premature placental separation, and lack of oxygen in the uterus (fetal hypoxia) (Ross). Women with eclampsia have a 2% chance of having another episode with a subsequent pregnancy, and 25% will have high blood pressure in their next pregnancy (Ross).

Source: Medical Disability Advisor

Differential Diagnosis

Acute memory disorders
Blood dyscrasias
Brainstem syndromes
Cardioembolic stroke
Cerebellar hemorrhage
Cerebral aneurysm(s)
Cerebral venous thrombosis
Chronic hypertension
Chronic kidney disease
Confusional states
Diseases of the gallbladder
Dural sinus thrombosis
Hemolytic-uremic syndrome (HUS)
Idiopathic thrombocytopenia purpura (ITP)
Intracranial hemorrhage
Migraine headache
Pancreas disorders
Seizure disorders
Subarachnoid hemorrhage
Thrombotic thrombocytopenic purpura (TTP)

Source: Medical Disability Advisor

Specialists

Gynecologist
Obstetrician/Gynecologist

Source: Medical Disability Advisor

Comorbid Conditions

Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
Chronic hypertension
Collagen-vascular disorders
Diabetes
Gestational trophoblastic disease
Obesity
Renal disease

Source: Medical Disability Advisor

Complications

Complications of preeclampsia and eclampsia include breakdown of red blood cells (hemolysis), critically impaired blood clotting function (disseminated intravascular coagulation [DIC]), liver damage, and renal failure. Neurological complications may be permanent after recurrent seizures. Additional complications from seizures may include bleeding in the brain (cerebral hemorrhage), brain damage due to lack of oxygen (hypoxic encephalopathy), and pneumonia caused by inhaling foreign matter into the lungs (aspiration pneumonia) during an eclamptic seizure. Tongue biting, head trauma, and broken bones also may occur during seizure.

Early emergency delivery may cause complications for both mother and premature infant. Placenta malfunction can result in low birth weight (intrauterine growth retardation), compromise of the neonatal circulation, and other deficiencies for the infant. Infants born to women with preeclampsia are more likely to experience health problems at birth if premature delivery is required and birth weight is low.

Source: Medical Disability Advisor

Factors Influencing Duration

The length of disability may be influenced by the severity of the condition, length of time to stabilize the condition, whether delivery was induced or by cesarean section, whether eclampsia occurred before, during, or after delivery, and the condition of the infant.

Source: Medical Disability Advisor

Ability to Work (Return to Work Considerations)

If a woman has mild preeclampsia, she may remain at home on relative rest. If her condition becomes more severe or progresses to eclampsia, she will need hospitalization. After she has been stabilized and discharged from the hospital, she usually can return to work 6 weeks following a vaginal delivery. A pregnant woman needs to keep appointments with her obstetrician and may need time off from work to attend appointments. Women will take longer to recover if a cesarean section was performed. Work restrictions may apply for a period after delivery if the job involves heavy lifting or other strenuous activity.

Source: Medical Disability Advisor

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

Did symptoms include new-onset hypertension, severe headache, tachycardia, dizziness, nausea, ringing or buzzing in the ears, double or blurred vision, irritability, drowsiness, vomiting, abdominal pain, and decrease in urinary output?
Was individual at high risk of preeclampsia because of a first pregnancy, age over 40, history of preeclampsia, multiple gestations, or chronic hypertension?
Was obesity a factor or chronic medical conditions such as diabetes, kidney disease, or antiphospholipid syndrome?
Were appropriate diagnostic tests performed on blood and urine samples?
Were brain CT or MRI done to assess for intracranial hemorrhage and neurological damage?
Did individual experience a mild or severe case of preeclampsia? Did it progress to eclampsia?
Did eclampsia occur before, during, or after delivery?
Was HELLP syndrome diagnosed?

Regarding treatment:

Was blood pressure reduced? How long did it take to stabilize maternal condition?
Was bed rest prolonged? Was hospitalization necessary?
If infant was delivered early, how early? By induced labor or cesarean section?
How long was mother hospitalized? Infant?
If eclampsia occurred, was appropriate treatment available immediately?
Was anticonvulsant therapy administered? With what results?

Regarding prognosis:

Has maternal blood pressure returned to the safe range?
Does mother attend regular checkups?
Did blood pressure return to normal by the 6-week checkup?
Is underlying cause being investigated?
Has mother developed any complications? Is additional treatment needed?
What is the condition of the infant? Have any complications developed? Are special treatments or care required?

Source: Medical Disability Advisor

References

Cited

Erogul, Mert. "Pregnancy, Preeclampsia." eMedicine. Eds. Assaad J. Sayah, et al. 22 May. 2009. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/796690-overview>.

Lim, Kee-Hak, and Guy Steinberg. "Preeclampsia." eMedicine. Eds. John J. Kavanaugh, et al. 31 Jul. 2009. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/1476919-overview>.

Ross, Michael G. "Eclampsia." eMedicine. Eds. Bruce A. Meyer, et al. 1 Apr. 2009. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/253960-overview>.

Source: Medical Disability Advisor