Pre-eclampsia is a condition that typically occurs after 20 weeks of pregnancy.
It is a combination of raised blood pressure (hypertension) and protein in your urine (proteinuria). The exact cause of pre-eclampsia is not understood.
Often there are no symptoms and it may be picked up at your routine antenatal appointments when you have your blood pressure checked and urine tested. This is why we ask you to bring a urine sample to your appointments.
Pre-eclampsia is common. It is usually mild and normally has very little effect on pregnancy. However, it is important to know if you have the condition because, in a small number of cases, it can develop into a more serious illness. Severe pre-eclampsia can be life-threatening for both mother and baby.
The symptoms tend to occur later on in pregnancy but can also occur for the first time only after birth.
The symptoms of severe pre-eclampsia include:
- severe headache that doesn’t go away with simple painkillers
- problems with vision, such as blurring or flashing before the eyes
- severe pain just below the ribs
- heartburn that doesn’t go away with antacids
- rapidly increasing swelling of the face, hands or feet
- feeling very unwell.
These symptoms are serious and you should seek medical help immediately. If in doubt, contact your midwife.
In severe pre-eclampsia, other organs, such as the liver or kidneys, can sometimes become affected and there can be problems with blood clotting. Severe pre-eclampsia may progress to convulsions or seizures before or just after your baby’s birth. These seizures are called eclamptic fits and are rare.
Does pre-eclampsia affect my baby?
Pre-eclampsia affects the development of the placenta (afterbirth), which may prevent your baby growing as it should. There may also be less fluid around your baby in the womb. If the placenta is severely affected, your baby may become very unwell. In some cases, your baby may even die in the womb. Monitoring aims to pick up those babies who are most at risk.
What are the risks of pre-eclampsia and how can I prevent it?
Pre-eclampsia can occur in any pregnancy but you are at higher risk if:
- this is your first pregnancy
- you have a pregnancy interval of more than 10 years
- you are 40 years or older
- you have a Body Mass Index (BMI) of 35 or more with a family history of pre-eclampsia
- this is a multiple pregnancy
- if you had hypertensive disease during a previous pregnancy
- you have an autoimmune disease such as lupus or anti-phospholipid syndrome
- you have Raised Blood Pressure Pre pregnancy Renal disease Type 1 or 2 diabetes.
If any of these apply to you, you should be advised to take low-dose aspirin (75 mg) once a day from 12 weeks of pregnancy, to reduce your risk.
How is pre-eclampsia monitored?
If you are diagnosed with pre-eclampsia, you should attend hospital for assessment. While you are at the hospital, your blood pressure will be measured regularly and you may be offered medication to help lower it. Your urine will be also tested to measure the amount of protein it contains. Your baby’s heart rate will be monitored and you may have ultrasound scans to measure your baby’s growth and wellbeing. You will also have blood tests done, one of which will measure the amount of growth hormone made by your placenta, which is affected by pre-eclampsia. If the test shows lower than expected levels of placental growth factor (PlGF), we will use this information along with other factors to suggest how to manage the condition in the safest way for your pregnancy. This could be more frequent visits to your community midwife or possibly admission to hospital for observation. If the test shows normal levels of placental growth hormone and your blood pressure is normal, it is likely you will go home with a plan for your next midwife contact. You will be asked to keep an eye on your symptoms during this time and contact your midwife if anything changes. No diagnostic test is 100% accurate but your care team will use the result of this to make recommendations about your care along with the results of the other bloods tests, your blood pressure and urine checks, and any symptoms you are having. You will continue to be monitored closely to check that you can safely carry on with your pregnancy. This may be done on an outpatient basis if you have mild pre-eclampsia. You are likely to be advised to have your baby at about 37 weeks of pregnancy or earlier if there are concerns about you or your baby. This may mean you will need to have labour induced or, if you are having a caesarean section, to have it earlier than planned.
How is severe pre-eclampsia treated?
The only way to prevent serious complications is for your baby to be born. Each pregnancy is unique and the exact timing will depend on your own particular situation. This should be discussed with you. There may be enough time to induce your labour. In some cases, the birth will need to be by caesarean section.
Treatment includes medication (either tablets or via a drip) to lower and control your blood pressure. You will also be given medication to prevent eclamptic fits if your baby is expected to be born within the next 24 hours or if you have experienced an eclamptic fit.
You will be closely monitored on the Central Delivery Suite (CDS) at Southmead Hospital. In more serious cases, you may need to be admitted to an intensive care or high dependency unit. Our CDS has the capability to deliver high dependency care.
What happens after the birth of my baby?
Pre-eclampsia usually goes away after birth. However, if you have severe pre-eclampsia, complications may still occur within the first few days and so you will continue to be monitored closely. You may need to continue taking medication to lower your blood pressure.
If your baby has been born early or is smaller than expected, he or she may need to be monitored. There is no reason why you should not breastfeed should you wish to do so.
You may need to stay in hospital for several days. When you go home, you will be advised on how often to get your blood pressure checked and for how long to take your medication.
You should have a follow-up with your GP six to eight weeks after the birth for a final blood pressure and urine check.
If you had severe pre-eclampsia or eclampsia, you should have a postnatal appointment with your obstetrician to discuss the condition and what happened. If you are still on medication to treat your blood pressure six weeks after the birth, or there is still protein in your urine on testing, you may be referred to a specialist Consultant.
Does pre-eclampsia affect future pregnancies?
Some women will get it again in a future pregnancy. You will be given information about the chance, in your individual situation, of getting pre-eclampsia in a future pregnancy and about any additional care that you may need. It is advisable to contact your midwife as early as possible once you know you are pregnant again.
For more information visit www.nhs.uk/conditions/pre-eclampsia