Articles

Key takeaways

• Pre-eclampsia involves high blood pressure and can affect organs.
• Symptoms include severe headaches, vision changes, and sudden swelling.
• Close monitoring and medication help manage pre-eclampsia.
• Delivering the baby is the only cure for pre-eclampsia.

What is pre-eclampsia?

About 1 in 10 people have high blood pressure (hypertension) during pregnancy.

Pre-eclampsia is a condition that usually develops after 20 weeks of pregnancy, or sometimes after birth. It involves high blood pressure (hypertension) and protein in the urine (proteinuria). Sometimes, it can affect organs such as the liver and kidneys, and blood clotting.

The earlier pre-eclampsia develops, the more severe it may become.

The exact cause of pre-eclampsia is not fully understood. It is thought to be related to the placenta not developing properly. The placenta is the organ that connects the mother’s blood supply to the baby.

How pre-eclampsia affects you and your baby

Pre-eclampsia can be mild, but it can also become serious for both mother and baby.

Pre-eclampsia affects blood vessels and raises blood pressure. This can affect how well important organs function. It can also affect how the baby's placenta works, which may impact the baby’s growth.

Risk factors for pre-eclampsia

Some factors can increase your chances of developing pre-eclampsia. The risk increases as more of these factors are present.

• Age – You are 40 years old or older.
• Body Mass Index (BMI) – Your BMI was 35 or more at the start of pregnancy.
• First pregnancy – This is your first ongoing pregnancy.
• Existing medical conditions – Such as diabetes, kidney disease, or high blood pressure. Other conditions include lupus or antiphospholipid syndrome.
• Family history – Your mother or sister has had pre-eclampsia.
• Previous pre-eclampsia – You had pre-eclampsia in a previous pregnancy.
• Time since last pregnancy – It has been 10 years or more since your last pregnancy.
• Expecting more than one baby – You are pregnant with twins, triplets, or more (multiple gestation).

Recognising the signs of pre-eclampsia

It is important to tell your midwife or doctor immediately if you notice any of these signs:

• Severe headache – A headache that does not go away with simple pain relief.
• Vision problems – Such as blurred vision or seeing flashing lights.
• Severe abdominal pain – Usually just below your ribs.
• Heartburn – That does not improve with antacids.
• Rapidly increasing swelling – Especially of the face, hands, or feet.
• Nausea and vomiting.
• Feeling very unwell.

Management and treatment during and after pregnancy

If you are diagnosed with pre-eclampsia, you will have an individual care plan. This plan depends on how many weeks pregnant you are and how high your blood pressure is. It also depends on whether there are any concerns about your or your baby's wellbeing.

Monitoring during pregnancy

Depending on the severity you may be admitted to the hospital for monitoring and treatment. You might also have regular outpatient appointments including:

• Frequent blood pressure checks – To identify any further increases.
• Regular urine samples – To check protein levels.
• Blood tests – To check the functioning of your kidneys and liver.
• Ultrasound scans – To check your baby's growth, blood flow through the placenta and the amount of amniotic fluid.
• Monitoring your baby's heart rate – This is done using a machine that creates a trace of the heartbeat (cardiotocography, or CTG) to check the baby’s wellbeing.

Medication

Medication may be recommended to help lower your blood pressure. This reduces the chance of serious complications like a stroke. Common medicines include labetalol, nifedipine, or methyldopa.

If your condition is severe you may also be given magnesium sulfate. This medicine helps reduce the chance of having an eclamptic fit. Your doctor will carefully choose the safest and most effective medicine for you and your baby.

Planned birth

The only way to cure pre-eclampsia is to give birth to the baby. You will be closely monitored until delivery. The timing of the birth will depend on the severity of your pre-eclampsia and how well you and your baby are.

If the pre-eclampsia is mild and there are no immediate concerns the aim is usually to deliver your baby around 37 weeks. If your condition becomes more severe before 37 weeks, earlier delivery may be necessary. This may mean your labour needs to be started artificially (induction of labour) or you may be recommended to have a caesarean section.

Postnatal care

Pre-eclampsia usually improves after birth, however, worsening or complications can still happen. You will continue to be monitored closely and may need to stay in hospital for observation or treatment.

Your blood pressure should be checked regularly after you leave the hospital. You may need to keep taking blood pressure medication for several weeks. Your healthcare team will ensure any medications are safe if you are breastfeeding.

You should have a follow-up appointment with a healthcare professional 6 to 8 weeks after giving birth. You may be referred to a specialist if you are still on medication or continue to have protein in your urine.

Why treatment is important: preventing serious complications

The goal of managing pre-eclampsia is to prevent rare but serious complications including:

• Eclampsia – This is a rare seizure or fit caused by pre-eclampsia, affecting about 1 in 4000 pregnancies in the UK. Magnesium sulfate can reduce the risk of eclampsia and treat it if a fit has already occurred.
• HELLP syndrome – This rare liver and blood clotting disorder is the name for the combination of Haemolysis (red blood cells breaking down), Elevated Liver enzymes, and Low Platelet count. Delivering the baby is the only way to treat this serious condition.
• Fluid on the lungs (pulmonary oedema) – This is when fluid builds up in and around the lungs, which stops them from working properly.
• Stroke – High blood pressure can disrupt the blood supply to the brain.