Doc Talk: Pre-Eclampsia

What Is Pre-Eclampsia?

Pre-eclampsia is a serious condition that can occur during pregnancy where there is high blood pressure and increased protein in the urine. It  can affect about 10 percent of pregnancies. Although most cases of pre-eclampsia are mild and cause no trouble, the condition can get worse for and be serious for both mother and baby. It can cause fits (seizures) in the mother, which is called ‘Eclampsia‘, and can affect the baby’s growth. If left untreated, it can be life threatening for mother & baby. 

Women can have pre-eclampsia and have no symptoms. It is therefore vital to have regular antenatal checks of blood pressure and urine to detect the condition before it becomes dangerous for mother and baby.  

Pre-eclampsia is sometimes called Pregnancy-induced hypertension (PIH), pre-eclamptic toxemia or hypertensive disease of pregnancy.

Who Is At Risk?

The causes of this condition are not fully understood, but genetic factors and the placenta seem to play significant roles. Pre-eclampsia tends to be more common in first, rather than subsequent, pregnancies. Women may be at risk if they:  

∙ have high blood pressure 

∙ have a chronic condition such as diabetes or a kidney disorder 

∙ have an autoimmune disorder such as Rheumatoid arthritis 

∙ have had pre-eclampsia before 

∙ are aged 40 years or more or aged under 18 years 

∙ are expecting twins or triplets 

∙ have a family history of pre-eclampsia  

∙ are very overweight at the beginning of pregnancy – BMI of more than 35 or above 

∙ have had a gap of 10 years or more since the last pregnancy 

∙ conceived with IVF 

If you have any of these risk factors, it is very important to attend regular check-ups to have your blood pressure and urine tested.

Symptoms

What are the symptoms? 

Pre-eclampsia can occur at any time during pregnancy, and up to 6 weeks after birth. It is most common after 20 weeks of pregnancy and in first pregnancies. It can develop gradually over many weeks, or come on suddenly over a few hours. 

Symptoms In Pregnant Woman 

Early symptoms 

The first signs of pre-eclampsia are a sudden rise in blood pressure (hypertension) and protein in the urine. You probably won’t notice these symptoms, but your doctor or midwife should pick them up during your antenatal appointments. 

Progressive symptoms 

As pre-eclampsia develops, it can cause fluid retention (oedema), which often causes sudden swelling of the feet, ankles, face and hands. Oedema is another common symptom of pregnancy, but it tends to be in the lower parts of the body, such as the feet and ankles. It will gradually build up during the day. If the swelling is sudden, and it particularly affects the face and hands, it could be pre-eclampsia. 

As pre-eclampsia progresses, it may cause: 

∙ severe headaches that don’t go away with painkillers 

∙ vision problems, such as blurring or seeing flashing lights 

∙ severe pain in the upper abdomen (just below the ribs) 

∙ heartburn that doesn’t go away with antacids 

∙ excessive weight gain due to fluid retention 

∙ feeling generally unwell 

If you experience any of these symptoms, contact your doctor or midwife straight away. 

However, it is possible to have severe pre-eclampsia without any symptoms. Pre-eclampsia can also develop soon after childbirth, and you should alert your doctor or midwife of any concerns you may have after your  baby is born. 

Symptoms In The Unborn Baby 

The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby.  The growing baby is starved of oxygen and nutrients and this will affect their growth.

Diagnosis

If you are pregnant, your blood pressure will be checked at every antenatal appointment because a rise in blood pressure can be the first sign  of pre-eclampsia. Pre-eclampsia can also be diagnosed by checking whether there is protein in the urine. 

If your doctor or midwife is concerned about pre-eclampsia, they may order blood tests, an ultrasound or monitor the baby’s heart rate.

Treatment

Once pre-eclampsia develops, it does not go away until after the baby is born. Treatment may start with rest at home, but some women need  to be admitted to hospital and to take medicines that lower high blood pressure and control the amount of fluid in the body. You may also  have medication to prevent seizures.  Occasionally, the only way to treat pre-eclampsia is to deliver the baby early, either by induction of labour or a caesarean section. 

After the birth, pre-eclampsia usually goes away quickly. However, there may still be complications so you may need to stay in hospital for  several days and keep taking medication to keep your blood pressure down. If your baby is small or premature, they may need care in a special nursery. If you are concerned about pre-eclampsia, contact your doctor or midwife straight away. If you are managing pre-eclampsia at home, make sure you drink enough to keep well hydrated and ensure regular follow up with your  doctor. Gentle exercise and keeping your feet raised when you’re sitting down can help. 

Complications

If left untreated, pre-eclampsia can increase the risk of a stroke, impaired kidney and liver function, blood clotting problems, fluid on the lungs and seizures. There is also an increased risk that the placenta will separate from the wall of the uterus, causing bleeding, called placental abruption. The baby may be born small, prematurely or may even be stillborn.  

Medical researchers are looking for ways to predict pre-eclampsia, in order to reduce the risks for mothers and their babies. Since pre-eclampsia tends to run in families, scientists are currently looking for the specific gene(s) which might be responsible for pre-eclampsia. If  discovered, it is hoped there will eventually be a pre-pregnancy test for the condition.

Get medical help immediately if you are pregnant and you have severe abdominal pain, headache, dizziness, vision problems,  confusion, nausea or vomiting, or if you experience a seizure, sudden swelling in your hands, ankles or face, trouble speaking, numbness or sudden and rapid weight gain.