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What is Pre-eclampsia?
Pre-eclampsia is a condition which typically occurs from 20 weeks of pregnancy but may also occur unexpectedly for the first time after birth. It is characterised by:
- raised blood pressure (Hypertension)
- protein in your urine (Proteinuria)
- abnormalities in the blood.
Often there are no symptoms and pre-eclampsia may be identified at your routine antenatal appointments with the midwife, when your blood pressure is checked and urine is tested. The exact cause is not understood but it is common, affecting between two and eight in 100 women.
It is usually mild and normally has little effect on the pregnancy. It is, however, important to know if you have the condition because in a small number of cases, it can develop into a more serious illness. Severe and untreated pre-eclampsia can be life-threatening for both mother and baby.
Only 1 in 200 women (0.5%) will develop severe pre-eclampsia during pregnancy but it is really important to report symptoms immediately, and access midwifery support and medical treatment in order to optimise the health of both you and your baby.
Symptoms to look out for
- severe headache not relieved by simple analgesia
- nausea & vomiting
- visual disturbance, such as blurring, flashing lights or floaters
- severe pain below the ribs
- heartburn unrelieved with antacids
- rapidly increasing swelling of the face, hands or feet
- feeling very unwell.
If you have any of these symptoms, please contact Maternity Triage, as early assessment by a senior doctor is key to keeping you and your baby safe in pregnancy and planning your ongoing care appropriately.
Pre-eclampsia as a result of high blood pressure can cause a stroke, and heart and blood vessel damage if untreated. In severe pre-eclampsia, organs such as the liver and kidneys can be affected and blood clotting problems can occur. Delay in treatment can increase the likelihood of convulsions or seizures before or just after the baby’s birth. The good news is that for women with symptoms of pre-eclampsia, only one in 4000 pregnancies will be affected by eclamptic fits when early medical treatment is accessed.
How may pre-eclampsia affect my baby?
- Pre-eclampsia affects development of the placenta (afterbirth) which may prevent your baby growing as they should. The growing baby receives less oxygen and fewer nutrients than needed, which can affect development. This is called intra-uterine or fetal growth restriction.
- There may be less fluid around the baby in the womb.
- If the placenta is severely affected, your baby may become very unwell and may even die in the womb.
Fetal monitoring (such as regular growth scans) aims to pick up those babies who are most at risk.
Always phone maternity triage immediately if there is any change in the normal pattern of fetal movements.
Pre-eclampsia can occur in any pregnancy but you are at higher risk if:
- your blood pressure was high pre-pregnancy
- your blood pressure was high in a previous pregnancy
- you have a medical condition affecting your kidneys, or your immune system, or diabetes.
Who is most at risk of Pre-eclampsia?
- First pregnancy (Primigravida).
- Your last pregnancy was more than 10 years ago.
- You are very overweight – BMI (Body Mass Index) above 35.
- Family or personal history of pre-eclampsia.
- Aged 40 or above.
- Previous stillbirth or placental abruption.
- You have a multiple pregnancy.
If any of these apply to you, you will be advised to take 150mg Aspirin once a day from 12 weeks of pregnancy to reduce your risk.
Diagnosis of Pre-eclampsia – What to expect
If you are diagnosed with pre-eclampsia, you will be advised to attend hospital for assessment of your blood pressure and medication may be required to help lower it.
We will offer blood sample and urine testing to observe for rising protein levels. You may need a drip for medication to lower your blood pressure and to prevent eclamptic fits as well as close monitoring on the labour ward, high dependency or intensive care unit (in some serious cases).
To identify any potential concerns with your baby’s growth and wellbeing, regular fetal assessments will be carried out with your consent.
Throughout your pregnancy, you will be monitored closely to determine when an appropriate delivery plan needs to be initiated as sometimes, when there are concerns about you or your baby, you may be offered and advised an earlier Induction of labour or caesarean birth.
The good news is after birth, pre-eclampsia usually goes away as it is a disease of the placenta. If you have severe pre-eclampsia, complications may still occur within the first few days, so monitoring is essential and blood pressure lowering medication in the post-natal period may continue. There is no reason why you should not breastfeed with review of blood pressure medication prior to discharge home; the community midwife and GP will oversee your follow-up care.
1 in 6 women with pre-eclampsia will have it again in a future pregnancy.
Of those women who had severe pre-eclampsia:
- 1 in 2 women will get pre-eclampsia in a future pregnancy, if their baby needed to be born before 28 weeks of pregnancy.
- 1 in 4 women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 34 weeks of pregnancy.
- 5-6% women go on to need medication for pregnancy-induced hypertension, as a result of pre-eclampsia.
Pre-eclampsia may disappear within hours, or any time up to six months after delivery. Most rarely, pre-eclampsia presents for the first time up to four weeks post-birth, and re-establishing normal blood pressure readings prior to going home may result in a longer hospital stay after the baby is born as well as referral to a specialist for long-term blood pressure management and review.
It is recommended that women who have been diagnosed with severe pre-eclampsia or eclampsia do not drive for at least the first week after birth and look out for and immediately report any symptoms of pre-eclampsia.
Although the risk of end-stage kidney disease is increased following pre-eclampsia/eclampsia, if the blood pressure has normalised and there is no protein in the urine at the 6 to 8 week postnatal check, the absolute risk is low and no further follow-up is needed.
In order to plan for subsequent pregnancies, it is important for you to have optimum blood pressure control, to increase your health in pregnancy and reduce the likelihood of recurring pre-eclampsia. Some blood pressure medications are associated with fetal complications and congenital abnormalities and will need to be reviewed to ensure alternative appropriate medications are offered. Early access to Obstetric-led care, for counselling, healthy eating in pregnancy, exercise, home blood pressure monitoring and fetal surveillance will all aim to increase maternal wellbeing and baby development in pregnancy.
The likelihood of pre-eclampsia returning increases with an interval between pregnancies of over 10 years.
Further reading; Where can I get more information?
- NICE guidance – Hypertension in pregnancy: diagnosis and management NG 133 update 25/6/19
- NICE guidance – The Management of Hypertensive Disorders during Pregnancy
- RCOG guidance
- Action on Pre-eclampsia Postnatal recovery from pre-eclampsia What to expect and medical management
- NHS website information about pre-eclampsia
Leaflet adapted from RCOG ‘Pre-eclampsia’ and Action on Pre-eclampsia ‘postnatal recovery from pre-eclampsia’ leaflets in addition to recommendations from the updated NICE guidance
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