Pre-eclampsia

Mild pre-eclampsia doesn’t usually have any symptoms. It’s often picked up at routine antenatal appointments, which is why it’s important to attend these. You will have your blood pressure checked and your urine tested regularly at your antenatal appointments.

Symptoms can develop as pre-eclampsia becomes more severe. These may include:

• headache – usually at the front of your head
• problems with your vision, such as flashing lights and blurred vision
• abdominal (tummy) pain – usually just below your ribs
• feeling or being sick
• feeling confused
• feeling very unwell
• shortness of breath
• sudden swelling of your hands, face or feet

If you are pregnant and have any of these symptoms, you should contact your midwife or GP straight away, or go to the accident and emergency department of a hospital.

Pre-eclampsia can develop into a condition called eclampsia if it’s not treated. Eclampsia develops in one in every 2,000 pregnant women. It can develop at any time during the second half of pregnancy, during labour or after delivery.

Eclampsia can cause fits, which look similar to epileptic fits. If a fit goes on for a long time, both mother and baby may not receive enough oxygen and this can be life-threatening.

Eclampsia can also lead to liver, kidney and lung failure and problems with blood clotting. A combination of all of these serious health problems is called HELLP syndrome. HELLP syndrome can be life-threatening for the mother and the only treatment is for the baby to be born. This may mean that you have to have your baby early, which can cause other health problems for your baby.

Doctors don't know the exact cause of pre-eclampsia. However, it seems to start with a problem with the placenta. In pre-eclampsia the placenta doesn’t develop properly, which means there is a reduced blood supply to it.

Doctors don't know why some women get pre-eclampsia and others don't, but there are certain factors that put you at higher risk. Your family history is important. If a close family member, for example your mother or sister, has had pre-eclampsia, you’re more likely to develop it.

You're also more likely to get pre-eclampsia if:

• this is your first baby or your first baby with a new partner
• you had pre-eclampsia in an earlier pregnancy
• you're having twins or other multiple pregnancies
• you're over 40
• you have other medical conditions including high blood pressure, diabetes and kidney disease
• you're very overweight, ie you have a body mass index (BMI) of over 30

Pre-eclampsia can be difficult to diagnose as there are a large number of different signs and symptoms. Some women have no symptoms at all.

When you go for your regular antenatal appointments you will have your blood pressure checked and your urine tested. If your blood pressure is raised above 140/90mmHg or there is an increase in your diastolic blood pressure reading of more than 20mmHg and the urine test shows that there is protein in your urine, this may show that you have pre-eclampsia.

The treatment for pre-eclampsia depends on how severe the condition is, your health and that of your baby, and how many weeks pregnant you are.

If the pre-eclampsia is mild, and you have no symptoms, it may not be necessary for you to be admitted to hospital and you can stay at home. Your midwife and doctor will monitor your blood pressure and test your urine regularly. You will probably also have regular blood tests.

If the pre-eclampsia becomes more severe, you will probably be admitted to hospital where you and your baby can be monitored closely. You will probably have the following tests when you’re in hospital.

• Blood pressure checks about every four hours, or more frequently depending on how serious your condition is.
• Urine collection over 24 hours to measure the exact amount of protein in your urine, followed by daily protein urine checks.
• Blood tests, including kidney, liver and blood clotting tests.
• Ultrasound scans to check the health of your baby.
• Monitoring of your unborn baby’s heart rate to check his or her wellbeing.

Medicines

You may be given medicines to help reduce your blood pressure. These can’t cure pre-eclampsia but they may prevent you developing more serious health problems. Medicines for high blood pressure can be taken as tablets or, if your blood pressure is very high, they may be given through a drip put into a vein in your hand or arm. Your doctor may also give you medicines to prevent fits. These medicines won’t harm your baby.

The only way to ‘cure’ pre-eclampsia is for your baby to be born. Every woman is different, so when this might happen will depend on your health and that of your baby. This may mean that your baby is born early, which may affect his or her health. Your doctor and midwife will discuss this with you.

There is nothing specific that you can do yourself that will prevent pre-eclampsia or reduce your risk of developing it.

If you’re at high risk of developing pre-eclampsia, your doctor may suggest that you take a small amount of aspirin every day. You’re at a high risk of developing pre-eclampsia if you have had the condition in a previous pregnancy, or already have high blood pressure or other health conditions such as diabetes or kidney failure. You will be asked to take aspirin from 12 weeks of pregnancy until your baby is born. You should only take aspirin if your doctor has advised you to.

I had pre-eclampsia in my first pregnancy. Am I more likely to get it again?

Answer

Yes. If you had pre-eclampsia in a previous pregnancy, you're at an increased risk of developing the condition if you become pregnant again.

Explanation

Your risk of developing pre-eclampsia during pregnancy goes up if you had pre-eclampsia in a previous pregnancy. However, this will vary for everyone and doesn’t mean that you will definitely have pre-eclampsia in a subsequent pregnancy. Many women who have had pre-eclampsia previously go on to have a normal, healthy pregnancy.

If you do develop pre-eclampsia again, it's likely to be less severe than the first time. When you become pregnant, it's very important that you tell your midwife and GP about your previous pre-eclampsia. Make sure you attend all your antenatal appointments and have your blood pressure checked regularly. You should also tell your midwife or GP if you're worried about anything or have any symptoms that you think might be caused by pre-eclampsia. This means that if you do develop pre-eclampsia, it can be treated straight away.

What happens after my baby is born?

Answer

You will probably need to stay in hospital for a few days after your baby is born. During this time your blood pressure and any symptoms you have will be monitored closely. You should be given an appointment to see your obstetrician (a doctor who specialises in pregnancy and childbirth) between six and eight weeks after the birth. If your blood pressure is still high, you will be referred to a specialist.

Explanation

Some women develop pre-eclampsia after their baby is born. If this happens, you will need to stay in hospital for a few days until you’re well enough to go home. You may need to carry on taking medicines to treat high blood pressure.

While you’re in hospital you will be monitored closely, with regular blood pressure checks. If you have any symptoms, such as a headache or abdominal (tummy) pain, tell your midwife or doctor straight away.

If your blood pressure is still high six weeks after your baby is born, or there is still protein in your urine, you may be referred to a specialist.

If you have had pre-eclampsia, you should have a postnatal appointment with your obstetrician between six and eight weeks after your baby is born. During this appointment you can discuss the condition and what happened, and talk to your doctor about your health and any pregnancies in the future.

Will there be any long-term effect on my health, and my baby’s, if I have had pre-eclampsia?

Answer

Most women and their babies have no long-term health problems after pre-eclampsia. However, pre-eclampsia may increase your risk of developing high blood pressure in the future.

Explanation

Most women will have no long-term effects on their health after pre-eclampsia.

However, if you have had pre-eclampsia, you’re at greater risk of developing high blood pressure later in life, compared with a woman who hasn’t had it. It’s not known whether pre-eclampsia causes this increased risk, or whether those women who develop high blood pressure were generally at increased risk, even before they developed pre-eclampsia.

A few women also have some long-term damage to their kidneys, though this risk is small.

Most babies and children who have been affected by pre-eclampsia have no future health problems. However, if your baby was born very early because of pre-eclampsia or if he or she did not get enough oxygen, they may have long-term health problems. Talk to your midwife and doctor for more information.

• Action On Pre-eclampsia 020 8427 4217 www.apec.org.uk
• Royal College of Obstetricians and Gynaecologists www.rcog.org.uk

• Your questions answered. Action on pre-eclampsia.www.apec.org.uk, published 2010
• Arulkumaran S, Symonds IM, Fowlie A. Oxford handbook of obstetrics and gynaecology. Oxford: Oxford University Press, 2004: 182–186
• Pre-eclampsia, eclampsia and hypertension. Clinical Evidence.www.clinicalevidence.bmj.com, published February 2011
• Pre-eclampsia – what you need to know. Royal College of Obstetricians and Gynaecologists.www.rcog.org.uk, published November 2007
• Eclampsia. Action on pre-eclampsiawww.apec.org.uk, published 2010
• Eclampsia. Royal College of Obstetricians and Gynaecologists.www.rcog.org.uk, published November 2007
• HELLP syndrome. Action on pre-eclampsia.www.apec.org.uk, published 2010
• Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. National Institute for Health and Clinical Excellence (NICE), January 2011.www.nice.org.uk