Pre-eclampsia

Pre-eclampsia is common in pregnancy, affecting between two and eight in every 100 women. 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.

Around one in 200 women develop severe pre-eclampsia during pregnancy. The symptoms tend to occur later on in pregnancy but can also occur for the first time only after birth. Severe pre-eclampsia can be life-threatening for both mother and baby.

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 the Maternity Assessment Unit at the RVI.

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 the baby’s birth. These seizures are called eclamptic fits and are rare, occurring in only one in every 4,000 pregnancies.

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, the baby may even die in the womb. Monitoring aims to pick up those babies who are most at risk.

Pre-eclampsia can occur in any pregnancy but you are at increased risk if:

• your blood pressure was high before you became pregnant or in a previous pregnancy
• you have a medical problem such as kidney problems or diabetes or a condition that affects the immune system, such as lupus.

If any of these apply to you, you are advised to take low-dose aspirin (75 mg) once a day from 12 weeks of pregnancy, to reduce your risk.

The importance of other factors is less clear-cut, but you are more likely to develop pre- eclampsia if more than one of the following applies:

• this is your first pregnancy
• you are aged 40 or over
• your last pregnancy was more than 10 years ago
• you are very overweight – a BMI (body mass index) of 35 or more
• your mother or sister had pre-eclampsia during pregnancy
• you are carrying more than one baby

If you have more than one of these risk factors, you may also be advised to take low-dose aspirin once a day from 12 weeks of pregnancy.

If you are suspected of having pre-eclampsia you should attend the Maternity assessment Unit (MAU) for assessment. While you are at the MAU, your blood pressure will be measured regularly and you may be offered medication to help lower it.

Your urine will be tested to measure the amount of protein it contains and you will also have blood tests done.

Your baby’s heart rate will be monitored and you may have ultrasound scans to measure your baby’s growth and wellbeing. If you are diagnosed with preeclampsia you are offered antenatal admission to ward 34 for close monitoring until delivery.

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.

If you develop severe pre-eclampsia, you will be cared for by a specialist team. 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 labour ward. In more serious cases, you may need to be admitted to our intensive care or high  dependency unit.

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 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.

15 in every 100 women who have had pre-eclampsia will get it again in a future pregnancy.

Of those women who had severe pre-eclampsia, or eclampsia:

• 50 in every 100 women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 28 weeks of pregnancy.
• 25 in every 100 women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 34 weeks of pregnancy.

You should 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