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Pre-eclampsia

Pre-eclampsia is a condition that can develop in pregnant women. Women with pre-eclampsia have high blood pressure and protein in their urine. Pre-eclampsia can cause eclampsia (fits) and other serious problems. In the baby it can result in growth problems and a premature birth. Severe pre-eclampsia can be life-threatening for both mother and baby.

Pre-eclampsia is a condition that only develops during pregnancy. It affects both you and your baby and can cause serious health problems if it’s not diagnosed and treated.

Pre-eclampsia starts in your placenta, the organ that joins you to your baby. The placenta supplies your baby with the blood and nutrients it needs to grow and develop.

If you have pre-eclampsia, your placenta doesn’t provide enough blood to your baby. This causes your blood pressure to rise and affects how well your kidneys work. As a result of this, protein leaks into your urine. The lack of blood supply to your baby can mean that he or she doesn’t grow properly.

Pre-eclampsia happens in up to one in every 10 pregnancies, though many of these women will have a mild form of the condition. It can develop anytime after 20 weeks of pregnancy until a few days after the birth of your baby.

In around one in 100 women, pre-eclampsia develops into a more serious condition called eclampsia. Eclampsia is a fit or fits (seizures) as a result of pre-eclampsia. Women with eclampsia can have a stroke or a fall into a coma. It can be life-threatening for both you and your baby.

You can have high blood pressure during pregnancy without having pre-eclampsia. You may have high blood pressure before become pregnant (chronic hypertension) or you can develop high blood pressure during pregnancy. This is called pregnancy-induced hypertension or gestational hypertension and can develop in the second half of pregnancy, after 20 weeks. It does not mean you have pre-eclampsia.

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Details

  • Symptoms Symptoms of 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. Your midwife or doctor will check your blood pressure and urine at your regular antenatal appointments.

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

    • severe headaches, which are not relieved by painkillers
    • 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
    • weakness or feeling generally very unwell
    • shortness of breath
    • sudden swelling of your hands, face or feet
    • heartburn (indigestion) that doesn’t improve with antacids

    If you  have any of these symptoms, you should contact your midwife or GP straight away, or go to an accident and emergency department.

  • Diagnosis Diagnosis of pre-eclampsia

    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.

    High blood pressure and protein in the urine can be signs of pre-eclampsia. When you go for your regular antenatal appointments your midwife will check your blood pressure and urine.

    If you develop high blood pressure (140/90mmHg) after 20 weeks of pregnancy and the urine test shows that there is protein in your urine, your doctor or midwife will refer you to a hospital maternity unit. He or she will also refer you if you have high blood pressure (160/110mmHg or above) even if there is no protein in your urine.

    At hospital, you will have blood tests to check how well your liver and kidneys are working and how well your blood is clotting. You will also have an ultrasound scan to check the health of the baby, and a test to check the baby’s heart rate and movement.

  • Treatment Treatment of 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 you have been diagnosed with pre-eclampsia, you will probably be admitted to hospital for close monitoring. You be asked to collect urine over 24 hours so your doctor can measure the exact amount of protein in your urine. Your midwife and doctor will check your blood pressure regularly, at least four times a day. You will also have regular blood tests to check your liver, kidneys and blood clotting.

    Your baby’s health will also be monitored with ultrasound scans and checks on heart rate and movement.

    If you have mild pre-eclampsia, you may be able to stay at home and just go to hospital for your tests.

    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. You may be able to take medicines for high blood pressure as tablets. If your blood pressure is very high, you may need medicines through a drip into a vein in your hand or arm. Your doctor may also give you medicines to prevent fits. Your doctor will give you medicines that are safe to take in pregnancy.

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

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  • Causes Causes of pre-eclampsia

    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
  • Complications Complications of pre-eclampsia

    If it’s not treated, pre-eclampsia can develop into a condition called eclampsia. Eclampsia happens in one in every 4,000 pregnancies. It can develop at any time during the second half of pregnancy, during labour or soon after delivery.

    Eclampsia is fits (seizures) as a result of pre-eclampsia, 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.

    Severe pre-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 also 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 may cause other health problems for your baby.

  • Prevention Prevention of pre-eclampsia

    There is nothing specific you can do to 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
    • have high blood pressure
    • have other health conditions such as diabetes or kidney failure

    Your midwife or doctor will ask you 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.

  • FAQs FAQs

    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 future pregnancy. Many women who have had pre-eclampsia before 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. 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 symptoms will be monitored closely. You should be given an appointment to see your GP or an 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 need to see a specialist.

    Explanation

    If you had pre-eclampsia during your pregnancy, complications can still happen after your baby is born. You will need to stay in hospital until your blood pressure is down and you’re well enough to go home. This can take a few days. You may need to carry on taking medicines to treat high blood pressure.

    While you’re in hospital your midwives and doctors will monitor you 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.

    Pre-eclampsia can develop up to four to six weeks after the baby is born. If you develop any symptoms soon after having your baby, such as upper abdominal pain, vomiting, severe headache, or visual disturbances, tell your GP 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 need to see a specialist.

    If you have had severe 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 future.

    Explanation

    Most women 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 women who develop high blood pressure were generally at increased risk, even before they developed pre-eclampsia.

    A few women may have some long-term damage to their kidneys.

    Most babies and children who have been affected by pre-eclampsia have no future health problems. However, babies born very early because of pre-eclampsia and babies who don’t get enough oxygen because of the condition are at risk of long-term health problems. Talk to your midwife and doctor for more information.

  • Resources Resources

    Further information

    Sources

    • Hypertension in pregnancy. Map of Medicine. www.eng.mapofmedicine.com, published 31 January 2011
    • Hypertension in pregnancy. NICE Clinical Knowledge Summaries www.cks.nice.org.uk, published November 2010
    • Hypertension in pregnancy. NICE Clinical Guideline 107. www.nice.org.uk, published August 2010
    • Preeclampsia. Medscape. emedicine.medscape.com, published 26 August 2013
    • Commonly Asked Questions. Action on Pre-eclampsia. www.action-on-pre-eclampsia.org.uk, accessed 10 September 2013
    • Eclampsia. Medscape. emedicine.medscape.com, published 16 July 2013
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010:824–825
    • Information for you: Pre-eclampsia. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2012
    • Antenatal care: Routine care for the healthy pregnant woman. NICE Clinical Guideline 62. www.nice.org.uk, published March 2008
    • HELLP Syndrome. Medscape. emedicine.medscape.com, published 22 July 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 12 September
    • Preterm labor. Medscape. emedicine.medscape.com, published 25 June 2013
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