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Pre-eclampsia


Expert reviewer Dr Evelyn Ferguson, Consultant Obstetrician Gynaecologist
Next review due January 2020

Pre-eclampsia is a condition that can develop when you’re pregnant. It can potentially cause serious problems for both you and your baby. It’s understandable that you might feel worried about conditions such as pre-eclampsia. But by being aware of the symptoms and getting checked at antenatal appointments, you can find out if you have the condition early. You can then get the right support and treatment.

An image showing the baby and surrounding structures in late pregnancy

What is pre-eclampsia?

Pre-eclampsia is a problem that starts in your placenta: the organ that joins you to your baby. You can get it any time after 20 weeks of pregnancy and even after you give birth.

The placenta supplies your baby with the blood and nutrients they need to grow and develop. If you have pre-eclampsia, your placenta doesn’t provide enough blood to your baby, which can affect how well they grow. This also causes your blood pressure to rise and affects how well your kidneys work. As a result of this, protein leaks into your urine. This can also cause fluid to leak from your blood circulation into your ankles and fingers, which can cause swelling. The three main features of pre-eclampsia are:

  • high blood pressure
  • protein in your urine
  • swelling

About one in 20 pregnant women get pre-eclampsia, although for many of these women it’s only mild.

It’s also important to remember that you can have high blood pressure while you’re pregnant without having pre-eclampsia. This is called gestational hypertension and it can happen after 20 weeks of being pregnant. It doesn’t necessarily mean you have pre-eclampsia, although it increases your risk of getting it as your pregnancy progresses. If you have high blood pressure before you get pregnant, it also increases your risk of developing pre-eclampsia at some point in your pregnancy.

Symptoms of pre-eclampsia

If you have pre-eclampsia, you might not have any symptoms. It’s often picked up at routine antenatal appointments, which is why it’s so important to attend these. Your midwife or doctor will check your blood pressure and test a urine sample at these appointments.

You might get symptoms if pre-eclampsia becomes more severe. These can include:

  • headaches, which are not relieved by painkillers
  • problems with your sight, such as seeing flashing lights and getting blurred vision
  • pain in your tummy (abdomen), usually on the right, just below your ribs
  • feeling or being sick
  • difficulty breathing
  • swollen hands, face or fee
  • not going to the toilet much (to wee)

If you have any of these symptoms, contact your midwife or GP straightaway, or go to the maternity unit at your local hospital.

Diagnosis of pre-eclampsia

Pre-eclampsia can be difficult to diagnose as there are lots of different signs and symptoms, and you might not have any symptoms at all. Most women find out they have it at antenatal appointments.

If you have high blood pressure and protein in your urine, it can be a sign that you might have pre-eclampsia. When you go for your regular antenatal appointments, your midwife will check these.

If your blood pressure goes over 140/90mmHg after 20 weeks of being pregnant, and you have protein in your urine, you’ll be referred. This will be to a hospital maternity unit. Your doctor or midwife will also refer you if you have high blood pressure even if you don’t have protein in your urine.

You’ll have blood tests to check how well your liver and kidneys are working, and how well your blood is clotting. You might also have what’s called a placental growth factor (PlGF)-based test. PlGF is a hormone that helps new blood vessels to grow in the placenta and if this is very low, it suggests you may have pre-eclampsia. It involves giving a sample of blood and you can only have it if you’re between 20 and 34 weeks pregnant, but it isn’t used in all hospitals yet.

You may also have an ultrasound scan to check the growth of your baby, and an assessment of your baby's heart rate and movement called a cardiotocograph (CTG). This involves sitting in a chair for about 30 minutes with a soft belt around your tummy, which picks up your baby's heartbeat.

Treatment of pre-eclampsia

Treatment for pre-eclampsia depends on how severe your condition is: your, your baby’s health, and how many weeks pregnant you are.

You may be admitted to hospital or regular reviews may be arranged in the maternity day assessment unit. This is so you can be monitored closely to check that you can carry on with your pregnancy safely. You might need to collect your urine over 24 hours so your doctor can measure the exact amount of protein in it. Your midwife and doctor will check your blood pressure regularly. You’ll also have regular blood tests to check your liver, kidneys and how well your blood is clotting.

Your baby’s health will also be monitored with ultrasound scans for checks on their heart rate and movement. If you have mild pre-eclampsia, you may be able to stay at home and just go to the day assessment unit for these tests.

Giving birth

The only ‘cure’ for pre-eclampsia is giving birth, although it sometimes gets worse for a while before it gets better. Sometimes pre-eclampsia will develop for the first time after you’ve given birth. So your midwife will continue to measure your blood pressure after you’ve had your baby. Everyone’s different. So when you should have your baby will depend on your health and your baby’s and how far along your pregnancy you are. You might need to have your baby early before you reach the full term of your pregnancy. And you might possibly need to have a caesarean delivery.

Your doctor and midwife will talk this through with you to make a plan. Ask them if you’re unsure about anything or have questions.

Medicines

Your doctor may prescribe you medicines, such as a beta-blocker tablet called labetalol to help reduce your blood pressure. These can’t cure pre-eclampsia, but they may prevent your blood pressure becoming very high, which can cause serious health problems. You might be able to take tablets, but if your blood pressure is very high, you may need medicines through a drip.

If your pre-eclampsia is very severe, your doctor may also give you medicines to prevent fits. An example is a medicine called magnesium sulphate, which is usually given through a drip.

Causes of pre-eclampsia

Doctors don't know the exact reasons why some women get pre-eclampsia. But it seems to start with a problem with the placenta. It doesn’t develop properly, which means there’s a reduced blood supply to it.

Some things are thought to increase your risk of getting pre-eclampsia. You might be more likely to get pre-eclampsia if:

  • this is your first baby
  • you have a close family history of pre-eclampsia – if your mother or sister had pre-eclampsia, you’re more likely to develop it
  • it’s been 10 years or more since you last had a baby
  • you're having more than one baby (twins or triplets for example)
  • you're over 35
  • you have other health conditions, such as high blood pressure, diabetes and kidney disease
  • you're very overweight

You’re also more likely to get pre-eclampsia if you’ve had it in a previous pregnancy, but it should be milder than the first time. And you might not necessarily get it again – many women who have had pre-eclampsia before go on to have a normal, healthy pregnancy. But it’s important to let your midwife and GP know if you’ve had pre-eclampsia before as they’ll want to monitor you more closely. Make sure you attend all your antenatal appointments and have your blood pressure checked regularly.

Complications of pre-eclampsia

If you don’t get treatment for pre-eclampsia, it may develop into a condition called eclampsia. This happens in one in every 4,000 pregnancies. It can develop at any time during the second half of your pregnancy, during labour or soon after you give birth.

Eclampsia means you have fits (seizures) as a result of pre-eclampsia, which look similar to epileptic fits. If a fit goes on for a long time, both you and your baby can struggle to get enough oxygen. This can potentially be life-threatening for you and your baby, but your hospital team will do everything they can to prevent this happening. They’ll give you a medicine called magnesium sulphate to prevent you having fits. And your doctor will aim to deliver your baby before eclampsia develops.

Severe pre-eclampsia can also lead to liver, kidney and lung failure and problems with how your blood clots. A combination of all of these serious health problems is called HELLP syndrome. This can also be life-threatening and the only treatment is for you to give birth. This might mean you have to have your baby early. Your doctor or midwife will support you through this decision and make sure you and your baby get the right treatment.

Prevention of pre-eclampsia

If you’re at high risk of developing pre-eclampsia, your doctor may suggest you take aspirin every day. This helps to improve the blood supply to your placenta. You’ll usually need to take it from 12 weeks of pregnancy until your baby is born, but only take it if your doctor has advised you to. To find out if you’re at high risk of pre-eclampsia, see Causes of pre-eclampsia.

It may also help to get some exercise and to lose any excess weight, but talk to your doctor about how to do this safely. For our tips on exercising while pregnant, see Related information.

Frequently asked questions

  • You’ll probably need to stay in hospital for a few days after you have given birth. Doctors and nurses will closely monitor your blood pressure and symptoms during this time. You’ll then usually be given an appointment to see your GP or an obstetrician between six and eight weeks later. An obstetrician is a doctor who specialises in pregnancy and childbirth.

    More information

    If you had pre-eclampsia during your pregnancy, you can still get complications after your baby is born. That’s why you’ll need to stay in hospital until your blood pressure is down and you’re well enough to go home, which can take a few days. You might need to carry on taking medicines to treat high blood pressure too.

    While you’re in hospital, your midwives and doctors will check your blood pressure often. If you have any symptoms, such as a headache or tummy pain, tell your midwife or doctor. And if you develop symptoms when you get home, tell your midwife or GP straightaway. If you get pre-eclampsia after you give birth, it will usually be within three days. But it can it be as late as four to six weeks after your baby is born.

    If your blood pressure is still high six weeks after your baby is born, or there’s still protein in your urine, you might need to see a specialist.

  • Most women and babies don’t have any long-term health problems after pre-eclampsia. But it may increase your risk of developing high blood pressure in the future.

    You might be more likely to get cardiovascular disease in later life if you’ve had pre-eclampsia. It’s also possible you might get some long-term damage to your kidneys but this isn’t common.

    Most babies and children don’t have any future health problems if you had pre-eclampsia. But if your baby was born very early because of pre-eclampsia, or didn’t get enough oxygen because of it, there might be some problems. For more information, talk to your midwife and doctor. They’ll make sure you and your baby get the right treatment.

  • No, it’s best not to fly because of the risks to you and your baby. Talk these through with your doctor or midwife.

    If you have pre-eclampsia, it can increase your risk of getting a blood clot (deep vein thrombosis – DVT) when you travel.

    You can usually travel safely by air when you’re pregnant, although most airlines won’t let you travel if you’re later on in your pregnancy. You’ll need to get a letter from your GP or midwife if you’re past 28 weeks to state that everything is normal. And once you get to 37 weeks you won’t be able to fly at all (or 32 weeks if you’re having twins). But if you have pre-eclampsia, you shouldn’t fly because of the extra risk involved. And you’ll also need to be at home to attend your appointments with your doctor who will want to monitor your condition.

    It’s important to think about the risk of DVT, and to hold off on travelling until after you’ve had your baby. If you can’t delay your trip, talk to your doctor and give your airline a call before you buy your ticket.


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Related information

    • PLGF-based testing to help diagnose suspected pre-eclampsia (Triage PLGF test, Elecsys immunoassay sFlt-1/PLGF ratio, DELFIA Xpress PLGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PLGF plus Kryptor PE ratio. National Institute for Health and Care Excellence (NICE), 11 May 2016. www.nice.org.uk
    • Hypertension in pregnancy: diagnosis and management. National Institute for Health and Care Excellence (NICE), 25 August 2010. www.nice.org.uk
    • Pre-eclampsia. BMJ Best Practice. bestpractice.bmj.com, last updated 6 December 2016
    • Preeclampsia. Medscape. emedicine.medscape.com, updated 15 September 2016
    • A low-lying placenta (placenta praevia) after 20 weeks. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published December 2011
    • Personal communication, Dr Evelyn Ferguson, Consultant Obstetrician Gynaecologist, and Medical Director at ABC 4D baby scan clinics, 28 December 2016
    • Pre-eclampsia. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2012
    • Hypertension in pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Preeclampsia and high blood pressure during pregnancy. American College of Obstetricians and Gynecologists. www.acog.org, published September 2014
    • Grivell RM, Alfirevic Z, Gyte GML, et al. Antenatal cardiotocography for fetal assessment. Cochrane Database of Systematic Reviews 2015, Issue 9. doi: 10.1002/14651858.CD007863.pub4
    • Kilby MD, Bricker L. Management of monochorionic twin pregnancy. BJOG 2016; 124:e1–e45. doi: 10.1111/1471-0528.14188
    • Q&A. Action on Pre-Eclampsia. www.action-on-pre-eclampsia.org.uk, accessed 7 December 2016
    • Eclampsia. Medscape. emedicine.medscape.com, updated 7 July 2016
    • HELLP syndrome. PatientPlus. patient.info/patientplus, last checked 25 May 2016
    • Map of Medicine. Postnatal care. International view. London: Map of Medicine; 2016 (issue 4)
    • Izadi M, Alemzadeh-Ansari MJ, Kazemisaleh D, et al. Do pregnant women have a higher risk for venous thromboembolism following air travel? Adv Biomed Res 2015; 4:60. doi: 10.4103/2277-9175.151879
    • International travel and health. World Health Organization. www.who.int, accessed 12 December 2016
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, January 2017
    Expert reviewer Dr Evelyn Ferguson, Consultant Obstetrician Gynaecologist
    Next review due January 2020



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