Pre-Eclampsia

Pre-eclampsia is a multi-organ pregnancy disorder that is thought to originate with improper implantation of the placenta. The first sign of this is high blood pressure after 20 weeks of pregnancy, which is why your midwife will take you blood pressure at each appointment, particularly after 20 weeks.

Most people have pre-eclampsia picked up in its early stages by their midwife, but the symptoms to watch for are detailed at this link. They include a severe headache, sudden severe swelling of the hands and face, pain in your upper abdomen, reduced foetal movements, and feeling unwell or nausea in your late second and third trimesters.

Pre-eclampsia affects between 3-8% of all pregnancies. You are more at risk of having pre-eclampsia if:

you have had it before
your mother or sisters have had it
you are under 18 or over 40 when you become pregnant
you already have high blood pressure
you are carrying multiple babies
you conceived via assisted reproduction (IVF, IUI etc)
this is your first baby or first baby with a new partner
you are overweight
you have an autoimmune disorder
and more

There’s a long list of risk factors, and many of them are not things you can change!

Risk factors do not mean that you will develop pre-eclampsia though – they just mean that you are a bit more likely to have it. If you have major risk factors, you may be prescribed medication to help prevent pre-eclampsia from developing. Not having risk factors also does not mean that you will not develop pre-eclampsia – it is possible to be in a low risk group and still develop it.

If you do develop pre-eclampsia, don’t blame yourself! We still don’t know exactly what causes it, and prevention is not an exact science.

If you have pre-eclampsia, it can have some serious effects on your pregnancy. It increases your risk of stroke, kidney and liver damage, blood clotting problems, and placental abruption. If left untreated, pre-eclampsia can also develop into eclampsia, which is seizures caused by the high blood pressure of pre-eclampsia. Pre-eclampsia can also develop into HELLP syndrome, which stands for haemolysis, elevated liver enzymes, and low platelets. HELLP is a serious complication that needs urgent treatment.

Pre-eclampsia can also affect your baby, increasing their chances of low birth weight, stillbirth, and premature birth (sometimes because you go into labour early, sometimes because of medical advice to have them born early for their and your safety).

Pre-eclampsia is serious and needs immediate obstetric consultation if your midwife suspects you might have it. You may be asked to have some blood and urine tests on your way to the hospital for assessment, or you may be sent directly to the hospital where they will run these tests.

Pre-eclampsia can only be treated by taking out the organ that’s causing the problems – the placenta. Therefore, if you have pre-eclampsia, the definitive treatment is to have your baby. If you develop pre-eclampsia, then you will be referred to the obstetric team for tests and treatment. They may admit you to hospital to monitor your blood pressure and try to lower it with medication to give your baby more time inside, or they may decide to help you have your baby immediately, depending on how severe it is and how far along you are. The obstetric team will make a plan with you at the time that is customised to your needs.

The obstetric plan will include timing and method of birthing. You may be able to have a vaginal birth, usually via induction, or you may have a caesarean birth recommended by the obstetric team. They will take into account the severity of your pre-eclampsia, your gestation, and the health of both you and your baby when they make this recommendation. It will be recommended that you birth in hospital so they can monitor you closely.

If you are under 34 weeks’ gestation, then the obstetric team may recommend steroid injections for you to help prepare your baby’s lungs for early birth. This is a series of two injections, usually 12-24 hours apart, and they will usually try to prolong your pregnancy for those 24 hours to give baby the best chance at breathing well after birth.

If you have severe pre-eclampsia, you may be on a magnesium sulphate drip to help prevent eclampsia (seizures). This medication can cross the placenta and helps protect your baby’s brain if they need to be born early. If you are put on this medication it usually means that you need to have your baby within 24 hours as you are very unwell.

After your baby is born, pre-eclampsia usually goes away. It may get worse straight after the birth though, so you will usually need to stay in hospital for a few days to make sure your blood pressure is coming down. You may be discharged still on medication if your blood pressure remains high, and may be followed up by a specialist if so. If you are not followed up by a specialist, you should follow up with your GP.

Having pre-eclampsia makes you more likely to get cardiovascular disease (heart and blood circulation problems) or have a stroke in the future.

For more information