Pre-eclampsia

Pre-eclampsia is a condition 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 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. 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 mean you have pre-eclampsia, although it increases your risk of getting it as your pregnancy progresses.

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

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

• headache – usually at the front of your head (which are not relieved by painkillers)
• problems with your vision, such as flashing lights and blurred vision
• abdominal (tummy) pain – usually on the right, just below your ribs
• feeling or being sick
• feeling confused
• feeling very unwell
• shortness of breath
• sudden swelling of your hands, face or feet
• not going to the toilet much

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

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

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 after 20 weeks of being pregnant, and you have protein in your urine, you’ll be referred 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 have a placental growth factor (PIGF)- based test. PGIF is a hormone that helps new blood vessels to grow in the placenta and if this is very low, it suggests that 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.

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.

Certain factors 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 or your first baby with a new partner
• It’s been 10 years or more since you last had a 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
• you're having twins or other multiple pregnancies
• you're over 35
• 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

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.

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.

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.

If you don’t get the right 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 can cause 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 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 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 that you have to have your baby early, which can cause other health problems for your baby.

There is nothing specific that you can do yourself in order 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 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.

It may also help to get some exercise and lose any excess weight, but talk to your doctor about how to do this safely.

1. 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.

2. 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.

3. 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.

4. Can I fly if I have pre-eclampsia?

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

Explanation
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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Further information

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

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