Pre Eclampsia

Pre-eclampsia or pregnancy induced hypertension, is thought to occur in 8-10 per cent of pregnancies, and 85 per cent of these are first-time pregnancies.

It is the commonest form of maternal death in the UK, killing around 10 women a year, and also leads to the death of about 1,000 babies a year. Although pre-eclampsia is usually mild, it should always be taken seriously as it can lead to complications. Mild pre-eclampsia affects around 1 in 14 women and usually occurs after the 20th week of pregnancy. This is a good thing because the only cure for pre eclampsia is immediate delivery of the baby, so the later the symptoms develop the better the outcome for you and your baby.

What are the symptoms?
Pre-eclampsia is characterised by high blood pressure, increased swelling of the hands and feet and sometimes face (oedema) and protein in the urine. Other symptoms include persistent headaches, blurred vision, flashing lights and abdominal pain on the right side of the body below the ribcage. Many women suffering from pre-eclampsia feel fine and only learn of the condition when their blood pressure is high.

Another sign of pre eclampsia is the slower growth of your baby because of poor blood supply from the placenta to the baby. Your baby may be classed as 'small for dates' if this happens, but being small for dates does not always indicate pre eclampsia.

If you notice any of the following tell your midwife immediately:
- High blood pressure (your midwife or GP will check this)
- Protein in your urine (your midwife or GP will check this)
- Fluid retention
- Severe headaches
- Flashing lights or blurred vision
- Pain in your upper abdomen
- Vomiting
- Sudden swelling of your hands, feet ankles and face

Am I at risk?
Pre-eclampsia can affect anyone, but those more at risk are mothers over 40, teenage mothers, or those who have diabetes, a history of blood pressure problems, kidney or rheumatology problems. You are also more at risk if this is your first pregnancy, you've had a long interval between pregnancies (such as ten years), you had pre eclampsia in a previous pregnancy (around 20 per cent of women who develop pre eclampsia in pregnancy will develop it again in subsequent pregnancies),
You are obese or expecting twins or multiples.

Why does pre-eclampsia happen?
The causes of pre-eclampsia are uncertain, but research suggests it may be linked to an immune reaction to the foetus or the placenta. Pre-eclampsia is often hereditary so ask your mum if she had any of the classic symptoms. Bear in mind that when your mother or grandmother had their babies, pre eclampsia was not as widely researched or known about so they may have had symptoms but never been diagnosed.

What is the treatment?  
Mild pre-eclampsia does not always require treatment and with regular check-ups and good antenatal care it can be monitored unless it starts getting worse. Some women are advised to rest or take tablets to reduce their blood pressure to further control the situation, although this won't make the pre eclampsia go away. Giving birth is the only cure and induction or a caesarean may be performed if you are severely affected. Obviously giving birth depends on when you develop pre eclampsia and the later the better, but often mothers who suffer from this condition have to give birth to premature babies.

Is there anything I can do?
Stress causes blood pressure to be raised, so try to eliminate anything too stressful from your life. Eat plenty of fruit and cut down on sodium and fat in your diet and drink lots of water.  Attend every check-up, as your midwife or GP will check your blood pressure and your urine for high levels of protein, so that pre eclampsia can be detected at an early stage. Mention to your midwife if there is someone in your family who suffered from the condition and also if you have excessive swelling of the hands, feet or face.

Read How to have a healthy pregnancy to get some tips on pregnancy health and how to eleviate stress.

Eclampsia
Pre-eclampsia can develop into Eclampsia and affects about 1 in 100 women. It is a rare but serious condition, characterised by seizures and possibly coma. Urgent delivery of the baby is required and the mother will be treated with drugs to stop the seizures. It is most common during the last three months of pregnancy and can be responsible for the deaths of 7-10 mothers and up to 1,000 babies. However, if you attend all your antenatal appointments your midwife will pick up on any of the classic symptoms early to help stop this from happening.

If I do develop pre eclampsia what will happen?
You are likely to be admitted to hospital, probably the early labour ward, where you will be monitored closely. You will have constant blood pressure checks to monitor your blood pressure and you will have to give urine samples for 24 hours to measure the protein levels in your wee. You may also have a blood test, an ultasound scan to check the blood flow from the placenta to your baby and your baby's heart rate will be recorded on a monitor to check the well being of your baby. Some women who show signs of improvement will be sent home and monitored regular through the antenatal clinic. If your symptoms worsen all attempts will be made to manage your symptoms until you reach 37 weeks of pregnancy and your baby can safely be born. Your baby may well end up being delivered early if your pre eclampsia seems to be getting worse.

Delivery usually ends all symptoms of pre eclampsia, although you and your baby and your blood pressure will be monitored very closely in the days after delivery. If you have experienced swelling, it should go down during the week after delivery and you will start to feel like your old self again!

Research into pre eclampsia
A new study published in BJOG: An international Journal of Obstetrics and Gynaecology has shown that the introduction of management guidelines for pre eclampsia has helped to lower the incidence of eclampsia and it's related complications. Other reserch has pointed to the efficacy of magnesium sulphate in routine treatments of pre eclampsia to reduce the risk of convulsions - and have resulted in a significant decrease. New research is being carried out all the time, but it is imperative for women to attend all antenatal check ups and have their blood pressure checked regularly so the early warning signs can be detected.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.