Pre-eclampsia

A condition that affects some pregnant women/birthing people, usually during the second half of pregnancy – from 20 weeks or soon after the baby is delivered. It is believed to be a condition cause by problems with the placental development and its function.

Early Signs of Pre-eclampsia:

High blood pressure (BP) otherwise known as hypertension and protein in your urine, known as proteinuria.

So, pre-eclampsia may be defined as “new hypertension presenting after 20 weeks with significant proteinuria” in its simplest term.

High BP in pregnancy is considered ≥140mmHg / 90 mmHg.

It is unlikely you’ll notice these signs, but they will be picked up at your routine antenatal appointments where the midwife will routinely check your BP and check your urine. If in the instance your BP is high and you have protein in your urine, you will be invited to the Jane Crookall Maternity Ward (JCMW) for further monitoring. This will usually include maternal and foetal observations as well as some blood tests and a BP profile (this is where the midwife will check your BP multiple times).

In some cases, further symptoms can develop which you may notice, these include:

• Severe/frontal headache that does not go away despite taking paracetamol

• Visual disturbances – blurred vision or flashing

• Upper epigastric pain – pain just below your ribs (upper right region)

• Vomiting

• Sudden localised swelling to hands, feet, face, ankles.

If you notice any of the above symptoms, seek medical advice immediately by calling the JCMW 650030 and speak to a midwife.

This condition can lead to serious complications for both the mother and baby if it is not monitored and treated.

The earlier pre-eclampsia is diagnosed and monitored, the better the outlook and reduced risks of complications.

Who is Affected?

Pre-eclampsia can happen to any pregnant woman/birthing person (approximately 3-4% of pregnancies) but there are certain risk factors which may increase your chances, these include:

• Diabetes (type I, II or gestational diabetes mellitus (GDM)

• High blood pressure

• Kidney disease

• Autoimmune conditions such as lupus or antiphospholipid syndrome

• First pregnancy

• Ethnicity – black women/birthing people are three times more likely develop pre-eclampsia than white people.

• Family history

• >40 years of age

• 10 years since your last pregnancy

• Body mass index (BMI) ≥ 35

• Multiple pregnancy (twins or triplets)

If you are thought to be high risk for developing pre-eclampsia (this will be determined at your booking appointment) you will be advised to take 75 to 150 mg daily dose of aspirin from the 12th week of your pregnancy.

Signs in the Unborn Baby:

The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby so women/birthing people at high risk of pre-eclampsia will be offered regular ultrasounds for foetal growth, amniotic fluid volume and umbilical artery doppler velocimetry (checking the flow of oxygenated blood from mother to baby through the umbilical cord).

With pre-eclampsia, the growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intra-uterine or foetal growth restriction.

If your baby is growing more slowly than usual, this will normally be picked up during your antenatal appointments, when the midwife measures your abdomen.

Treating Pre-eclampsia:

If you are diagnosed with pre-eclampsia, you should be referred for an assessment by a specialist doctor in hospital.

While in hospital, you'll be monitored closely to determine how severe the condition is and whether a hospital stay is needed. You may be able to return home afterwards and attend regular (possibly daily) follow-up appointments.

The only way to cure pre-eclampsia is to deliver the baby, so you'll usually be monitored regularly until it's possible for your baby to be delivered.

This will normally be at around 37 to 38 weeks of pregnancy, but it may be earlier in more severe cases.

At this point, labour may be started artificially (induction of labour), or you may have a caesarean section.

You'll be offered medicine to lower your BP. These medicines reduce the likelihood of serious complications, such as stroke. Some of the medicines used regularly in the UK include labetalol or nifedipine.

After the Delivery:

Although pre-eclampsia usually improves soon after your baby is born, complications can sometimes develop a few days later. You may need to stay in hospital after the birth so you can be monitored.

Your blood pressure will be measured regularly, and you may be offered medicine if it gets too high, if you are not taking medicine already.

Your baby may also need to be monitored and stay in a hospital neonatal intensive care unit if they're born prematurely.

Once it's safe to do so, you'll be able to take your baby home.

You'll usually need to have your blood pressure checked regularly after leaving hospital, and you may need to continue taking medicine to lower your blood pressure for several weeks.

Your community midwife will work closely with the specialist doctors to ensure your treatment is working. They will monitor to see whether your treatment needs to be changed or stopped.