Pre-eclampsia

What is pre-eclampsia?

Pre-eclampsia is thought to happen when the placenta isn’t working properly (NHS 2015). It can make you and your baby quite ill if you don’t receive the treatment you need.

Pre-eclampsia causes the flow of blood to the placenta to be reduced. This means that your baby may not get enough oxygen and nutrients, which may restrict his growth (NHS 2015).

Pre-eclampsia usually happens in the second half of pregnancy, or shortly after the birth (NCCWCH 2010, NHS 2015, 2018, RCOG 2012). You’re most likely to develop it after 20 weeks, although it can happen earlier than this (SOMANZ 2014).

What are the symptoms of pre-eclampsia?

Many women with pre-eclampsia don’t realise they have it until it’s picked up during a routine antenatal appointment (RCOG 2012). This is because the two most common signs of pre-eclampsia aren’t easy to identify at home. They are:

• high blood pressure
• protein in your urine
  (NCCWCH 2008, NHS 2015)

Your midwife or doctor will measure your blood pressure at every antenatal appointment throughout your pregnancy (RANZCOG 2016). She’ll test your urine at your first appointment, and may do so at subsequent appointments (RANZCOG 2016), especially if your blood pressure seems to be higher than usual (SOMANZ 2014).

But there are certain signs and symptoms of pre-eclampsia that you should be aware of. If you notice any of the following symptoms, contact your doctor, midwife or maternity unit straight away:

• severe headache
• problems with your vision, such as blurring or flashing before your eyes
• severe pain just below your ribs
• nausea or vomiting
• severe heartburn
• sudden, severe swelling of your face, hands or feet
  (NCCWCH 2010, NHS 2015)

Pre-eclampsia can range from mild to severe. If it’s mild, you may not even know you have it until your midwife or doctor picks up the signs. Early monitoring and treatment will help keep you and your baby well.

Am I likely to get pre-eclampsia?

Pre-eclampsia affects about three pregnant women in every 100 in Australia (DH 2018, RANZCOG 2017). Severe pre-eclampsia is, thankfully, much less common. Around one in 200 women develop it during their pregnancy (Gain 2012, RCOG 2012).

You're much more likely to develop pre-eclampsia if you:

• Had high blood pressure in a previous pregnancy. About one mum in six who has had pre-eclampsia gets it again.
• Have chronic kidney disease.
• Have an autoimmune condition, such as lupus.
• Have either Type 1 or Type 2 diabetes.
• Had high blood pressure before you were pregnant.
  (NCCWCH 2010)

If any of these apply to you, your doctor may recommend that you take a daily low dose of aspirin from the time you find out you’re pregnant until 36 weeks of pregnancy (NCCWCH 2010). Only take aspirin if your doctor recommends it, though, as it isn’t safe for all pregnant women.

You may also be offered extra antenatal appointments to check your baby’s growth (NCCWCH 2010). Your doctor or midwife may also offer you cardiotocograph (CTG) monitoring, if she’s concerned about your baby’s wellbeing (NCCWCH 2010). This is a type of Doppler scan that lets your caregiver monitor your baby’s heartbeat.

You have a moderately increased risk of developing pre-eclampsia if:

• This is your first pregnancy.
• You’re 40 or older.
• You had a gap between pregnancies of 10 years or more.
• You were obese before you became pregnant, with a body mass index (BMI) of 35 or more at the start of your pregnancy.
• Your mum or sister had pre-eclampsia.
• You’re expecting twins or triplets.
  (NCCWCH 2010, RCOG 2012)

If two or more of these apply to you, your doctor may recommend that you take a daily low dose of aspirin from when you find out you’re pregnant until 36 weeks of pregnancy (NCCWCH 2010, RCOG 2012). Don’t take aspirin without discussing it with your doctor, though, as aspirin isn’t safe for all pregnant women.

If you’ve become pregnant using a donated egg, you may also have a higher risk of developing pre-eclampsia (Blázquez et al 2016, Masoudian et al 2016). Talk to your midwife or doctor about your options for extra appointments.

How can I prevent pre-eclampsia?

There’s no guaranteed way to prevent pre-eclampsia. The best approach is to attend all your antenatal appointments and take any medication that’s been prescribed for you, even if you feel well. If you have to cancel your appointment for any reason, reschedule as soon as possible.

Every time your doctor or midwife tests your urine for protein, and measures your blood pressure, she’s checking for early signs of pre-eclampsia (NCCWCH 2008, NHS 2015).

It’s a good idea to familiarise yourself with the symptoms of pre-eclampsia, so you’ll know when to seek immediate help.

Research has shown that calcium supplements can lower the risk of pre-eclampsia in women with low-calcium diets (Hofmeyer et al 2014, Mackillop 2015, WHO 2016), so talk to your doctor or midwife to see if she thinks you may benefit.

How is pre-eclampsia treated?

If you’re diagnosed with pre-eclampsia, you should be admitted to hospital so you can be monitored (NCCWCH 2010, RCOG 2012).

Mild pre-eclampsia
You’ll have your blood pressure checked at least four times a day and blood tests to check for complications (NCCWCH 2010). Depending on the test results, you may be able to go home and rest, and attend further check-ups as an outpatient (NICE 2015). Or you may need to stay in hospital for longer to be monitored.

Moderate pre-eclampsia
You’ll have your blood pressure checked at least four times a day and take medication to lower your blood pressure. You’ll have blood tests and you may have also have ultrasound scans if you were diagnosed before 34 weeks or if your doctor is concerned about your baby. These will probably include Doppler scans, to measure the flow of blood from the placenta to your baby (NCCWCH 2010).

If your baby is well, and your condition improves over the following days, you may be able to go home before your baby is born (NICE 2015). Your doctor will probably advise you to have your baby at about 37 weeks, or earlier if there are concerns about your health or your baby’s health. She may offer you an induction, which means starting your labour artificially.

If you’re having a planned caesarean, your doctor may recommend that you have it earlier than planned (RCOG 2012). If you’re already past 37 weeks, your doctor is likely to recommend you give birth within 24 or 48 hours (NCCWCH 2010).

Severe pre-eclampsia
You’ll need to stay in hospital if you have severe pre-eclampsia, so you can be monitored closely. You’ll have blood pressure, urine and blood tests at least four times a day, as well as medication to control your blood pressure (NCCWCH 2010).

Your baby will also be carefully checked. Doctors will monitor his growth and wellbeing via scans, and his heart rate will measured (NCCWCH 2010).

Your medical team’s top priority is to stop you developing complications. So your fluid levels will be controlled, and you may be put on a drip that contains magnesium sulfate (Gain 2012, NCCWCH 2010, RCOG 2012). Magnesium sulfate will lower your risk of developing eclampsia. Sometimes, severe pre-eclampsia can cause fits, and magnesium sulfate can help prevent that happening (Duley et al 2010, Gain 2012, NCCWCH 2010).

If your blood pressure can’t be controlled, and your doctor is concerned about your baby’s wellbeing, your baby may need to be born earlier than expected (NCCWCH 2010). Your doctor will look at your circumstances and your baby's medical needs, and explain all your options. She may recommend you have your labour induced, or have your baby by caesarean section.

Even if your baby has to be born early, he’s likely to be fine. Every case of pre-eclampsia is different. So a lot will depend on how early he was born, and how much he weighed when he was born. If he’s smaller than expected, he may need to be monitored more closely, in a special care baby unit (SCBU).

Can pre-eclampsia lead to any other complications?

If pre-eclampsia goes from mild to severe, it starts to affect other systems of your body. This means you may get more serious symptoms, and you may need to go to intensive care or a maternity high-dependency unit (NCCWCH 2010, RCOG 2012).

That’s why it’s so vital to be diagnosed as soon as possible if you have pre-eclampsia. If you aren’t diagnosed, it may result in the following serious complications.

Eclampsia
This is a rare but serious condition that can lead to seizures or convulsions, and can put both you and your baby at great risk (NCCWCH 2010, NHS 2015, NICE 2015, RCOG 2012).

Eclampsia can develop during pregnancy and birth. It can also happen in the first few days after your baby is born (NHS 2015, RCOG 2012, Smith et al 2013), especially if your pre-eclampsia was severe (Smith et al 2013).

Although eclampsia is a severe illness, complications caused by pre-eclampsia only very rarely become serious enough to be life-threatening (Smith et al 2013).

HELLP syndrome
This is a rare liver and blood clotting disorder that can develop before pre-eclampsia has been diagnosed. HELPP stands for:

• H: haemolysis, which means the breaking down of red blood cells
• EL: elevated liver enzymes, which is a sign that your liver isn’t working properly
• LP: low platelet count, which means you may not have enough platelets to allow your blood to clot
  (NICE 2015)

HELLP is most likely to develop after the birth. But it can sometimes develop from mid-pregnancy onwards or, in rare cases, even earlier (NHS 2015).

Other complications
These can include:

• liver and kidney failure
• stroke (cerebral haemorrhage)
• fluid in the lungs (pulmonary oedema)
• blood clotting disorders
  (NHS 2015, NICE 2015)

But your caregiver will be looking out for signs of pre-eclampsia throughout your pregnancy, and you’ll receive swift treatment and care if you do develop symptoms. So it’s very unlikely that you’ll develop any of these problems.

Pre-eclampsia can be treated. It’s important to go to all your antenatal appointments, so it can be picked up and managed as early as possible.

Will I make a full recovery from pre-eclampsia?

You’re very likely to make a full recovery from pre-eclampsia. But you’ll need to rest and recuperate in hospital for a few days after your baby’s birth, so your blood pressure can be monitored and blood tests carried out (NCCWCH 2010, Smith et al 2013).

When you’re allowed home, you should have a care plan that sets out how often your caregiver needs to check your blood pressure (NCCWCH 2010). Depending on the severity of your pre-eclampsia, it may be every day or every other day.

Your blood pressure should return to normal within weeks of giving birth. Routine checks after your baby’s birth may show that you had high blood pressure before you were pregnant (NCCWCH 2010). If this is the case, you may need to continue with treatment for high blood pressure (NCCWCH 2010, Smith et al 2013).

Rarely, serious complications such as eclampsia or HELLP can have long-term effects on your health, such as kidney problems (NCCWCH 2010). But most cases of pre-eclampsia are picked up and treated in time to prevent this.

If you had severe pre-eclampsia or eclampsia, your doctor should explain what happened, and whether or not it may affect your future pregnancies (Bramham et al 2013, NCCWCH 2010, RCOG 2012). One in six women with pre-eclampsia will get it again in a future pregnancy, and the risk rises if your pre-eclampsia was severe (NCCWCH 2010).

Your doctor should offer you extra checks at your six-week postnatal appointment, including a urine test to check for protein (NCCWCH 2010).

Pre-eclampsia puts you at risk of developing high blood pressure, heart disease and related problems in later life, so checking your blood pressure and heart health regularly will be important (NCCWCH 2010). Always ask your doctor or midwife if you have any questions about your treatment.

Where can I find out more about pre-eclampsia?

• Australian Action on Pre-eclampsiaOpens a new window is an organisation that provides support and information for families who have experienced pre-eclampsia.
• PEARLS (Pre-eclampsia Research Laboratories)Opens a new window is based at the Royal Prince Alfred Hospital in Sydney and raises funds to support research into the cause of pre-eclampsia. It also provides information about pre-eclampsia and stories from women who’ve had it.

You may also like:

• Learn more about the link between high blood pressure and pre-eclampsia.
• Have you been pregnant before? Find out if you’re more likely to get pre-eclampsia this time around.
• Discover which other pregnancy symptoms you should never ignore.