Updated October 2013

Explaining premature birth - risks and causes

Pre-eclampsia and premature birth

Pre-eclampsia is a serious condition that only occurs during pregnancy, typically after 20 weeks. It is a combination of hypertension (high blood pressure) and proteinuria (protein in your urine).

You may not be aware of these things but they will be detected by your GP or midwife during antenatal check-ups. It is one of the reasons why regular antenatal care is so important. 

Sometimes other organs, such as the liver or kidneys can become affected and there can be problems with blood clotting. It can cause problems with the baby’s growth (intrauterine growth restriction/fetal growth restriction).

Pre-eclampsia literally means 'before eclampsia' as it can potentially progress to a more dangerous condition known as eclampsia. Eclampsia can cause fits or convulsions. In severe cases, eclampsia can sometimes cause the death of the mother or the baby. Therefore, it is important to spot the problem early and manage it safely.

Pre-eclampsia is thought to affect between two and eight in 100 women. In most of these cases, it will be a mild case and may have no effect on pregnancy.

Read more about baby growth/development problems/intrauterine growth restriction

Signs and symptoms of pre-eclampsia

Women with mild pre-eclampsia may not show any symptoms, and the condition is usually only discovered during routine antenatal appointments (through standard blood pressure checks and urine samples). The main signs are raised blood pressure combined with the presence of protein in the urine.

If pre-eclampsia gets more severe, more serious symptoms can develop, including:

  • severe headache that doesn’t go away with simple painkillers
  • problems with vision, such as blurring or flashing before the eyes
  • severe pain just below the ribs
  • heartburn that doesn’t go away with antacids
  • swelling of the face, hands or feet
  • vomiting
  • feeling very unwell.

These symptoms are serious and you should seek medical help immediately.

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How common is pre-eclampsia?

Pre-eclampsia is common, affecting between two and eight in 100 women during pregnancy. It is usually mild and normally has very little effect on pregnancy. It develops into a serious illness, severe pre-eclampsia, in a small number of cases. Around one in 200 women (0.5%) develop severe pre-eclampsia. The symptoms tend to occur later on in pregnancy but can also occur for the first time only after birth.

A mild case of high blood pressure that develops during pregnancy is not harmful (especially if there is no extra protein in the urine) and just means that you will have more frequent appointments with the healthcare team.

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Treatment for pre-eclampsia

If your routine blood pressure and urine tests show that you have pre-eclampsia, you will probably be referred to a specialist team at your local hospital. The team may recommend more tests to check for problems with your kidney, liver or blood clotting. You’ll also be monitored by blood tests, and checking your blood pressure and urine.

The team will also check that your baby is growing properly, and will look at the volume of amniotic fluid and the flow of fluids through the umbilical artery,

If you have a mild case of pre-eclampsia, the team may advise you to rest and may give you medicine to lower your blood pressure.

If you have severe pre-eclampsia you may need to have an emergency caesarean.

To read more about pre-eclampsia, click here.

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HELLP Syndrome

HELLP syndrome is a severe form of pre-eclampsia, and is potentially as dangerous as eclampsia  It is most likely to occur immediately after the baby is delivered, but can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks.

Signs include haemolysis (where the red blood cells disintegrate), raised levels of liver enzymes and a low count of platelets (white blood cells).

The main symptoms are:

  • nausea and vomiting
  • pain in your upper abdomen (below the ribs)
  • general feeling of illness and discomfort
  • swelling of the body.

The only way to treat the condition is to deliver the baby as soon as possible.


Sources

NICE (2012) High blood pressure in pregnancy, Understanding NICE guidance, National Institute for Health and Clinical Excellence

RCOG (2006) The Management of Severe Pre-eclampsia/Eclampsia,  Royal College of Obstetricians and Gynaecologists

RCOG (2012) High blood pressure in pregnancy, iNFORMATION FOR YOU, Royal College of Obstetricians and Gynaecologists 

James D, Steer P et al (2011) High risk pregnancy, management options, fourth edition, Elsevier Saunders

NHS Choices (accessed March 2014) http://www.nhs.uk/Conditions/Pre-eclampsia/Pages/Complications.aspx

NICE (2010) Hypertension in pregnancy, The management of hypertensive disorders during pregnancy, National Institute of Health and Clinical Excellence

 


The causes and problems of premature birth

Your premature baby:

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Signs and symptoms

How common is pre-eclampsia

Treatment of pre-eclampsia

HELLP Syndrome



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You may be able to reduce high blood pressure by keeping your BMI in the healthy range. Ideally, you should start this before you become pregnant. Ask your healthcare team for advice.