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).

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

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.

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. They can also occur after the 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.

Risk factors for pre-eclampsia

You are considered higher risk if you have one or more of the following risk factors:

  • this is your first pregnancy
  • you are aged 40 or over
  • your last pregnancy was more than 10 years ago
  • you are very overweight
  • you have a family history of pre-eclampsia
  • you are carrying more than one baby

Your risk of pre-eclampsia is also higher if any of the following apply to you:

  • you had high blood pressure before you became pregnant
  • you had high blood pressure in a previous pregnancy
  • you have chronic kidney disease, diabetes, or a disease that affects the immune system, such as lupus.

Some women are advised to take aspirin from 12 weeks of pregnancy until delivery if they are at higher risk of pre-eclampsia. Check with your doctor whether this advice applies to you.

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 induction of labour or to have an emergency caesarean.

HELLP Syndrome

HELLP syndrome is a complication 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.

The letters in the name HELPP describe the syndrome: ‘H’ is for haemolysis (where the red blood cells disintegrate), ‘EL’ is for raised levels of liver enzymes, and ‘LP’ is for low platelet count (the cells that help blood to clot).

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.

To read more about pre-eclampsia, click here

Sources

  1. NICE (2010) High blood pressure in pregnancy, Information for the public, National Institute for Health and Clinical Excellence, p4 https://www.nice.org.uk/guidance/cg107/resources/high-blood-pressure-in-...

  2. Royal College of Obstetricians and Gynaecologists (2006) The Management of Severe Pre-eclampsia/Eclampsia, p1, http://www.rcog.org.uk/files/rcog-corp/GTG10a230611.pdf

  3. RCOG (2012) Information for you, Pre-eclampsia, Royal College of Obstetricians and Gynaecologists, p1

  4. NHS Choices (Accessed Oct 2016. Next review: 12/02/2017) Pregnancy-induced hypertension and pre-eclampsia http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pre-eclampsia-preg...

  5. James D, Steer P et al (2011) High risk pregnancy, management options, fourth edition, Elsevier Saunders
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Last reviewed on October 5th, 2016. Next review date October 5th, 2019.

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