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Pre-eclampsia

pre eclampsia

Pre-eclampsia is a condition that only occurs during pregnancy. It causes high blood pressure (hypertension) and it also causes protein to leak from your kidneys into your urine. This can be detected by testing your urine for protein. Pre-eclampsia can cause complications for you as the mother, for your baby, or for both of you. The more severe the condition becomes, the greater the risk that complications will develop.

Eclampsia is a type of seizure (a fit or convulsion) which is a life-threatening complication of pregnancy.

Is pre-eclampsia the same as gestational high blood pressure?

No. Many pregnant women develop mild high blood pressure that is not pre-eclampsia. Gestational high blood pressure is new high blood pressure that comes on for the first time after the 20th week of pregnancy. If you have gestational high blood pressure, you do not have protein in your urine when it is tested by your doctor during your pregnancy. With pre-eclampsia, you have high blood pressure plus protein in your urine.

What causes pre-eclampsia and who gets it?

The exact cause is not known. It is probably due to a problem with placenta. It is thought that there are problems with the development of the blood vessels of the placenta in pre-eclampsia and also damage to the placenta in some way. This may affect the transfer of oxygen and nutrients to your baby.

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

  • This is your first pregnancy, or it has been 10 years or more since your last pregnancy.
  • You are aged 40 or more.
  • You are obese (your body mass index (BMI) is 35 or over).
  • You have a pregnancy with twins, triplets, or more.
  • Your mother or sister has had pre-eclampsia.

You have a higher risk of developing pre-eclampsia if:

  • You have had high blood pressure or pre-eclampsia during a previous pregnancy.
  • You have diabetes or chronic (persistent) kidney disease.
  • You had high blood pressure before the pregnancy started.
  • You have antiphospholipid syndrome.
  • You have systemic lupus erythematosus.

How is pre-eclampsia diagnosed?

Your blood pressure becomes high, and You have an abnormal amount of protein in your urine.

High blood pressure (hypertension) means that the pressure of the blood in your artery blood vessels is too high. Normal blood pressure is below 140/90 mm Hg. During pregnancy:

  • Mildly high blood pressure is blood pressure between 140/90 and 149/99 mm Hg.
  • Moderately high blood pressure is blood pressure between 150/100 and 159/109 mm Hg.
  • Severely high blood pressure is blood pressure of 160/110 mm Hg or higher.

Initially, a simple test can be used to check for protein in your urine. During this test, a special stick called a urine dipstick is used. If you are found to have protein in your urine on testing with a dipstick, your doctor may suggest that your urine be collected over a 24-hour period so that the total amount of protein in your urine can be measured.

What are the symptoms of pre-eclampsia?

If pre-eclampsia becomes worse, one or more of the following symptoms may develop. See a doctor or midwife urgently if any of these occur:

  • Severe headaches that do not go away.
  • Problems with your vision, such as blurred vision, flashing lights or spots in front of your eyes.
  • Tummy (abdominal) pain.
  • Vomiting later in your pregnancy (not the morning sickness of early pregnancy).
  • Sudden swelling or puffiness of your hands, face or feet.
  • Not being able to feel your baby move as much.

What are the possible complications of pre-eclampsia?

  • For the mother
  • Liver, kidney, and lung problems.
  • A blood clotting disorder.
  • Bleeding into the brain (a stroke).
  • Severe bleeding from the placenta.
  • HELLP syndrome. This occurs in about 1 in 5 women who have severe pre-eclampsia. HELLP stands for 'haemolysis, elevated liver enzymes and low platelets', which are some of the medical features of this severe form of pre-eclampsia. Haemolysis means that your blood cells start to break down. Elevated liver enzymes means that your liver has become affected. Low platelets means that the number of platelets in your blood is low and you are at risk of serious bleeding problems, as the platelets work to help your blood to clot.

For the baby

Babies of mothers with pre-eclampsia tend to be smaller. There is also an increased risk of premature birth and of stillbirth. Babies are also more likely to develop breathing problems after they are born.

What is the treatment for pre-eclampsia?

You may be admitted to hospital. If you develop new high blood pressure (hypertension) or new protein in your urine, you will also usually be referred for a specialist opinion. You may also be asked to collect your urine over a 24-hour period so that the amount of protein in your urine can be measured.

Giving birth to your baby

The only complete cure for pre-eclampsia is to give birth to your baby. At delivery, your placenta is delivered just after your baby is born. Therefore, what is thought to be the cause of the condition is removed. After the birth, your blood pressure and any other symptoms usually soon settle.

It is common practice to induce your labour if pre-eclampsia occurs late in your pregnancy. A Caesarean section can be done if necessary. The risk to your baby is small if he or she is born just a few weeks early.

Other treatments

  • Medication to reduce your blood pressure.
  • Steroid drugs.
  • Magnesium sulphate. Studies have shown that if mothers with pre-eclampsia are given magnesium sulphate, it roughly halves the risk of them developing eclampsia. Magnesium sulphate is an anticonvulsant (it helps to stop you having a seizure) and it seems to prevent eclampsia much better than other types of anticonvulsants.

What is the risk of developing pre-eclampsia again in a future pregnancy?

If you had pre-eclampsia in your first pregnancy:

  • You have somewhere between a 1 in 2 and a 1 in 8 chance of developing gestational high blood pressure (gestational hypertension) in a future pregnancy.
  • You have about a 1 in 6 chance of developing pre-eclampsia in a future pregnancy.
  • If you had severe pre-eclampsia, HELLP syndrome or eclampsia that meant that your baby had to be delivered before 34 weeks, you have about a 1 in 4 chance of developing pre-eclampsia in a future pregnancy.
  • If you had severe pre-eclampsia, HELLP syndrome or eclampsia that meant that your baby had to be delivered before 28 weeks, you have about a 1 in 2 chance of developing pre-eclampsia in a future pregnancy.

Being obese is a risk factor for pre-eclampsia. If you have had pre-eclampsia in a previous pregnancy and you are planning for another pregnancy but you are overweight or obese, you should try to lose weight before you become pregnant again.


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