WHAT YOU NEED TO KNOW ABOUT PRE-ECLAMPSIA

What is pre-eclampsia?

Pre-eclampsia is a serious medical condition that develops during pregnancy. Women with pre-eclampsia often have high blood pressure (hypertension) and high levels of protein in the urine (proteinuria). Pre-eclampsia usually develops after the 20th week of pregnancy. It can also affect other organs in the body and can be dangerous for both the mother and the developing baby. Because of these risks, pre-eclampsia must be managed promptly by a healthcare provider.

What happens in pre-eclampsia?

When you have pre-eclampsia, your blood pressure rises (above 140/90 mmHg) and you may have high levels of protein in your urine. Pre-eclampsia puts strain on the heart and other organs and can cause serious complications. It can also affect the blood supply to the placenta, affect liver and kidney function, or cause fluid to build up in the lungs. Protein in the urine is a sign of kidney dysfunction.

How common is pre-eclampsia?

Pre-eclampsia is a condition that occurs during pregnancy and complicates up to 8% of all births worldwide.

Who can get pre-eclampsia?

Pre-eclampsia tends to be more common in first pregnancies. However, it is not clear why some women develop pre-eclampsia. Some factors that may put you at higher risk are:

• A history of high blood pressure, kidney disease or diabetes
• Multiple pregnancy
• A family history of pre-eclampsia
• Autoimmune diseases
• Obesity

What are the symptoms?

Many women with pre-eclampsia have no symptoms. For those who do, some of the first signs of pre-eclampsia are high blood pressure, protein in the urine and fluid retention (which can cause weight gain and swelling). Other signs of pre-eclampsia include:

• Headaches
• Blurred vision or sensitivity to light
• Dark spots appearing in your vision
• Abdominal pain on the right side
• Swelling of the hands and face (oedema)
• Difficulty breathing

It is essential to tell your gynaecologist about all the symptoms you have during your pregnancy. Many women do not know they have pre-eclampsia until their blood pressure and/or urine is checked at an antenatal appointment. Severe pre-eclampsia can include symptoms such as:

• Hypertensive emergency (blood pressure of 160/110 mmHg or higher)
• Reduced kidney or liver function
• Fluid in the lungs
• Low platelet levels in the blood (thrombocytopenia)
• Reduced urine output

If your pre-eclampsia is severe, you may be admitted to hospital for closer monitoring, or you may need to give birth to your baby as soon as possible. Your obstetrician may give you medication for high blood pressure or to help the baby's lungs develop before birth.

What causes pre-eclampsia?

As mentioned, there is currently no established cause for the development of pre-eclampsia. It is believed, however, to originate from a problem with the placenta (the organ that develops in the uterus during pregnancy and is responsible for supplying oxygen and nutrients to the baby). The blood supply to the placenta may be reduced in pre-eclampsia, and this can lead to problems for both the pregnant woman and the baby.

Can stress cause pre-eclampsia?

While stress can affect blood pressure, it is not one of the direct causes of pre-eclampsia. Although some stress is unavoidable during pregnancy, it is a good idea to avoid high-stress situations or to develop stress-management techniques.

In which week of pregnancy does pre-eclampsia start?

Pre-eclampsia usually appears after 20 weeks of pregnancy, but it can also appear earlier. Most pre-eclampsia occurs at around 37 weeks of gestation. Pre-eclampsia can also occur after birth (postpartum pre-eclampsia), usually between the first few days and one week after delivery. In rare cases, it begins weeks after delivery.

Will pre-eclampsia affect my baby?

Pre-eclampsia can cause preterm birth. Premature babies are at increased risk of health complications such as low birth weight and breathing problems.

How is it diagnosed?

Pre-eclampsia is often diagnosed at routine antenatal appointments, when the gynaecologist checks your weight gain, blood pressure and urine. If pre-eclampsia is suspected, your healthcare provider may: → Order additional blood tests to check kidney and liver function. → Suggest a 24-hour urine collection to monitor proteinuria. → Perform an ultrasound scan and other fetal monitoring to check the size of the baby and assess the volume of amniotic fluid. Pre-eclampsia can be classified as mild or severe. You may be diagnosed with mild pre-eclampsia if you have high blood pressure plus high levels of protein in your urine. You are diagnosed with severe pre-eclampsia if you have the symptoms of mild pre-eclampsia plus:

• Signs of kidney or liver damage (seen in blood tests)
• A low platelet count
• Fluid in the lungs
• Headaches and dizziness
• Impaired vision or seeing spots

How is pre-eclampsia managed?

Your gynaecologist will advise you on the best way to manage pre-eclampsia. Treatment generally depends on how severe the pre-eclampsia is and how far along you are in your pregnancy. If you are close to term (37 weeks pregnant or more), your baby will probably be delivered early. You may still be able to have a vaginal birth, but a caesarean section is sometimes recommended. Your healthcare provider may give you medication to help the baby's lungs develop and to manage your blood pressure until the baby is born. Sometimes it is safer to deliver the baby early than to risk prolonging the pregnancy. When pre-eclampsia develops earlier in pregnancy, you will be closely monitored in an effort to prolong the pregnancy and allow the baby to grow. You will have more antenatal appointments, including ultrasound scans, urine tests and blood tests. You may be asked to check your blood pressure at home. If you are diagnosed with severe pre-eclampsia, you may stay in hospital until your baby is born. If the pre-eclampsia worsens or becomes more severe, your baby will need to be delivered. During labour and after delivery, people with pre-eclampsia are often given magnesium intravenously to prevent the development of eclampsia (seizures caused by pre-eclampsia).

Is there a cure for pre-eclampsia?

No, there is no established cure for pre-eclampsia. Pre-eclampsia can only be resolved by delivery. Your healthcare provider will still want to monitor you for several weeks after delivery to make sure your symptoms go away.

Prevention – How can I reduce my risk of pre-eclampsia?

For people with risk factors, there are some steps that can be taken before and during pregnancy to reduce the chance of developing pre-eclampsia. These steps may include:

• Losing weight if you are overweight/obese (before the weight gain associated with pregnancy)
• Controlling your blood pressure and blood sugar (if you had high blood pressure or diabetes before pregnancy).
• Keeping up a regular exercise routine
• Getting enough sleep
• Eating healthy foods low in salt and avoiding caffeine

What are the most common complications of pre-eclampsia?

If left untreated, pre-eclampsia can be potentially fatal for both you and your baby. Before delivery, the most common complications are preterm birth, low birth weight or placental abruption. Pre-eclampsia can cause HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count). This happens when pre-eclampsia damages the liver and red blood cells and interferes with blood clotting. Other signs of HELLP syndrome are blurred vision, chest pain, headaches and nosebleeds. After you have given birth, you may be at increased risk of:

• Kidney disease
• Heart attack
• Stroke
• Developing pre-eclampsia in future pregnancies

Does pre-eclampsia go away after delivery?

Pre-eclampsia usually resolves within days to weeks after delivery. Sometimes your blood pressure may stay high for a few weeks after birth, requiring treatment with medication. Your healthcare provider will work with you after your pregnancy to manage your blood pressure. People with pre-eclampsia — especially those who develop the condition early in pregnancy — are at greater risk of high blood pressure (hypertension) and heart disease later in life. Knowing this, they can work with their primary care provider to take steps to reduce these risks.

What is postpartum pre-eclampsia?

Postpartum pre-eclampsia is when you develop pre-eclampsia after your baby is born. It usually happens within two days of delivery, but it can also develop several weeks later. The signs of postpartum pre-eclampsia are similar to those of pre-eclampsia and include swelling of the limbs, headaches, seeing spots, stomach pain and nausea. It is a serious condition that can cause seizures, stroke and organ damage.

What is the difference between pre-eclampsia and eclampsia?

Eclampsia is severe pre-eclampsia that causes seizures. It is considered a complication of pre-eclampsia, but it can occur without signs of pre-eclampsia. In rare cases, it can lead to coma, stroke or death.

In summary

Pre-eclampsia is a serious condition that you may not even know you have. It is important to keep all your antenatal appointments and to be open about any symptoms you experience during pregnancy. When pre-eclampsia is diagnosed early, it can be managed, and both you and your baby can be kept safe and healthy. Most women with pre-eclampsia go on to have healthy babies.