High Blood Pressure

Pre-eclampsia

Pregnancy-induced high blood pressure

 Pre-eclampsia

  

Pre-eclampsia

  
What is pre-eclampsia?

Pre-eclampsia means ‘before eclampsia’. It is a condition that only occurs in pregnancy. In some cases, pre-eclampsia may progress to a serious condition known as eclampsia.

Pre-eclampsia is a combination of:
  • raised blood pressure (hypertension) and
  • protein in your urine on testing (proteinuria).
swelling Swelling of the ankles is common in pregnancy and is usually nothing to worry about, but it can be a feature of pre-eclampsia.

Mild pre-eclampsia does not have any symptoms. It is usually picked up at your routine antenatal appointments.

The exact cause of pre-eclampsia is not understood.
However, it is thought that a problem develops with the blood vessels in the placenta, causing it to be underdeveloped. Researchers have discovered that levels of the hormone (activin A) are raised in the bloodstream of women with pre-eclampsia, but the reason for this is unknown.

More serious symptoms may develop as pre-eclampsia progresses and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition
Around one in 200 (0.5%) women develops severe pre-eclampsia. The symptoms tend to occur later on in pregnancy but can occur for the first time after birth.

The symptoms of severe pre-eclampsia include:
  • headaches
  • blurred or altered vision
  • feeling very unwell
  • abdominal pain
  • nausea or vomiting
  • confusion
  • shortness of breath.
Early detection and care can make a big difference in the course of pre-eclampsia. These symptoms are serious and you should seek medical help immediately. If you are in any doubt, contact your Doctor, midwife, health care provider or the delivery unit at your local hospital.
 
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Who gets pre-eclampsia?

  
Any pregnant woman can develop pre-eclampsia. It occurs in about 1 in 14 pregnancies. However, you have an increased risk of developing pre-eclampsia if you:
  • Are pregnant for the first time, or are pregnant for the first time by a new partner. About 1 in 30 women develop pre-eclampsia in their first pregnancy.
  • If you are a mother who has had a long interval between pregnancies, usually more than 10 years apart.
  • Have had pre-eclampsia before - roughly 20% of women with pre-eclampsia will develop the condition again in later pregnancies.
  • Have a family history of pre-eclampsia. Particularly if it occurred in your mother or sister.
  • Had high blood pressure before the pregnancy started.
  • Have diabetes or chronic (persistent) kidney disease.
  • Are aged below 20 or above 35.
  • Have a pregnancy with twins, triplets, or more.
  • Are obese at the start of your pregnancy, with a BMI of 35 or more.
 
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How is pre-eclampsia detected?

  
Hypertension (high blood pressure)

Unless her blood pressure is very high, a woman will not be aware that it has increased. As a general rule a blood pressure greater than 140/90mmHg in pregnancy is considered to be raised.

Very high blood pressure (greater than 170/110mmHg)

Often accompanied by headaches and the appearance of flashing lights before the eyes. Measuring a woman's blood pressure is an essential part of any antenatal clinic visit.

Protein in the urine

This is detected by your doctor or midwife by using a special stick to dip into a clean sample of urine. There are other causes of proteinuria but pre-eclampsia is the cause with most significance for the mother and foetus.

Sudden or insidious weight gain with swollen hands, feet, face or other parts of the body

Some swelling is normal in pregnancy but it should prompt a woman to have her blood pressure and urine checked.

Pain in the right upper abdomen

May indicate involvement of the liver, which in severe cases can be complicated by an imbalance of the coagulation system that causes an increased or decreased ability of the blood to clot.

Headaches, fatigue, and pains in the upper abdomen

These are all symptoms of the more severe stage of the condition.

Pre-eclampsia is often subdivided into mild, moderate and severe depending on the level of blood pressure and the involvement of other organs in the disease process. In the worst cases, pre-eclampsia can develop into eclampsia, a situation where the mother has a convulsion.

Fortunately, eclampsia is rare, but this is largely because women with pre-eclampsia are usually detected and treated before eclampsia can develop.

All the symptoms will disappear after the delivery and normally the blood pressure and protein level in the urine will be back to normal after a maximum of two weeks.
Pre-eclampsia can develop anytime after 20 weeks of pregnancy. Pre-eclampsia is present if:
  • your blood pressure becomes high, and
  • you have an abnormal amount of protein in your urine.
 
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Symptoms of pre-eclampsia and how does it progress?

  
There are no symptoms in the early stages of pre-eclampsia, and it can only be detected by regular antenatal check-ups. It is natural for many women to experience increased blood pressure during their pregnancy, but this alone is not a sure sign of pre-eclampsia. Regular antenatal check ups can determine whether your increased blood pressure is as a result of pre-eclampsia, usually by the checking for protein in your urine.

The severity of pre-eclampsia is usually (but not always) related to the blood pressure level. You may have no symptoms at first, or if you have only mildly raised blood pressure and a small amount of leaked protein in your urine. If pre-eclampsia becomes worse, one or more of the following symptoms may develop. See a doctor or midwife if any of these occur.
  • Headaches.
  • Blurring of vision, or other visual problems.
  • Abdominal (tummy) pain. The pain that occurs with pre-eclampsia tends to be mainly in the upper part of the abdomen, just under the ribs.
  • Vomiting.
  • Just not feeling right.
Swelling or puffiness of your feet, face, or hands (oedema) is also a feature of pre-eclampsia. However, this is common in normal pregnancy. Most women with this symptom do not have pre-eclampsia, but it can become worse in pre-eclampsia. Therefore, report any sudden worsening of swelling of the hands, face or feet promptly to your doctor or midwife.

Regular checks may be all that you need if pre-eclampsia remains relatively mild. If pre-eclampsia becomes worse, you are likely to be admitted to hospital. Tests may be done to check on your well-being, and that of your baby. For example, blood tests to check on the function of your liver and kidneys. Also, an ultrasound scan is usual to see how well your baby is growing.

If your blood pressure cannot be controlled, your obstetrician may suggest that you have your labour induced or that you deliver your baby by caesarean section.
 
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Understanding blood pressure readings

  
Normal blood pressure is below 140/90 mmHg. The first number (systolic pressure) is the pressure at the height of the contraction of the heart. The second number (diastolic pressure) is the pressure in the arteries when the heart rests between each heart beat.Blood pressure
  • Mildly high blood pressure is 140/90 mmHg or above, but below 160/100 mmHg.
  • Moderate to severe high blood pressure is 160/100 mmHg or above.
High blood pressure can be:
  • just a high systolic pressure, for example, 170/70 mmHg.
  • just a high diastolic pressure, for example, 130/104 mmHg.
  • or both, for example, 170/110 mmHg.
However, any substantial rise in the blood pressure from a reading taken in early pregnancy is a concern, even if it does not get as high as the levels listed above. (You may have quite low blood pressure to start with.)

Is pre-eclampsia the same as high blood pressure of pregnancy?
No. Many pregnant women develop mild high blood pressure. Most do not have pre-eclampsia. With pre-eclampsia you have high blood pressure, plus protein in your urine, and sometimes other symptoms and complications listed above. About 1 in 5 pregnant women with high blood pressure progress to pre-eclampsia.
Therefore, if you develop mild high blood pressure, it is vital that you have regular ante-natal checks which can detect pre-eclampsia, if it occurs, as early as possible.
 
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What is the treatment for pre-eclampsia?

  

Delivering the baby

The only complete cure is to deliver the baby. At delivery the placenta (often called the afterbirth) is delivered just after the baby. Therefore, the cause of the condition is removed. After the birth, the blood pressure and any other symptoms in the mother usually soon settle.

Attempts will be made to manage your pre-eclampsia until a delivery after 36 weeks of pregnancy can be achieved. Treatment is often aimed at lowering your blood pressure, which includes bed rest and medication, usually in hospital where your condition can be monitored constantly.

It is common practice to induce labour if pre-eclampsia occurs late in the pregnancy. A caesarean section can be done if necessary. The risk to the baby is small if he or she is born just a few weeks early. However, a difficult decision may have to be made if pre-eclampsia occurs earlier in the pregnancy. The best time to deliver the baby has to balance several factors which include:
  • The severity of the condition in the mother, and the risk of complications occurring.
  • How badly the baby is affected.
  • The chance of a premature baby doing well. As a rule, the later in pregnancy the baby is born, the better. However, some babies grow very poorly if the placenta does not work well in severe pre-eclampsia. They may do much better if they are born, even if they are premature.

As a rule, if pre-eclampsia is severe, then delivery sooner rather than later is best. Pre-eclampsia is therefore the cause of around 15% of premature births. If the pre-eclampsia is not too severe, then postponing delivery until nearer full term may be best.
 
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Will pre-eclampsia develop in my next pregnancy?

  • If you had pre-eclampsia in your first pregnancy, you have about a 1 in 10 chance of it recurring in future pregnancies. However, this means you have about a 9 in 10 chance of it not happening again. There is no way of predicting if you will develop it again.


  • If you do not have pre-eclampsia in your first pregnancy, it is unusual to develop it in future if you become pregnant again by the same partner.
 
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