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Aileen Keigher, Midwife
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Community Midwife Team Leader Whittington Hospital, London
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Healthy weight

Pre-eclampsia & hypertension

Pre-eclampsia, sometimes called toxaemia, is a pregnancy-related condition - where the pregnancy can cause an increase in the woman's blood pressure. Pre-eclampsia usually develops after the 20th week of pregnancy or soon after the birth. It is potentially life-threatening for the mother and baby if left untreated and develops into eclampsia.
In Short
Symptoms of pre-eclampsia include high blood pressure (hypertension and protein in the urine (proteinuria).

These symptoms might not be noticed by you but will be picked up in your routine antenatal appointments.

Other symptoms include welling of the feet, amkles, face and hands which is caused by oedema (retention of fluid);

a bad headache; pain just below your ribs; and problems with your vision.

This is why routine antenatal checks are so important. Your antenatal care team will pick up signs of any pregnancy-induced raised blood pressure and protein in your urine straight away and start the appropriate management procedures.

If you notice any of the symptoms yourself - call your midwife, GP surgery immediately, or NHS 111.

The earlier pre-eclampsia is diagnosed, the easier it is to treat. If it's left unmonitored or treated, it can lead to serious complications for both mother and baby.

Pre-eclampsia and hypertension during pregnancy

Pre-eclampsia is quite common – occurring in around six percent of pregnancies. Severe cases develop in around 1-2% of pregnancies. By monitoring blood pressure and urine, it can usually be detected when the condition is still mild. This usually means it can be managed until delivery is possible, usually with medication. There is no cure as such – other than delivering the baby. However, if you have moderate or severe pre-eclampsia you will be monitored more closely and may be prescribed blood pressure medication. However, it usually goes away several weeks after the birth. It may mean that your baby needs to be delivered soon after 36 weeks or even earlier.

Are some women at higher risk of pre-eclampsia and hypertension?

You are considered higher risk if you are in one or more of the following categories:

  • This is your first pregnancy.
  • You are aged 40 or over.
  • Your last pregnancy was more than 10 years ago.
  • You are obese (BMI over 35).
  • You have a family history of pre-eclampsia.
  • You are carrying more than one baby.

In addition, you are at statistically greater risk if you:

  • Had high blood pressure in a previous pregnancy.
  • Have chronic kidney disease.
  • Suffer with diabetes.
  • Have a disease that affects the immune system, such as lupus or antiphospholipid syndrome.
  • Had pre-eclampsia in a previous pregnancy.
What other symptoms are there?

Even if you’re not in one of the high-risk groups, call your antenatal care team or your doctor straight away if you have any of the following symptoms:

  • Pain in the upper right part of your abdomen.
  • Swelling of your hands or your face.
  • Dizziness.
  • Sudden weight gain.
  • Blurred, or changes in vision.
  • Headaches.
  • Shortness of breath.
  • Anxiety.

If you’re at high-risk of developing pre-eclampsia, you may be advised by your Midwifery team to take a daily dose of lose-dose asprin from the 12th week of pregnancy up until the delivery.

What causes pre-eclampsia?

It’s not really known what the exact cause of pre-clampsia is, but it’s thought to arise from a problem with the placenta.

Treatment and management of pre-eclampsia

If you’re at high risk of pre-eclampsia, or are diagnosed with it, your midwifery team will probably send you to an assessment by a specialist team – probably in hospital. While you’re in the hospital, you’ll be monitored closely. If your condition is severe, they may suggest a hospital stay.

You might want to discuss using a blood pressure monitor at home during your pregnancy, but you should talk to your Midwife to make sure that you are using this properly before you start.

The only way to stop the development of pre-eclampsia is to deliver your baby early. This means if you are diagnosed with pre-eclampsia you will have your blood pressure and urine monitored regularly until it’s safe for your baby to be delivered. This will normally be around 37-38 weeks of pregnancy. However, in severe cases, babies will be delivered earlier.

Early delivery with either be artificially induced to start labour or a caesarean section will be scheduled.

You may be prescribed medication to lower your blood pressure until your baby is delivered.

How can pre-eclampsia impact your baby?

The main impact of pre-eclampsia on your baby, if any, is slow growth. This is because of reduced blood supply through the placenta to your baby – which means they will be receiving less oxygen and fewer nutrients than they should. This is called intra-uterine or foetal growth restriction.

The reason the placenta isn’t delivering the blood through to a baby is if the placenta and its blood vessels hasn’t developed properly in the early stages of the pregnancy. It’s not yet fully understood why this occurs. It might be partly genetic but not all cases are inherited.

Slow growth will usually be picked up at your antenatal appointments – which is one of the reasons your doctor or midiwife will measuring your baby’s size.

What happens if pre-eclampsia isn’t treated?

Without quick treatment, pre-eclampsia may lead on to a series of serious complications, including:

  • Convulsions (eclampsia);
  • HELLP syndrom (a combined liver and blood clotting disorder);
  • Stroke.

DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.