Pre-eclampsia: symptoms and treatment
Pre-eclampsia is a condition that restricts the flow of oxygen to the placenta. It affects about 6% of pregnancies, and 1-2% of pregnant women will experience a more severe form. Here are the symptoms to look out for, and the treatment you can expect if you develop pre-eclampsia during your pregnancy.
What are the signs and symptoms of pre-eclampsia?
High blood pressure, otherwise known as hypertension, is one of the most common symptoms of pre-eclampsia – which is why your midwife will check yours at every antenatal appointment. Sometimes high blood pressure is the only symptom of pre-eclampsia – but headaches, sudden swelling or unexpected weight gain, vision problems, severe heartburn, upper abdominal pain and nausea can all be symptoms too.I had no symptoms I was aware of other than swelling, which I had for weeks before I was diagnosed. I went for my routine midwife appointment and had raised protein in my urine and high blood pressure – she sent me straight to the hospital. They induced me straight away.
If you notice any of these symptoms or are generally worried about your health during pregnancy, do tell your doctor or midwife. They will perform a simple urine test to check for protein in your urine, which is one of the first signs of pre-eclampsia.
Some women might experience pre-eclampsia headaches – these are headaches which are severe but non-migrainous. The major differences between severe headaches and migraines is that a severe headache feels like a dull pressure, as opposed to the throbbing or pulsing pain of migraines. You will often experience other symptoms during a migraine headache, like flashing lights, nausea or dizziness.
Not all women with pre-eclampsia experience headaches, and of course they can be completely unrelated – but it's definitely worth flagging these with your doctor or midwife, particularly if you didn't suffer from them before you became pregnant.
What causes pre-eclampsia?
It’s not clear what causes pre-eclampsia, but there are certain risk factors which increase your chances of developing it.
If you have a preexisting health condition such as diabetes, kidney disease, high blood pressure, PCOS or lupus, you're at an increased risk of developing pre-eclampsia, according to NHS guidelines. Likewise, if you've previously had pre-eclampsia, there’s a moderate chance you will develop the condition again in later pregnancies.
Other factors which can increase your chance of developing pre-eclampsia are being over 40, being very overweight, having a large gap between pregnancies (10 years plus) and expecting multiple babies. There's also a genetic link, so if there’s a family history of the condition, do let your midwife or doctor know.
Can I prevent or reduce the risk of pre-eclampsia?
Unfortunately, there’s no way to prevent pre-eclampsia, but rest assured that once it is diagnosed you will be closely monitored. If you're currently obese and trying to conceive, you can reduce your risk by losing weight before you get pregnant.
When does pre-eclampsia start?
Pre-eclampsia usually appears after the 20th week of pregnancy, and most commonly seen in the final trimester, but it can occur earlier or even after your baby is born – so if you have any concerns, it’s always best to speak to your GP for some reassurance.
Very rarely, women go on to develop eclampsia itself, which can cause seizures and be life-threatening for you and your baby. Pre-eclampsia can develop in previously trouble-free pregnancies, and it’s worth familiarising yourself with the symptoms so you can spot them if necessary.
How is pre-eclampsia treated?
Following a diagnosis of pre-eclampsia, it is likely you will be admitted to the hospital so doctors can assess how severe your case is.
Doctors will monitor your blood pressure closely, and take blood tests to check for complications. Depending on the results of these tests, you may be able to go home and rest, attending further monitoring appointments as an outpatient, or you may be kept in for observation.
You’ll be monitored similarly to above, but also given medication to lower your blood pressure and have ultrasound scans to measure the blood flow from placenta to your baby. If your baby is well and your condition improves, you may be able to go home before the birth. If you haven’t had the baby by your 39th or 40th week, you may be offered an induction.
With severe pre-eclampsia, it is likely you’ll need to stay in hospital where you can be monitored closely. Doctors will take frequent blood pressure, urine and blood tests, as well as giving you medication to control your blood pressure. Your baby’s growth and wellbeing will be closely monitored, as will his heartrate.I went from absolutely fine to my liver failing entirely within four hours.
Hospital staff will do everything within their power to prevent you from developing complications, and it is likely they will control your fluid levels. You may also be put you on a magnesium sulphate drip to lower your risk of developing eclampsia and fitting.
In some cases, your baby may need to be born earlier than expected – your doctor will assess your situation carefully, and explain all your options. You may be advised to have an induction or a caesarean around the 37th week, or earlier in extreme cases.
Will pre-eclampsia harm my baby’s development?
There is a moderate chance that your baby will be born prematurely if you suffer from pre-eclampsia. Premature births have been linked to various lifelong challenges, but try not to panic too much. Your doctor should be able to help advise you about how a premature birth could affect you and your baby.
Intrauterine Growth Restriction
Because pre-eclampsia restricts blood flow to the placenta, it can also limit the supply of food to your baby, which is referred to as Intrauterine Growth Restriction (IUGR). As a result, your baby may become malnourished or small for its gestational age. Ultrasound scans can help identify IUGR, and many babies who suffer from it will catch up on their growth within a few months. However, recent research does suggest that growth restricted infants are more prone to developing diseases later in life such as diabetes, congestive heart failure and hypertension. It’s important to not blame yourself if your baby does develop IUGR – it’s related to a failing placenta, and you can be eating a perfectly healthy diet and still develop it.
Acidosis is another potential result of pre-eclampsia, in which your baby’s body produces too much lactic acid and becomes unconscious in the womb. In this instance, delivery is essential even if the baby is premature.
There is also a small chance of stillbirth, particularly if you suffer from severe pre-eclampsia, HELLP syndrome or pre-eclampsia superimposed on chronic hypertension. This means it is essential to detect pre-eclampsia early and to monitor it accordingly. If you have any worries at all, it’s definitely worth speaking to your GP or midwife, who will be able to advise you.
What other complications could pre-eclampsia lead to?
Severe pre-eclampsia can lead to various complications, including Eclampsia, HELLP syndrome – which is why it is so important that the symptoms are identified early so you can be monitored and treated.
Eclampsia is a rare but serious condition where the membranes of your brain become irritated. This can lead to seizures, which put both you and your baby at risk. Eclampsia can develop during pregnancy and birth, as well as in the first few days and weeks after your baby’s birth, particularly if your pre-eclampsia was severe.
This might sound scary, and eclampsia is a severe illness, but it is a very rare complication – and once pre-eclampsia has been diagnosed, your medical team will do everything they can to prevent complications.
HELLP syndromeI had severe pre-eclampsia leading to HELLP syndrome – I was very lucky not to have convulsions. My reflexes were amazing – if someone touched my knee my whole leg flew up in the air uncontrollably. This is a sign of cerebral irritability which means that you are very likely to fit.
HELLP syndrome is a rare liver and blood-clotting disorder, which can develop before pre-eclampsia has been diagnosed. HELLP stands for:
H: haemolysis, which means the breaking down of red blood cells.
EL: elevated liver enzymes, which is a sign that your liver is not working properly.
LP: low platelet count, which means your blood may not clot as easily as it should.
HELLP is most likely to develop after you give birth – particularly if you have had severe pre-eclampsia – but it can sometimes develop from mid-pregnancy onwards, or in rare cases, even earlier.
It is possible to suffer any of these complications as a result of pre-eclampsia:
- liver and kidney failure
- stroke (cerebral haemorrhage)
- fluid in the lungs (pulmonary oedema)
- blind patches
However, your midwife and doctor will be looking out very carefully for symptoms of pre-eclampsia, and if you have been diagnosed you will be monitored very closely, so it is very unlikely you will experience any of these problems. But do make sure you attend all of your antenatal appointments, and raise any concerns with your midwife or GP – even if they seem small.
Will I make a full recovery from pre-eclampsia?
Most women make a full recovery from pre-eclampsia once they have given birth, but it is likely you will have to stay in the hospital for a few days to rest and have your blood pressure monitored.
All being well, your blood pressure will return to normal within weeks of having your baby. Routine checks following birth may show that you had high blood pressure before you were pregnant, and you may be given medication or advice to treat this.
Rare complications such as eclampsia or HELLP can impact long-term on your health, such as causing kidney problems, but most cases of pre-ecalmpsia are diagnosed and treated quickly, preventing these complications.
If you have had severe pre-eclampsia or eclampsia, your doctor will explain to you what happened, and how this might affect future pregnancies. Pre-eclampsia does put you at risk of developing high blood pressure and related problems in later life, so you will be encouraged to have regular blood pressure checks in future.