Pregnant women to be offered new blood test for pre-eclampsia
NHS England will be offering pregnant women a new kind of blood test to check for pre-eclampsia, a potentially life-threatening condition affecting about 6% of pregnancies.
A new type of blood test will be offered to pregnant women in England to check for pre-eclampsia, a condition that affects tens of thousands of pregnancies each year, but which can be more successfully managed if detected earlier in pregnancy.
Evidence suggests that the new test can speed up diagnosis of pre-eclampsia. Carrying out the new test alongside the usual blood pressure and urine test was found to cut the average diagnosis time from four days to around two days.
Over 1,000 women at 11 UK maternity units took part in the trial of the new PLGF (placental growth factor) blood test over the course of their second and third trimesters.
Earlier diagnosis was linked to a reduced chance of serious complications arising as a result of pre-eclampsia.
Prof Tony Young, from NHS England, said to the BBC, “The NHS, with partners in government, will be making this test more widely available across the NHS as part of our plans to ensure as many patients as possible can benefit from world-class health innovations.”
What is pre-eclampsia?
Pre-eclampsia is a condition affecting about 6% of pregnancies, usually characterised by symptoms of high blood pressure and protein in your wee. Essentially, it stops the placenta from functioning as it should, restricting the flow of oxygen to it. As well as negatively affecting your health, it can also make your baby ill by depriving him or her of nutrients and oxygen, which can lead to complications.
Luckily, most cases are mild, with only one in 200 women experiencing a severe form, and can be managed with close monitoring by your hospital.
- protein in your urine (proteinuria)
- high blood pressure
These two are usually the first signs. High blood pressure, otherwise known as hypertension, is the most common symptom, which is why your midwife will check yours at routine antenatal appointments. If you notice either of these symptoms or are generally worried about your health during pregnancy, do tell your doctor or midwife. They'll perform a simple urine test to check for protein.
Sometimes high blood pressure is the only symptom present and, by and large, the condition develops later on in pregnancy. After about 20 weeks, however, you could experience some of the below:
- unexpected weight gain caused by water retention
- sudden swelling of the hands, feet or face
- vision problems, including flashing lights
- severe heartburn that isn't improved by over-the-counter medicine
- upper abdominal pain
Some women might experience 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 the condition will 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.
It’s not entirely clear what the causes are, but it's thought that a problem with the blood supply to the placenta prevents it from developing properly. There are also certain risk factors which increase your chances of developing it. According to NHS guidelines, these are:
- pre-existing diabetes
- kidney disease
- high blood pressure
- being over 40
- a large gap between pregnancies (10 years or more)
- familial instances of the condition, usually in mothers or sisters
- previous experience of the condition
- expecting multiple babies
- a BMI over 35
Can I prevent or reduce the risk of it?
Unfortunately, there’s no surefire way to prevent yourself from developing it, but rest assured that once you've been 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. Eating a healthy diet and staying active is a step in the right direction, and could reduce your chances of developing high blood pressure, too.
When does pre-eclampsia start?
Usually appearing after the 20th week of pregnancy, it's 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. It can also develop in previously trouble-free pregnancies, and it’s worth familiarising yourself with the symptoms so you can spot them if necessary.
Following a diagnosis, it is likely you will be admitted to the hospital so doctors can assess how severe your case is. Most cases are relatively mild, with severe cases affecting only 1-2% of pregnancies.
Doctors will monitor your blood pressure closely, and take blood tests to check for any 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 the above, but you'll also be given medication to lower your blood pressure and have ultrasound scans to measure the blood flow from the 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.
In severe cases, 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 or her heart rate.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 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, at which point your baby is not considered premature. In extreme cases, doctors may suggest induction earlier than 37 weeks, but you will be closely monitored and all the potential risks and benefits of delivering early will be discussed with you first.
Will it harm my baby’s development?
There is a moderate chance that your baby will be born prematurely. 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 the condition 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 complication, 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.
In severe cases, there is also a small chance of stillbirth. This means it is essential to detect the condition 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.
Severe cases can lead to various complications, including eclampsia, HELLP syndrome, or pre-eclampsia superimposed on chronic hypertension, which is why it's so important that the symptoms are identified early and controlled by your doctor and midwife.
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 case was severe.
This might sound scary, and eclampsia is a severe illness, but it is a very rare complication in the UK and once pre-eclampsia has been diagnosed, you will be closely monitored, and your medical team will do everything they can to prevent complications.
HELLP syndromeI had it severely, 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:
Haemolysis, which means the breaking down of red blood cells.
ELevated liver enzymes, which is a sign that your liver is not working properly.
Low Platelet count, which means your blood may not clot as easily as it should.
The Preeclampsia Foundation says: "HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder disease, or other conditions.
“The global mortality rate of HELLP syndrome has been reported to be as high as 25%. That's why it's critical for expecting mothers to be aware of the condition and its symptoms so they can receive early diagnosis and treatment.”
HELLP is most likely to develop immediately after you give birth – particularly if you had severe pre-eclampsia – but it can sometimes develop from mid-pregnancy onwards, or in rare cases, even earlier. While it is a serious condition, once the baby has been delivered, and you are receiving medical care, it is possible to make a full recovery.
It is possible to suffer any of these complications, though they are rare:
- liver and kidney failure
- stroke (cerebral haemorrhage)
- fluid in the lungs (pulmonary oedema)
- blind patches
Rest assured that your midwife and doctor will be looking out very carefully for any symptoms, and if you have been diagnosed you will be monitored very closely, so it's unlikely you will experience any of these problems as a result. That said, it's vital 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?
Most women make a full recovery from the condition 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 have a long-term impact on your health, such as causing kidney problems, but these complications are very rare, affecting only 0.5% to 0.9% of pregnancies.
If you have had severe pre-eclampsia or eclampsia, your doctor will explain to you what happened, and how this might affect future pregnancies. It may mean you're at risk of developing high blood pressure and related problems in later life, so you will be encouraged to have regular blood pressure checks from then on.
Support and information
- Action on Pre-eclampsia is a charity that raises awareness of the condition.
- Tommy's Campaign funds research into pregnancy complications and premature birth.
- Mumsnet Talk – chat to others who have experienced the condition.
What Mumsnetters are saying
I was diagnosed at 36 weeks and was admitted to hospital the same day. I had a c-section at 37 weeks.
My baby was small and not growing properly. That gave it away.
I felt awful – huge swollen feet, light-headed, tired, pain above and below my ribs, violently sick and I had awful heartburn.
My consultant told me that a c-section isn't necessary unless I or my baby rapidly deteriorated and there was no time for an induction.
I was diagnosed at 36 weeks and admitted to hospital as my blood pressure was very high. They controlled it with medication and told me that within a week (either naturally or via induction) my baby would be born. They released me five days later and within two days my baby arrived naturally. She weighed 5lbs 6ozs, so we had to stay in hospital for a couple of days. After that, everything was fine and dandy.
It's very unpredictable and shows up differently in everyone.
Unfortunately, it generally won't improve – the only cure is delivery.
I was admitted at 31 weeks and monitored very closely until 34 weeks when they decided that the risk of delivery was less than the risk to my health.
I had high blood pressure, protein in my urine and swelling. At 38 weeks they admitted me and monitored every drop of my urine for 24 hours.