Risk of preterm labour/pre-eclampsia in subsequent pregnancies? Help!

[BionicEmu]

I had my 12 week scan and consultant obstetrician appointment yesterday for my second baby. Scan was great, baby looks good, but something's been playing on my mind and I can't stop thinking about it.

I had a bit of an odd time last pregnancy with DS (now 21 months old)- went for routine scan at 33+5, all was fine but I mentioned I'd been having some crampy/stretchy pain for a few days, doc checked me and I was 4cm dilated and the tiny pains were actually contractions. Labour slowed that night (Wed), but was still contracting every 15 minutes or so so had to stay in hospital to be monitored. Then on the Fri evening my blood pressure rocketed and I got stinking headaches, on the Sat they said I had severe pre-eclampsia as my blood tests were all skewiff and they were going to induce me on the Sun. Didn't need inducing as DS came Sun morning anyway.

Anyway, obstetrician yesterday said she thought my chances of going full-term with this new pregnancy were minimal. Firstly as I went into labour spontaneously at 33 weeks, so higher chances of another preterm labour. And secondly because I had severe pre-eclampsia last time, she said I have a greater than 50% chance of getting it again, and as I have some permanent kidney damage from last time they would whip baby out as soon as pre-eclampsia was confirmed.

Does this seem right? Greater than 50% chance or PE again is much higher than I thought from reading around. Has anyone got any advice, or opinions, or anything to try and stop me worrying about this so much?

(And thankyou if you've read this far, this turned out rather epic I'm afraid as I thought it'd be easier if I told the whole back story!)

Hi BionicEmu,
The recurrence rate is variable depending upon at what stage you delivered n your last pregnancy. As you delivered before 34 weeks your risk of getting again are about 1 in 4 (25%). According to NICE it is when you deliver before 28 weeks your risk rises to around 1 in 2 (55%). However it really is unique for every woman. I'm writing from the charity Action on Pre eclampsia - There is a lot of information on our website www.apec.org.uk
I hope this helps. Remember that you will be very closely monitored. I hope all goes well for you. Ann Marie at APEC

Ah, thankyou! Will check out the website :)

Have they recommended that you should take low dose aspirin? These Nice guidelines recommend taking it as a precaution from 12 weeks until term if you're high risk for pre-eclampsia (you are high risk if you've had it previously).

Obviously, speak to your doctor or midwife first - don't just starting taking it - since there might be other factors in your case.

Also, what were your Papp-A levels? I've been reading some interesting stuff recently about how placental health problems are associated with all kinds of things like pre-eclampsia and pre-term birth. It's something that doesn't seem to be followed very consistently in the UK. To be fair, they haven't figured out a very good way of checking who is at risk yet, but very low Papp-A levels at the 12 week scan seem to sometimes be an early warning sign. If your Papp-A levels were very low (e.g. below about 0.3 MOM), then it would be worth asking for extra checks of your placental function. These tests would happen at about 20 weeks, and basically check blood flow in your uterus and the umbilical cord, to make sure blood perfusion is OK, as well as just checking the look of the placenta. There's a good article about it here

Thanks for replying strawberry!

Yes, the obstetrician started me on 75mg of aspirin a day, I have to stop taking it at 36 weeks (if I get that far).

I have no idea about Papp-A levels - I didn't have any bloods taken at my 12 week scan. They couldn't get the NT measurement as baby wasn't cooperating, so said there was no point taking any bloods until I could have the quadruple test at 15-20 weeks, but I don't think Papp-A is one of the things they test for with the quadruple test?

I don't think I have very good genetics when it comes to placentas, TBH. My mother had 2 children - I was born on my due date and my sister was 2 weeks early, but we both had blood poisoning due to the placenta breaking down. From the other side of the family, my paternal grandmother had pre-eclampsia and delivered my father at 34 weeks. (I am my father's blood group too, not my mother's, and am far more similar physically to my father's family than my mother's - I have the same spinal problems as his mother had etc. I have recently starting finding out about the association between blood groups and health/diseases - very interesting)

Anyway, thanks very much for replying, and I shall go and read that article!

That's great that you're already on aspirin. Don't worry about not knowing your Papp-A levels, since that would just have been another clue that taking aspirin might help you, and I think that with your personal and family history it would still be reasonable for you to ask for a placenta health check (in fact, they're probably already planning to do one).

Try not to worry too much: it might not feel like it, but you're actually in a much better position for this pregnancy than the last one. You know about your risk now, so the doctors are already treating you, and will keep a really close eye on you throughout your pregnancy.

Wishing you all the best for a healthy, problem-free pregnancy!