Pre-eclampsia is a disorder of pregnancy that if not diagnosed and managed correctly can result in complications to both the pregnant woman and the developing fetus.
What is pre-eclampsia?
Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. It is associated with other complications of damage to other organ system most often the liver and kidneys. Pre-eclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Left untreated, pre-eclampsia can lead to serious — even fatal — complications for both the pregnant woman and her developing fetus. Without immediate treatment, pre-eclampsia may lead to a number of serious complications, including:
• convulsions (eclampsia)
• HELLP syndrome (a combined liver and blood clotting disorder)
• stroke
These complications are rare.
What are some signs and symptoms of pre-eclampsia?
This disorder of pregnancy might develop with few or no signs. A feature of pre-eclampsia is high blood pressure. This sometimes might develop slowly or it may have a sudden onset. Regular visits to the doctor or midwife will detect these changes in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.
High blood pressure affects 10 to 15% of all pregnant women, so this alone does not suggest pre-eclampsia. If protein in the urine is found at the same time as high blood pressure, it is a good indicator of the condition.
Other signs and symptoms of pre-eclampsia may include:
• Excess protein in your urine (proteinuria)
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in your blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath, caused by fluid in your lungs
Sudden weight gain and swelling (oedema) — particularly in the face and hands — may occur with pre-eclampsia, but these also occur in many normal pregnancies, so they are not considered reliable signs of pre-eclampsia.
If you notice any symptoms of pre-eclampsia, get medical advice immediately.
What causes pre-eclampsia?
Despite many studies the exact cause of pre-eclampsia is not fully understood.
Pre-eclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it.
Who is at increased risk of getting pre-eclampsia?
Some factors have been identified that could increase a woman’s chances of developing pre-eclampsia. These include:
• having an existing medical problem – such as diabetes, kidney disease, high blood pressure.
• previously having pre-eclampsia – there is an approximately 16% chance a woman will develop the condition again in later pregnancies
Some factors also increase your chances by a small amount.
If you have 2 or more of these together, your chances are higher:
• first pregnancy – pre-eclampsia is more likely to happen during the first pregnancy than during any subsequent pregnancies
• it has been at least 10 years since your last pregnancy
• have a family history of the condition – for example, your mother or sister has had pre-eclampsia
• over the age of 40
• you were obese at the start of your pregnancy – meaning you had a body mass index (BMI) of 35 or more
• you are expecting multiple babies such as twins or triplets.
Treatment
Pre-eclampsia can only be cured by delivering the baby. If you have pre-eclampsia, you will be closely monitored until it is possible to deliver the baby, usually in hospital.
Once diagnosed, you should be under the care of a senior obstetrician for further assessment and any necessary treatment.
Complications
The more severe your pre-eclampsia, and the earlier it occurs in the pregnancy, the greater the risks. Pre-eclampsia may require induced labour and delivery.
Delivery by cesarean (C-section) may be necessary if there are clinical or obstetric conditions that require a speedy delivery. Complications of pre-eclampsia may include:
• Fetal growth restriction
• Some babies of women with pre-eclampsia can even die in the womb and be stillborn
• Stroke
• Placental abruption
• HELLP syndrome
• Eclampsia. When pre-eclampsia is not controlled, eclampsia — which is essentially pre-eclampsia plus seizures — can develop. It is very difficult to predict which patients will have pre-eclampsia that is severe enough to result in eclampsia.
Prevention
Researchers continue to study ways to prevent pre-eclampsia but, so far, no clear strategies have emerged. Regular visits to your healthcare provider during pregnancy is important in detecting early signs of pre-eclampsia, allowing for early diagnosis and appropriate treatment. Discuss the use of low dose aspirin with your obstetrician if you are a high-risk patient for pre-eclampsia.
Once you are pregnant, take care of yourself — through early and regular prenatal visits. Talk to your obstetrician about any concerns you have. If pre-eclampsia is detected early, you and your doctor can work together to prevent complications and make the best choices for you and your developing fetus.
Conclusion
Pre-eclampsia is a disorder of pregnancy that if not diagnosed and treated correctly can result in serious complications to both the pregnant woman and her developing fetus. High blood pressure and protein in the urine are common symptoms, but other symptoms might occur. Delivery of the fetus is the only cure for this disorder but various other medications are needed to help prevent complications. If you are pregnant make sure you have regular prenatal visits to help prevent pre-eclampsia and many other disorders.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-six years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5928).
