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Pre-eclampsia

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What is pre-eclampsia?

Pre-eclampsia is one of the most common serious complications of pregnancy.

In the US, pre-eclampsia is thought to affect around 5-10% of all pregnancies. Of these, 1-2% of cases are severe and can threaten the lives of the mother and her baby.

The main features of pre-eclampsia are high blood pressure and protein in the urine (proteinuria). These may not cause any noticeable symptoms, but are generally detected by a doctor in a regular check-up during your pregnancy.

Signs and symptoms

Pre-eclampsia usually develops during the second half of pregnancy, but may sometimes develop shortly after giving birth. The main signs of pre-eclampsia are a sudden increase in blood pressure (hypertension) and the presence of protein in the urine, known as proteinuria, which develops during pregnancy. These symptoms can occur without any noticeable effect on the mother, so it is very important for women to have regular check-ups during pregnancy.

Pre-eclampsia can also lead to excess fluid retention, which may appear as swelling, particularly in the hands, feet and face. Some swelling is common in a normal pregnancy, so it can sometimes be difficult to tell whether swelling is a result of pre-eclampsia.

In severe cases of pre-eclampsia, the symptoms can include:

Causes and risk factors

The placenta plays the central role in development of pre-eclampsia. The placenta is a specialized organ that develops in a woman's uterus during pregnancy and transfers nutrients and oxygen from the mother to the baby so that the baby can grow and develop. Women with conditions such as a molar pregnancy, where the placenta develops but the fetus does not, can still develop pre-eclampsia.

In pre-eclampsia, the blood vessels within the placenta do not form normally, due to unclear immune factors, inherited causes and other unknown reasons. This results in a reduced supply of nutrients and oxygen to the fetus. This undersupply causes the placenta to release chemicals in an attempt to restore normal blood flow. These chemicals affect the kidney, liver and other organs in the mother, which cause the signs and symptoms of pre-eclampsia, such as liver failure and brain swelling.

A number of factors can trigger pre-eclampsia. 

There are several factors that can increase your risk of developing pre-eclampsia during pregnancy. You are more likely to develop pre-eclampsia if you:

Methods for diagnosis

Pre-eclampsia is usually detected in a routine check-up during pregnancy. During this check-up your doctor will measure your blood pressure. If you have a high blood pressure reading and pre-eclampsia is suspected, your doctor may also carry out some other tests to monitor your condition and make sure your baby is healthy.

Symptoms of pre-eclampsia may be detected during a routine check-up. 

Urine testing

Your doctor may request a sample of your urine to measure protein levels. This is known as a urinalysis. Having protein in your urine may be a sign of pre-eclampsia. If the analysis is positive for protein, your doctor may request further tests.

Blood tests

Your doctor may also collect a blood sample to test your kidney and liver function, and assess blood cell counts, which can be abnormal in pre-eclampsia.

Ultrasound

Your doctor may conduct an ultrasound to assess that your baby is healthy.

Types of treatment

If you have pre-eclampsia, you will need to have your blood pressure monitored closely for the rest of your pregnancy. The treatment you need will usually depend on how far along your pregnancy is and how serious your condition is.

Self care

If you have mild pre-eclampsia, your doctor may recommend that you stay off your feet and get lots of rest. This may help improve the blood flow to the placenta and help prevent any complications.

Medication

In some cases, antihypertension medications, such as labetalol or methyldopa, can be used to help control blood pressure and prevent complications. If your blood pressure is very high, you may be admitted to hospital so that it can be monitored closely.

Delivery

If you have pre-eclampsia and your blood pressure is not well controlled by medication, your doctor may recommend delivering your baby early by caesarean section or induced labor. This will generally depend on how far along you are with your pregnancy and how severe your doctor has assessed the pre-eclampsia to be. Delivering the baby - and the placenta - is the only way to cure pre-eclampsia.

Potential complications

Eclampsia

Pre-eclampsia can sometimes develop into eclampsia, which is a serious condition that causes the mother to have seizures during her pregnancy, or within a short time after giving birth. These seizures can result in a coma, brain damage, or death for the mother or baby.

Magnesium sulfate is a type of medication that is given to a mother with severe pre-eclampsia to reduce the risk of these seizures. It is not very common for pre-eclampsia to progress to eclampsia, if it is detected and treated early.

HELLP syndrome

HELLP syndrome is a serious complication that can develop in severe cases of pre-eclampsia. It can lead to damage of the mother's liver, a breakdown of her red blood cells and lower platelet counts. Symptoms of HELLP syndrome include headache, nausea, vomiting, abdominal pain, swelling and changes in vision. These are very similar to the symptoms of pre-eclampsia.

Reduced blood flow to the placenta

During pregnancy, a baby receives oxygen and nutrients from the placenta, which allows normal growth and development. Pre-eclampsia can reduce the flow of blood to the placenta. In some cases this means that the baby does not get enough oxygen or nutrients, which affects its development. Babies may be born smaller in size, born early and/or with other complications.

Placental abruption

Pre-eclampsia can sometimes lead to placental abruption, which occurs when the placenta separates from the wall of the uterus. This can cause abdominal or lower back pain and vaginal bleeding. In severe cases, placental abruption can prevent the baby getting enough oxygen and nutrients, and be life-threatening for both the mother and her baby.

Prognosis

The signs of pre-eclampsia usually go away shortly after giving birth. If it is left untreated, pre-eclampsia can lead to serious complications and can threaten the life of the mother and her baby.

Prevention

There is no known way to prevent pre-eclampsia. Regular check-ups with your doctor during pregnancy may help to detect and treat the condition early, which is the best way to prevent serious complications. If you have a high risk of developing pre-eclampsia, your doctor may recommend taking low doses of aspirin during pregnancy to reduce the risk.

References

  1. Pre-eclampsia. The Royal Women’s Hospital. Accessed 23 November 2014 from link here
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10 Most frequently asked questions (FAQs)

What is pre-eclampsia?
Pre-eclampsia is a condition that develops during or very soon after pregnancy. It is one of the most common serious complications of pregnancy and can threaten the lives of both the mother and baby. It is characterized by high blood pressure and the presence of protein in the urine. Some women may also develop swelling, especially in the hands, feet and face.
How common is pre-eclampsia?
Pre-eclampsia is the most common serious complication of pregnancy. In Australia, it is thought to affect around 5-10% of all pregnancies. Of these, around 1-2% of cases are severe and threaten the lives of the mother and her baby.
How will pre-eclampsia affect my baby?
Pre-eclampsia can reduce the blood supply to the placenta, which transfers nutrients and oxygen from the mother to the fetus for growth and development. Having a reduced blood supply can affect the placental function and the fetal growth. In some cases where the blood flow to the placenta is very poor, the baby may need to be delivered early.
What causes pre-eclampsia?
It is not known what causes pre-eclampsia. It is thought to occur because of a problem with the placenta, which transfers nutrients and oxygen from the mother to the fetus. There are several factors that may increase the risk of developing pre-eclampsia during pregnancy. Women are more likely to develop pre-eclampsia if they are experiencing their first pregnancy, are overweight, have high blood pressure before they get pregnant, or have a close family member who has experienced pre-eclampsia.
How can I prevent pre-eclampsia?
There is no known way to prevent pre-eclampsia. Having regular check-ups with a doctor during pregnancy may help to detect the condition early. Getting treatment early and managing the condition is the best way to prevent serious complications of pre-eclampsia.
What is the treatment for pre-eclampsia?
The treatment for pre-eclampsia may depend on how far along your pregnancy is and how serious your condition is. The only cure for pre-eclampsia is to deliver the baby. Mild cases of pre-eclampsia may be treated with close monitoring of blood pressure and lots of rest to help improve the blood flow to the placenta. In some cases, medication may be used to help control blood pressure and prevent complications.
How do I know if I have pre-eclampsia?
Many women with pre-eclampsia do not experience any symptoms. The condition is usually detected by a doctor during a routine pregnancy check-up, when they measure your blood pressure. If you have a blood pressure reading and your doctor suspects that you have pre-eclampsia, they may also test a sample of your urine to check for protein, which is another sign of pre-eclampsia.
How will pre-eclampsia affect me after my pregnancy?
Pre-eclampsia is usually cured by delivering the baby. Some women who experience pre-eclampsia during their pregnancy may develop high blood pressure later in their life.
What are the signs of having pre-eclampsia?
The main signs of pre-eclampsia are a sudden increase in blood pressure and the presence of protein in the urine. It is common for pre-eclampsia to develop after week 20 of gestation. Pre-eclampsia can occur without any noticeable symptoms. The symptoms of severe pre-eclampsia can include headaches, dizziness, nausea and vomiting, abdominal pain and blurry vision, or visions of flashing lights.
What is eclampsia?
Pre-eclampsia can sometimes develop into a serious condition called eclampsia. This can cause the mother to have seizures during her pregnancy, or a very short time after giving birth. The seizures can result in a coma, brain damage, or death for the mother or her baby. It is not very common for pre-eclampsia to progress to eclampsia if it is detected and treated early.

Related topics

HELLP syndrome

HELLP syndrome is a rare but serious condition that can develop in the second half of pregnancy, or soon after delivery. It causes liver inflammation, poor clotting and the breakdown of red blood cells. It requires urgent treatment.

Cholestasis of pregnancy

Cholestasis is a condition in which the flow of bile from a pregnant woman’s liver is slowed, causing a build-up of bile acids in the bloodstream. It may occur in the later stage of pregnancy and the most notable symptom is intense itching.

Ectopic pregnancy

An ectopic pregnancy occurs when an embryo begins to develop at a site other than within the uterus, such as in a fallopian tube. Unfortunately, it results in the loss of the pregnancy. If left untreated, an ectopic pregnancy can cause dangerous complications, such as haemorrhage into the abdomen.

Gestational diabetes

Gestational diabetes is a form of diabetes that occurs exclusively to pregnant women, marked by high blood sugar levels. These high sugar levels can affect the pregnancy and the unborn baby’s health. The condition commonly settles soon after delivery of the baby, but it does increase the mother’s risk of developing diabetes in the future.

About this article

Title: Pre-eclampsia

Author: Dr Joanne Van der Velden PhD, BSc (Hons)

First Published: 24 Nov 2014

Last reviewed: 17 Jan 2022

Category: Information on Pre-eclampsia

Average rating: 4.5 out of 5 (1425 votes)

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