Pre-eclampsia: What You Need To Know

The earlier it’s diagnosed, the better the outcome for mom and baby

Do you know why your healthcare provider monitors your blood pressure and checks your urine at your prenatal visits? These screening tests are used to pick up pregnancy complications, among them, a serious condition called pre-eclampsia, which occurs in around 5 to 8% of pregnancies.

Regular Pre-Natal Checks

Early detection and management of pre-eclampsia are important for the health of both mom and baby. Regular pre-natal checks with your healthcare provider are vital to pick up the symptoms of pre-eclampsia, some of which may be mistaken for normal symptoms of pregnancy.

Characteristics and Causes

Pre-eclampsia is characterised by hypertension (high blood pressure), protein in the urine and oedema (swelling caused by fluid retention) in the ankles, feet and hands. It usually occurs from around 20 weeks and towards the end of the third trimester. It can also start earlier in pregnancy, or rarely, develop after the birth.

Doctors aren’t yet sure what causes pre-eclampsia and there is no way to prevent it.  However, they believe that problems with the placenta, the organ in your uterus that provides nutrients and oxygen for your baby, and a lack of blood flow to the uterus may contribute to its development. There may also be a genetic link.

Increased Risk

Some women may have a higher risk for developing pre-eclampsia. If you fall into a higher risk category, speak to your healthcare provider about what you can do to lower your risk or catch the condition early if it does develop. You must see your healthcare provider for your monthly antenatal checks.

Risk factors are:

• If this is a first pregnancy
• High blood pressure before pregnancy
• Pre-eclampsia in a previous pregnancy
• Chronic conditions like type 1 or 2 diabetes and kidney disease prior to the pregnancy or auto-immune disorders, like lupus
• Maternal age – over 40 years of age
• Less than two or more than 10 years between pregnancies
• Carrying twins or other multiples
• Obesity (prior to the pregnancy); a Body Mass Index (BMI) of 35 or above

Signs And Symptoms

Regular prenatal check-ups are essential to monitor your blood pressure and urine as some women with pre-eclampsia do not have other symptoms. Early diagnosis can help prevent long-term problems for both you and your baby.

Some of these symptoms are common complaints in pregnancy, but if you have several together or they develop or worsen quickly, contact your healthcare provider immediately.

• You feel generally unwell
• You have a headache that doesn’t go away with a safe painkiller (paracetamol)
• You have blurred vision or see flashing lights
• You feel dizzy
• You feel nauseous and/or vomit
• You have pain in the upper right side of your abdomen, below the ribs
• You are urinating much less or not at all
• You gain weight over one to two days (caused by fluid retention)
• Your hands, feet and face look swollen
• You have severe heartburn that doesn’t go away with antacids that are safe to use in pregnancy

Complications

Left untreated, it can cause complications for both mom and baby and may even be life-threatening. Pre-eclampsia may cause damage to various organs, including the liver, kidneys, lungs, heart and eyes, with an increased risk for a stroke. The placenta may not work properly, and this can compromise the baby’s growth and development. Serious complications include placental abruption (the placenta pulls away from the uterine wall) and stillbirth. Severe cases of pre-eclampsia can develop into eclampsia, characterised by seizures. Women with severe pre-eclampsia may also develop HELPP syndrome, a life-threatening variant of pre-eclampsia that requires immediate treatment and delivery of the baby.

In milder cases or a slower onset of pre-eclampsia (where high blood pressure develops more slowly), the condition may be managed for several weeks, prior to the baby’s delivery.

What To Expect

A diagnosis of pre-eclampsia in pregnancy can be frightening but it is important to stay calm and follow your healthcare provider’s advice. They will carefully monitor you and your baby and prescribe treatment based on your individual needs.

• Your healthcare provider may require more tests to determine the severity of the condition and the well-being of your baby. These may include further urine analysis, blood tests and foetal ultrasound
• In mild cases, you will be sent home. You will be carefully monitored and may be asked to come in for frequent prenatal checks to monitor your symptoms and your baby’s wellbeing. You may be prescribed medication to help lower your blood pressure
• In more severe cases and depending on how far along you are in your pregnancy, your healthcare provider may hospitalise you for closer monitoring
• If your blood pressure cannot be controlled and/or there is concern about your baby’s well-being, you may be advised to deliver your baby
• Depending on the severity of the condition, you may need an immediate Caesarean (C-section) or you may be induced (labour started by medications) for a normal vaginal delivery
• Babies born before 37 weeks will require care in the neonatal intensive care unit (NICU)

Coping Emotionally

If you don’t understand any aspect of your condition, reach out to your healthcare provider and ask questions. If you feel anxious, worried about the baby or depressed, contact your midwife at the Maternity Programme for counselling and support.

Research shows that women diagnosed with pre-eclampsia have higher incidence of postnatal depression (PND) and post-traumatic stress disorder (PTSD) after the birth. Share this with your partner or a close relative or friend, so that after your baby’s birth they are able to support you better.

Contact your healthcare provider if you are concerned or have any questions regarding your risk.

Resources:   https://www.tommys.org/; https://www.parents.com/; https://www.whattoexpect.com/; https://www.nhs.uk/; https://www.webmd.com/; https://utswmed.org/; https://www.preeclampsia.org/; https://ada.com/