Pre-eclampsia

Pre-eclampsia is a serious pregnancy condition marked by high blood pressure after 20 weeks of pregnancy, together with signs that other organs (kidneys, liver) are affected — usually protein in the urine. It can progress rapidly to life-threatening complications for both mother and baby. For a broader overview of blood-pressure problems in pregnancy, see our page on High Blood Pressure in Pregnancy.

Symptoms

Early pre-eclampsia often has no obvious symptoms — which is why routine blood-pressure checks at antenatal visits are so important. Signs and symptoms that should prompt urgent review include:

• Severe or persistent headache
• Blurred vision, seeing spots or flashes
• Pain under the ribs on the right side
• Swelling of the face, hands, or feet (swollen feet alone can be a normal finding in pregnancy)
• Sudden weight gain
• Nausea or vomiting in the second half of pregnancy
• Reduced foetal movements

Who is at higher risk?

• First pregnancy
• Previous pre-eclampsia
• Chronic hypertension, kidney disease, diabetes (including gestational diabetes), lupus, or antiphospholipid syndrome
• Twin or triplet pregnancy
• Age under 20 or over 40
• Obesity
• Long gap since previous pregnancy
• Family history of pre-eclampsia

Complications

Pre-eclampsia can progress to:

• Eclampsia — seizures, which can be fatal
• HELLP syndrome — a rare but severe variant with liver damage and low platelets
• Placental abruption — the placenta separating from the uterus
• Poor foetal growth and low birth weight
• Preterm birth
• Long-term cardiovascular risk for the mother, later in life

Treatment

The only cure for pre-eclampsia is delivery of the baby. Until that's safe, management aims to control blood pressure and keep the pregnancy going as long as possible:

• Closer monitoring — blood pressure, urine protein, foetal monitoring
• Blood-pressure medicines safe in pregnancy — your doctor will choose the right one for you
• Magnesium sulphate — to prevent seizures in severe pre-eclampsia
• Steroids — to speed up foetal lung development if preterm delivery is likely
• Hospital admission for severe cases
• Timing of delivery — based on how severe the condition is and how mature the baby is

Prevention

Symptoms usually resolve within 6 weeks after delivery, but long-term follow-up matters — women who had pre-eclampsia are at higher risk of cardiovascular disease later in life.