Pre-eclampsia during pregnancy: Frequently asked questions

How is the diagnosis made?

Pre-eclampsia is a condition that only occurs in pregnancy and usually after 20 weeks. It causes high blood pressure (or makes existing high blood pressure worse) and leaky kidneys with protein in the urine. The diagnosis is made based on symptoms you may experience, blood tests and urine tests.

What does this mean?

For me

The only cure for pre-eclampsia is giving birth to your baby (and placenta) but the timing of birth needs to be balanced with how unwell you and/or you baby are and what early birth would mean for your baby. You may experience headaches, blurred vision, vomiting, swelling of your hands and face or feel generally unwell. At worst, pre-eclampsia can cause kidney or liver failure, blood clotting problems and seizures.

For my baby

Pre-eclampsia affects the way the placenta works and can cause babies not to grow well in the womb and need to be born early. Babies born early may need to spend time on the Neonatal Unit to help them with breathing, feeding and temperature control. Sadly, some babies don’t survive in the womb because of pre-eclampsia.

What will the medical team recommend?

Your medical team will recommend regular checks and occasionally admission to hospital for very close monitoring. You will have regular blood tests to check your kidneys, liver and blood and your blood pressure will be monitored regularly. Extra scans of your baby will be recommended to check that they are growing well in the womb. If you develop pre-eclampsia before 37 weeks of pregnancy, then you may give birth earlier or be recommended to have labour induced at 37 weeks. If you develop pre-eclampsia after 37 weeks, induction of labour will be recommended straight away. This may be a difficult time for you and your family so it is important to have regular and open conversations with your medical team.

What tests will/may be considered? How often may they be needed?

The amount of protein in your urine will be tested alongside tests of your blood, kidney and liver function. The blood test called Placental Growth Factor that shows how well the placenta is working and helps doctors and midwives make the diagnosis of pre-eclampsia before 37 weeks.

What symptoms and signs should I be looking out for?

Headaches,swelling in your hands and face, blurred vision, pain in your tummy, vomiting, or your baby moving less than is normal.

What are the ‘red flag’ symptoms/concerns, which should be reported immediately?

If your baby isn’t moving as normal, then you should be seen at the hospital immediately. If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.

Likely recommendations

Treatment options

Tablet treatment for your blood pressure will be recommended if your blood pressure reading is more than or equal to 140/90 mmHg The tablets most commonly used are:

• Labetalol
• Nifedipine
• Methyldopa

Timing of birth

This will depend on how well you and your baby are in the pregnancy. From 37 weeks, induction of labour will be recommended as the risks of remaining pregnant for you and your baby are higher than if you give birth after this time.

How may this affect my birth choices?

Continuous monitoring of your baby’s heart beat in labour will be recommended whether you labour spontaneously or are induced, this is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This is available in hospital on the labour ward.

How may this affect care after the birth?

• You will need to have your blood pressure checked very regularly and stay in the hospital for at least 24 hours after you give birth
• Any blood pressure treatment will be switched to those suitable for breastfeeding (enalapril or amlodipine)
• You may need to have magnesium and restrict how much fluid you drink
• You will need to see your GP for ongoing monitoring of your blood pressure and treatment after the birth

What will this mean for future pregnancies? How can I reduce my risk of this happening again?

High blood pressure can be reduced through diet and exercise if you are overweight or inactive. You will be advised to take aspirin in future pregnancies to reduce the risk of developing pre-eclampsia again as aspirin helps the placenta work well.

What will this mean for future/my long-term health and how can I influence this?

Pre-eclampsia increases your lifetime risk of high blood pressure four times compared to women who don’t have pre-eclampsia in their pregnancies. Your risk of high blood pressure and heart disease can be reduced by eating healthily, especially by reducing your salt intake and exercising regularly. Your risk of heart disease can also be reduced by taking your blood pressure treatment to control your blood pressure and your GP will tell you how low they would like your blood pressure to be on treatment.