When I was pregnant, I saw a lot of my doctors thanks to my blood pressure and I not getting along. In the later stages of my pregnancy, the words “pre-eclampsia” were bandied about a bit. It was discussed at length as to whether or not specific results that day indicated if I did or didn’t have it, or if it seemed likely I would. Nobody sounded very happy about the possibility so I for sure knew it wasn’t a good thing. However, there was little enough information being sent my way about it which led me to googling what it could possibly mean.
For a pregnant lady whose blood pressure was already high, googling may not have been the best idea. There’s a lot of information out there online. In particular, information in well meaning forums where pregnant women and mothers discuss different symptoms and features of pregnancy, birth and beyond. A lot of this can be misleading, or more frightening than it should be.
So, for the sake of my past self who was terrified of what this diagnosis could mean for me and my baby (thank you Downton Abbey), here is a No Nonsense Intro to Pre-Eclampsia – hopefully if you’re reading this due to a similar Google search, it will allay some of your fears. While it is a very serious condition which can be very dangerous if not managed correctly, it is also key to keep in mind that when it is caught in time, which is the majority of cases in modern Ireland, mother and baby get through it healthily and happily.
So, What is Pre-Eclampsia?
A preliminary google search found me the sentence “Pre-eclampsia is a dangerous condition which may strike without warning and kill within hours” – because that’s not going to rise the blood pressure at all, is it? Not exactly very helpful. Try not to panic, here comes the medical bit which is a whole lot less sensational.
Pre-eclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. It usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal. For this reason, it is important that your healthcare provider checks your blood pressure regularly during pregnancy – even a slight increase can be a preliminary symptom. It can also be referred to as “toxaemia”.
Pre-eclampsia affects up to 5% of women in pregnancy. It usually affects first time mothers, though it can occur in later pregnancies after previous healthy deliveries. If there is a family history (mother, aunt, sister) of pre-eclampsia this can increase your risk of having it. Obesity, PCOS, or a medical history of high blood pressure/diabetes/kidney disease can also increase your risk. Mothers who are carrying more than one child, or who have become pregnant as a result of in vitro fertilisation also carry this risk factor.
Signs and Symptoms
So what exactly is involved here?
In a lot of pregnancies, women can find that they have swelling in their extremities: ankles, wrists, etc. While this can be harmless, it is always best to check with your doctor as it can be a symptom of pre-eclampsia.
Your doctor/midwife will check a urine sample for protein – increased protein in the urine is a key indicator in the diagnosis of pre-eclampsia.
Consistent high blood pressure or hypertension is the third thing to look out for – this shouldn’t be ignored.
Other things to watch out for
- Rapid weight gain caused by a significant increase in bodily fluid
- Abdominal pain
- Severe headaches
- Change in reflexes
- Reduced urine or no urine output
- Excessive vomiting/nausea
- Vision changes
If you have experienced any of these symptoms, make sure to let your healthcare provider know: while on their own they may be harmless, it is never a bad thing to be too careful.
The only outright cure for pre-eclampsia is delivery of the baby – this can be quite straight forward if in later weeks of the pregnancy, however if it is earlier in the pregnancy there is likely to be a lot of attempts to manage the symptoms until the baby is likely to be viable and healthy upon delivery. Blood pressure can be managed with anti-hypertension medication, and it is possible that doctors will suggest steroid injections to the mother which will speed up the development of the baby’s lungs as to lessen the ill effects of an earlier delivery. (While these injections are totally worth it for the healthy baby lungs, they do hurt like hell when they’re being administered).
If they feel you are at risk of seizure, your medical team will give you magnesium sulphate. This also protects baby from ill effects on the brain from being born early.
A diagnosis of pre-eclampsia will mean a much more managed birth – it is unlikely that any plans for a home birth will be recommended by your medical team – however they will work with you to ensure that your baby is delivered safely and that both mother and baby are protected.
Pre-eclampsia can prevent the placenta from receiving enough blood. This can cause your baby to be born very small. It is also one of the leading causes of premature births. The complications that can follow include learning disabilities, epilepsy, cerebral palsy, hearing and vision problems.
In moms-to-be, pre-eclampsia can cause rare but serious complications that include:
- Water in the lungs
- Heart failure
- Reversible blindness
- Bleeding from the liver
- Bleeding after you’ve given birth
Pre-eclampsia can also cause the placenta to suddenly separate from the uterus, which is called placental abruption. This can cause stillbirth.
Globally, pre-eclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year worldwide.
Although all of that is a rather scary read; it is key to note that if attended to by your healthcare providers, the chances of these ill effects are substantially minimised. An increase in blood pressure during an appointment isn’t necessarily a sign that danger is imminent. For some people, being in the doctors/hospital may increase your blood pressure slightly – it’s called white coat syndrome. If this is the case, they will retake it after a few minutes to ensure the corrected measurement is taken. If you have any worries, bring them to your doctor, or give the maternity unit a call. It’s always best to err on the side of caution to make sure you and your baby are safe and healthy.
For further information about pre-eclampsia, check out the Irish NeoNatal Health Alliance website here.