Condition Basics

What is pre-eclampsia?

Pre-eclampsia is high blood pressure after 20 weeks of pregnancy that may affect the mother's organs or the baby. Severe pre-eclampsia can lead to dangerous seizures (eclampsia). Pre-eclampsia usually goes away after the baby is delivered. But symptoms may last a few weeks or more and can get worse (or show up) after delivery.

What causes it?

Experts don't know the exact cause of pre-eclampsia. It seems to start because the placenta doesn't grow the usual network of blood vessels deep in the uterine wall. This leads to poor blood flow in the placenta. It's not clear what causes this placenta problem and why the mother then develops high blood pressure.

What are the symptoms?

Mild pre-eclampsia usually doesn't cause symptoms. But it may cause rapid weight gain and sudden swelling of the hands and face. Severe pre-eclampsia causes symptoms such as a very bad headache and trouble seeing and breathing. It also can cause belly pain and decreased urination.

How is it diagnosed?

Pre-eclampsia is usually found during a routine prenatal visit. That's one reason it's important to go to all of your prenatal visits. You need to have your blood pressure checked often. Your blood pressure is measured at each prenatal visit. A sudden increase in blood pressure often is the first sign of a problem.

You'll also be weighed and have a urine test at each visit to look for signs of pre-eclampsia. Women who are at high-risk for pre-eclampsia may have other tests too.

If tests suggest that you have pre-eclampsia, you'll be carefully checked for the rest of your pregnancy. Your baby's health also will be closely watched. The more severe your condition is, the more often you'll need testing. This might range from once a week to daily.

How is pre-eclampsia treated?

If you have mild pre-eclampsia that isn't quickly getting worse, home care may be enough. You may only have to reduce your level of activity, watch how you feel, and have frequent office visits and testing.

For severe pre-eclampsia, you may need to be in the hospital. You may get medicines to lower your blood pressure and to prevent seizures. You also may get medicine to help prepare your baby's lungs for birth.

The only "cure" for pre-eclampsia is having the baby. But symptoms may last a few weeks or more and can get worse after delivery. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.

What Increases Your Risk

Some things increase your risk of pre-eclampsia. For example, your risk is higher if you:

• Have chronic (ongoing) high blood pressure, chronic kidney disease, certain autoimmune diseases, or diabetes.
• Had high blood pressure in a past pregnancy, especially before week 34.
• Had pre-eclampsia before.
• Have a family history of pre-eclampsia.
• Were very overweight when your baby was conceived.
• Are pregnant with more than one baby (such as twins or triplets).
• Are pregnant for the first time ever.
• Are older than 35.

Prevention

Lowering your blood pressure helps to prevent pre-eclampsia. If you have chronic high blood pressure, you can lower your blood pressure before pregnancy by:

• Exercising.
• Eating a diet low in sodium and rich in fruits and vegetables.
• Staying at a healthy weight.

When you are pregnant, regular checkups are important. They let the doctor find and treat problems early. With prompt treatment, you are more likely to prevent severe and possibly life-threatening pre-eclampsia.

To reduce your risk for pre-eclampsia, your doctor may recommend that you take low-dose aspirin during the second and third trimesters of your pregnancy.

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Symptoms

Mild pre-eclampsia usually doesn't cause symptoms. But it may cause symptoms such as:

• Swelling of the hands and face that doesn't go away during the day.
• Rapid weight gain—more than 1 kg (2 lb) a week or 3 kg (6 lb) a month.

Severe pre-eclampsia can cause:

• A severe headache that will not go away with medicine such as acetaminophen.
• Blurred or dimming vision, spots in the visual field, or periods of blindness.
• Decreased urination—less than 500 mL (16 oz) in 24 hours.
• Lasting belly pain or tenderness, especially on the upper right side.
• Bleeding from a cut or injury that lasts longer than usual.
• Trouble breathing, especially when lying flat.
• HELLP syndrome, a very serious liver disorder.

Severe pre-eclampsia can lead to seizures (eclampsia). Eclampsia is life-threatening for both mother and baby.

What Happens

Pre-eclampsia can be mild or severe. It may get worse gradually or quickly. It affects your blood pressure, and can also affect your placenta, liver, blood, kidneys, and brain.

Delivering the baby and placenta is the only "cure" for pre-eclampsia. If your condition becomes dangerous enough that delivery is necessary but you don't go into labour, your doctor will induce labour. Or they will deliver the baby with surgery (caesarean section). Symptoms of pre-eclampsia may last a few weeks or more and can get worse after delivery. Rarely, symptoms of pre-eclampsia don't show up until days or even weeks after childbirth.

After you've had pre-eclampsia, you have a higher-than-average risk of heart disease, stroke, and kidney disease. This may be because the same things that cause pre-eclampsia also cause heart and kidney disease. To protect your health, work with your doctor on living a heart-healthy lifestyle and getting the checkups you need.

Complications of pre-eclampsia

When you have pre-eclampsia, it's very important to get treatment. That's because both you and your baby could suffer life-threatening problems that involve your:

• Blood pressure. The blood vessels increase their resistance against blood flow, raising your blood pressure. Very high blood pressure keeps your baby from getting enough blood and oxygen. Also, blood volume doesn't increase as much as it should during pregnancy. This can affect the baby's growth and well-being.
• Placenta. The blood vessels of the placenta don't grow deep into the uterus as they should. And they don't widen as they normally would. So they can't provide normal blood flow to the baby.
• Liver. Poor blood flow to the mother's liver can cause liver damage. Liver impairment is related to the life-threatening HELLP syndrome, which requires emergency medical treatment.
• Kidneys. When affected by pre-eclampsia, the kidneys can't work as well as they should to remove waste and extra water.
• Brain. Vision impairment, persistent headaches, and seizures (eclampsia) can develop. Eclampsia can lead to maternal coma and fetal and maternal death. This is why women with pre-eclampsia are often given medicine to prevent eclampsia.
• Blood. Low platelet levels in the blood are common with pre-eclampsia. In rare cases, a potentially life-threatening blood-clotting and bleeding problem develops along with severe pre-eclampsia. This condition is called disseminated intravascular coagulation (DIC). After delivery, DIC goes away. In the meantime, you may be given a medicine (clotting factor), blood transfusion, or platelet transfusion.

Problems for the baby

The earlier in the pregnancy that pre-eclampsia starts and the more severe it gets, the greater the risk of preterm birth. A preterm birth can cause problems for the newborn.

An infant born before 37 weeks may have trouble breathing because of immature lungs (respiratory distress syndrome).

A newborn affected by pre-eclampsia may also be smaller than normal. This is because the baby can't get enough nutrition due to poor blood flow through the placenta.

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When to Call a Doctor

Share this information with your partner or a friend. They can help you watch for warning signs.

Call 9-1-1 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have a seizure.

Seek medical care now if you are pregnant and start to have symptoms of pre-eclampsia, such as:

• Blurred vision or other vision problems.
• Frequent headaches that are getting worse or a persistent headache that does not respond to non-prescription pain medicine.
• Pain or tenderness in your belly, especially in the upper right section.
• Weight gain of 1 kg (2 lb) or more over a 24-hour period.
• Shoulder, neck, and other upper body pain (this pain starts in the liver).

If you have mild high blood pressure or mild pre-eclampsia, you may not have any symptoms. It's important to see a health professional regularly throughout your pregnancy.

Symptoms such as heartburn or swelling in the legs and feet are normal during pregnancy. They usually aren't symptoms of pre-eclampsia. You can discuss these symptoms with your doctor or midwife at your next scheduled prenatal visit. But if swelling occurs along with other symptoms of pre-eclampsia, contact your doctor or midwife right away.

Examinations and Tests

Pre-eclampsia is usually found during regular prenatal checkups. That's one reason it's important to go to all of your prenatal visits. Tests are done at each visit to check for pre-eclampsia, including these tests:

Blood pressure reading.

Blood pressure is always watched closely during pregnancy.

Urine test.

Too much protein in the urine is a sign of kidney damage caused by pre-eclampsia.

Weight measurement.

Rapid weight gain can be a sign of pre-eclampsia.

Women who are at high risk for pre-eclampsia may also have other tests, including:

Blood tests.

Blood tests may be done to check for problems such as HELLP syndrome and kidney damage.

A creatinine clearance test.

This is done to check how well the kidneys are working. It requires both a blood sample and a 24-hour urine collection.

A 24-hour urine collection test.

This is done to check protein in the urine.

Follow-up testing

If tests suggest that you have pre-eclampsia, you'll be carefully checked for the rest of your pregnancy. Your baby's health also will be closely watched. The more severe your pre-eclampsia is, the more often you'll need testing. This might range from once a week to daily.

Tests for the mother.

You may have a physical examination to check for signs that pre-eclampsia is getting worse. You may also have:

• Blood tests to check for blood problems and kidney damage.
• Creatinine clearance test.

Tests for the baby.

Tests commonly used include:

• Electronic fetal heart monitoring to record the baby's heart rate.
• Fetal ultrasound to check the baby, the placenta, and the amount of amniotic fluid.
• Doppler ultrasound to see how well the placenta is working.

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Treatment Overview

If you have mild pre-eclampsia that isn't quickly getting worse, home care may be enough. You may only have to reduce your activity, watch how you feel, and have frequent office visits and testing.

For severe pre-eclampsia, or for pre-eclampsia that is quickly getting worse, you may need to be treated in the hospital. This often includes taking medicine and keeping a close watch on you and your baby.

Severe pre-eclampsia is treated with magnesium sulfate. This medicine can stop a seizure and can prevent seizures.

Delivery

The only "cure" for pre-eclampsia is having the baby. But symptoms may last a few weeks or more and can get worse after delivery. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.

• If you are near delivery or have severe pre-eclampsia, your doctor will plan to deliver your baby as soon as possible.
• If you are less than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will probably get corticosteroid medicine. This can help prepare your baby's lungs for birth.

A vaginal delivery is usually safest for the mother. It is tried first if the mother and the baby are both stable. A caesarean section (C-section) is needed if pre-eclampsia is quickly getting worse or the baby can't safely handle labour contractions.

Care after birth

If you have moderate to severe pre-eclampsia, your risk of seizures (eclampsia) continues for the first 24 to 48 hours after childbirth. So you may keep getting magnesium sulfate for 24 hours after delivery.

If your blood pressure is still high after delivery, you may be given a blood pressure medicine. You will have regular checkups with your doctor.

If you didn't have high blood pressure before pregnancy, your blood pressure is likely to return to normal a few days after delivery.

Rarely, symptoms of pre-eclampsia don't show up until days or even weeks after childbirth.

After having pre-eclampsia, you have a higher risk for heart disease, stroke, and kidney disease. To protect your health, work with your doctor to build heart-healthy habits and get the checkups you need.

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Self-Care

• Take and record your blood pressure at home if your doctor tells you to.
  • Ask your doctor to check your blood pressure monitor to be sure that it is accurate and that the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
  • You should not eat, use tobacco products, or use medicine known to raise blood pressure (such as some nasal decongestant sprays) before you take your blood pressure.
  • Avoid taking your blood pressure if you have just exercised. Also avoid taking it if you are nervous or upset. Rest at least 15 minutes before you take your blood pressure.
• You may need to take medicine to manage your blood pressure. Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Do not smoke. Quitting smoking will help improve your baby's growth and health. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Eat a balanced and healthy diet that has lots of fruits and vegetables.
• You can keep track of your baby's health by checking your baby's movement. A common method for this is to note the length of time it takes to count 6 movements (such as kicks, flutters, or rolls). Call your doctor or nurse advice line if you don't feel at least 6 movements in a 2-hour period. Track your baby's movements once each day. Bring this record with you to each prenatal visit.

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Medicines

If you have pre-eclampsia, you may take medicine to:

Control high blood pressure.

Lowering high blood pressure doesn't prevent pre-eclampsia from getting worse. That's because high blood pressure is only a symptom of pre-eclampsia. It's not a cause. Your doctor may recommend blood pressure medicine if your blood pressure reaches high levels that may be dangerous to you or your baby.

Prevent seizures.

Magnesium sulfate is usually started before delivery and continued for 24 hours after delivery for women who have:

• Pregnancy-related seizures (eclampsia).
• Moderate to severe pre-eclampsia.

Speed up your baby's lung development.

When possible, steroid medicine is given to the mother before a premature birth. It helps the baby's lungs to mature over a 24-hour period. This lowers the baby's risk of breathing problems after birth.

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