Pre-eclampsia and Hypertension in pregnancy

If you are planning on having a baby, or in the early stages of pregnancy – it’s important to be informed about pre-eclampsia and the consequences it can pose for you and your baby.

What is pre-eclampsia?

Pre-eclampsia is a complication that occurs most often at around 20 weeks gestation or the 3rd trimester of pregnancy. In rarer instances, it can occur as early as the 2nd trimester or very rarely, after the baby is delivered (this is called post-partum pre-eclampsia). 

It is characterised in the mother developing hypertension (or high blood pressure) and protein in the urine. 

What is hypertension?

Hypertension (or high blood pressure) is a common condition which if left untreated may eventually result in health problems including heart disease. Your blood pressure is determined by the amount of blood your heart pumps, and the resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the high your blood pressure. 

Some women have hypertension before becoming pregnant, and others develop it for the first time during pregnancy.

Is pre-eclampsia dangerous?

Although most cases of pre-eclampsia are mild, it can worsen during pregnancy. If left undiagnosed, pre-eclampsia can lead to serious or even fatal complications for mother and baby resulting in seizures in the mother and impacts on the baby’s growth.

What are the symptoms of pre-eclampsia?

Sometimes pre-eclampsia develops without any symptoms. Hypertension can develop slowly or have a sudden onset which is why it’s essential that your blood pressure is checked regularly as part of your pre-natal care.

Other symptoms of pre-eclampsia can include:

• Increased levels of protein in your urine or other signs of kidney problems
• Severe headaches
• Vision changes including blurred vision, light sensitivity, or even a temporary loss of vision
• Nausea or vomiting
• Pain in the upper abdominal area
• Decreased levels of urine output
• Decreased levels of platelets in the blood
• Impaired liver function
• Shortness of breath
• Sudden swelling of the hands, ankles, or face
• Sudden weight gain and swelling

Who is at risk of developing pre-eclampsia?

It is not full known why some women develop pre-eclampsia, however there are some recognised “high risk” factors and “moderate risk” factors. 

Women who are at high risk include:

• Those who have pre-eclampsia in a past pregnancy
• Multiple fetus’
• Had certain pre-existing health conditions before becoming pregnant including chronic hypertension, kidney disease, diabetes
• Has an autoimmune condition

Women who are at moderate risk include:

• First time pregnancy
• Women with a BMI over 30
• Close family history of pre-eclampsia (mother or sister)
• Age:  very young women or women over 35

How is pre-eclampsia diagnosed?

In most cases, a high blood pressure reading is the first sign of pre-eclampsia. This is why when you attend for your pre-natal checks it is important that your blood pressure is taken at every visit. 

If you do have a high reading, other tests are undertaken including a urine test to check for protein, and in some instances further tests to check your liver and kidney function and your blood platelet levels.

Can pre-eclampsia be prevented?

Unfortunately, there is no screening test available to predict the development of pre-eclampsia during pregnancy. For now, prevention is limited to identifying whether you have risk factors, and if it is identified you are at risk, monitoring during your pregnancy.

If you are identified as being high risk or if you have two or more risk factors of developing pre-eclampsia, low dose aspirin and calcium supplements may be recommended.

You should discuss this with Dr Parashar at your pre-natal visits, and please DO NOT start taking aspirin or calcium supplements on your own.

What if I have high blood pressure and I am trying to become pregnant?

If you have high blood pressure and want to become pregnant you should first arrange for an obstetric check-up. This is to determine if your high blood pressure is under control and what affects (if any) it has had on your health. Your medications will also be reviewed in case they need to be changed to a safer option during pregnancy.

How is pre-eclampsia treated or cured?

The treatment is based on whether the pre-eclampsia is mild or severe and is focused on lowering blood pressure and the management of other symptoms.

It is important to note that the only cure for pre-eclampsia is delivering the baby.

Mild pre-eclampsia is managed by monitoring through frequent antenatal visits with the following regular checks:

• Blood pressure to check for any increase (hypertension)
• Urine tests for protein
• Checking of the development of other symptoms

Severe pre-eclampsia is more difficult to manage and may need you to be admitted to hospital. Treatment will be focused on:

• Bed rest
• Anti-hypertensive medication
• Anti-convulsant medication

As pre-eclampsia worsens as the pregnancy progresses, if you have severe pre-eclampsia, you and your baby will be closely monitored and checked for:

• Abnormal blood pressure increases
• Blood and urine tests to check your liver and kidney functions
• Physical examinations to test leg reflexes
• Ultrasound scans to check blood flow through the placenta and observe your baby’s growth rate, breathing and movements
• Monitoring of your baby’s heart rate

When will I deliver my baby if I have pre-eclampsia?

If you have mild to moderate re-eclampsia you will likely be advised to deliver at around 37 weeks by either induced labour or caesarean section.

In the case of severe pre-eclampsia, the delivery time will be determined by close monitoring. Unfortunately, this could mean that your baby is born very early and may be at risk of developing complications due to being premature.

Specialist obstetric care

If you are diagnosed with pre-eclampsia you will need ongoing treatment and management during your pregnancy for best outcomes. As a qualified obstetrician, Dr Parashar is an expert in the treatment and management of pre-eclampsia. 

If you are trying to become pregnant, or you are pregnant, please ask your family doctor for a referral and call our team on 1300 811827 to arrange for an appointment. At your consultation, Dr Parashar will review your history and pregnancy, read your blood pressure, and undertake all other necessary tests. She will then be able to discuss your risks for pre-eclampsia and develop a management and treatment plan to ensure your good health is maintained.