Pre-eclampsia

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What is pre-eclampsia?

What are the signs of pre-eclampsia?

What tests and checks for pre-eclampsia will I have?

How common is pre-eclampsia?

When does pre-eclampsia develop?

What increases my risk of getting pre-eclampsia?

Is there anything I can do to prevent pre-eclampsia?

Can pre-eclampsia lead to other complications?

What is HELLP syndrome?

HELLP syndrome symptoms

HELLP syndrome treatment

How can pre-eclampsia affect my baby?

What is the treatment for pre-eclampsia?

Will having pre-eclampsia affect how I give birth?

What happens after I give birth?

Can having pre-eclampsia affect my long-term health?

Will I get pre-eclampsia in my next pregnancy?

What is pre-eclampsia?

Pre-eclampsia is a condition that affects some people in pregnancy (usually after 20 weeks) or soon after their baby is delivered. Signs of it are high blood pressure (hypertension) and protein in wee (proteinuria).

It can be mild, but it can lead to serious complications for you and your baby. If you have pre-eclampsia, it’s best to be diagnosed and monitored as soon as possible.

What are the signs of pre-eclampsia?

The early signs of pre-eclampsia include protein in your wee and high blood pressure. You probably won’t notice this yourself, which is why you’ll have regular wee and blood pressure checks as part of your routine antenatal care.

If the condition gets worse, you may have the following symptoms:

• a headache that doesn’t go away with simple painkillers
• vision problems, such as blurring or flashing
• severe pain just below the ribs
• feeling sick or vomiting
• heartburn that doesn’t go away with antacid medicines
• rapidly increasing swelling of the face, hands or feet
• feeling very unwell. 

What tests and checks for pre-eclampsia will I have?

Pre-eclampsia can be diagnosed through the routine checks you have in pregnancy.

At your antenatal appointments a sample of your wee will be tested for protein. Take a wee sample with you, if you can. You may be asked for another sample for testing if the first test shows your wee has protein in it.

Your blood pressure will be checked at your antenatal appointments too.

If the doctor or midwife thinks you may have pre-eclampsia, you may be offered a blood test. This tests for a protein called placental growth factor (PIGF). If your PIGF levels are low, it could be a sign of pre-eclampsia, but you would need further tests to be sure. 

How common is pre-eclampsia?

Pre-eclampsia affects between 1 and 5 in 100 pregnant women and birthing people in the UK. It’s usually mild but can develop into a more serious illness.

When does pre-eclampsia develop?

Pre-eclampsia usually happens after 20 weeks of pregnancy, although it can happen earlier, or soon after your baby is born.

Pre-eclampsia seems to be linked to problems with the placenta, which joins your blood supply to your baby’s. But experts don’t know exactly what causes it. At Tommy’s, we are funding research to figure out why it happens and how we can stop it.

What increases my risk of getting pre-eclampsia?

You are at higher risk if:

• your blood pressure was high before you got pregnant  
• your blood pressure was high in a previous pregnancy
• you have a medical condition such as diabetes, kidney problems or a condition that affects your immune system, such as lupus or antiphospholipid syndrome.

Other things that can increase your risk of developing pre-eclampsia include if:

• you are 40 or older
• this is your first pregnancy
• your last pregnancy was more than 10 years ago
• your mother or sister had pre-eclampsia  
• you are overweight with a BMI (Body Mass Index) of 35 or more
• you are expecting more than 1 baby.

Is there anything I can do to prevent pre-eclampsia?

There’s no guaranteed way to prevent pre-eclampsia. The best thing to do is go to all your antenatal appointments and follow your healthcare professional’s advice.

There is good evidence that low-dose aspirin slightly reduces the risk of pre-eclampsia and its complications. You may be prescribed low-dose aspirin (75 -150 mg) once a day from 12 weeks of pregnancy to 36 weeks or, if you have more than 1 risk factor for pre-eclampsia, until your baby is born.  

You’ll be given the same advice as every pregnant person about exercise and eating well. There is specific advice for people with pre-existing diabetes or gestational diabetes.

Following this advice will help you have as healthy a pregnancy as possible. 

Can pre-eclampsia lead to other complications?

If pre-eclampsia is severe, it can start to affect your body functions and organs. It can also affect your baby’s growth or make them very unwell or even die in your womb. This is why it’s vital to be diagnosed as soon as possible. 

Fits (eclampsia)

If you have a fit because of pre-eclampsia, it’s called eclampsia or an eclamptic fit. During a fit, your arms, legs, neck or jaw will twitch in jerky movements. You may lose consciousness and wet yourself. The fit usually lasts less than a minute. 

In the UK, eclampsia is rare, affecting around 1 in 4000 pregnancies.

You may be offered treatment with magnesium sulfate to prevent fits or if you have eclampsia.

What is HELLP syndrome?

HELLP syndrome causes problems with the liver and blood clotting. HELLP stands for the three parts of the condition:

H for hemolysis, where red blood cells break down.

EL for elevated liver enzymes – lots of these enzymes are a sign of liver damage.

LP for low platelet count. Platelets are blood cells that help blood to clot.

HELLP syndrome happens in about 1 in 200 pregnancies but in 1 to 2 in every 10 people with severe pre-eclampsia.

It's most likely to develop immediately after the baby is delivered. But it can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks. 

HELLP syndrome symptoms

Most people with HELLP syndrome have the key signs of high blood pressure and high levels of protein in their wee. Typical symptoms include:

• bad pain just below the ribs
• feeling sick and vomiting
• extreme tiredness (fatigue)
• headache.

HELLP syndrome treatment

HELLP syndrome is potentially as dangerous as eclampsia. You and your baby will be closely monitored. With treatment, it’s possible to make a full recovery. 

If you are more than 34 weeks pregnant, it’s likely that your baby will be delivered as soon as possible. If you are less than 34 weeks and your doctors feel it’s safe to wait longer before your baby is delivered, you are likely to be given medicines to control your blood pressure and reduce the risk of fits, and steroids to help your baby’s lungs grow. You may also need to be given a blood transfusion, via a drip.

Other complications of pre-eclampsia

These can include:

• liver and kidney failure
• stroke (cerebral haemorrhage)
• fluid in the lungs (pulmonary oedema)
• blood clotting disorder.

Your healthcare team will be looking for signs of pre-eclampsia throughout your pregnancy, and you’ll get treatment and care immediately if you do develop symptoms. So it is very unlikely that you’ll develop any of these problems. 

How can pre-eclampsia affect my baby?

Because your placenta may not be working as well as it should be, your baby may not get all the nutrients and oxygen they need. This may affect their growth. This is called fetal growth restriction.  

If you are diagnosed with pre-eclampsia, you will usually have extra ultrasound scans to monitor your baby’s growth.

If you have mild pre-eclampsia, you’ll probably be advised to have your baby at about 37 weeks. If your healthcare team is concerned about you or your baby, you may need to give birth earlier.

You will probably be given antenatal corticosteroid medication to help improve your baby’s lung development before they are born. Babies born before 37 weeks may have some problems associated with being born premature. Your baby may need extra care in a neonatal intensive care unit.

Very sadly, some babies may be stillborn.

What is the treatment for pre-eclampsia?

Pre-eclampsia can only be cured by delivering the baby. You will be closely monitored until your baby can be delivered.

If you are diagnosed with pre-eclampsia, you’ll be referred to a hospital specialist for more tests. You may be allowed to go home after these tests, or you may be admitted to hospital for monitoring and treatment. 

Some people with severe pre-eclampsia may need to be in hospital for the rest of their pregnancy. This may be on the labour ward or in more serious cases, you may need to be admitted to an intensive care or high dependency unit.

While in hospital you’ll have:

• regular blood pressure checks
• regular wee tests (to check your protein levels)
• blood tests (to check your kidney and liver health)
• ultrasound scans (to check your baby’s growth and the amount of amniotic fluid surrounding them)

Your baby’s heart rate will also be monitored.

You may need extra scans to check your baby’s health if you had any of the following in a previous pregnancy:

• severe pre-eclampsia
• pre-eclampsia that resulted in birth before 34 weeks
• pre-eclampsia with a baby whose birth weight was low (less than the 10th centile)
• stillbirth
• placental abruption.

Your medical team’s priority will be to stop you developing complications. You’ll be given medication (tablets) to lower and control your blood pressure. This will help reduce your risk of stroke.

Will having pre-eclampsia affect how I give birth?

For most people with pre-eclampsia, having your baby around 37 weeks is recommended, or sooner if needed. You will either be induced or you may need a caesarean section. If you planned to have a caesarean, you are likely to have it earlier than planned.

Exactly when this will be will depend on your situation. You should be given information about the risks of both premature birth and pre-eclampsia so you can make the best decision about your treatment.

Find out more about giving birth to a premature baby.

What happens after I give birth?

Although pre-eclampsia usually gets better soon after the baby is born, you might have complications after a few days. You may need to stay in hospital to be monitored for a while.

You’ll have your blood pressure checked regularly after leaving hospital. You may also need to take medication to lower your blood pressure for several weeks. Your healthcare team will make sure that your medicines are safe to use while breastfeeding.

If you are taking medicine, you should be offered an appointment with your GP 2 weeks after your transfer from hospital care to the community midwives. You’ll be offered another appointment 6 to 8 weeks after your baby is born. This is to review your progress and check whether your treatment needs to change or can stop. This is separate from the check offered to everyone 6 to 8 weeks after they’ve given birth. 

If you are still on medication to treat your blood pressure 6 weeks after the birth, or there is still protein in your wee, you may be referred to a specialist.

You can also talk to your midwife or health visitor at any time if you have any concerns. 

Can having pre-eclampsia affect my long-term health?

Having pre-eclampsia increases the risk of developing high blood pressure and heart disease in later life. Taking care of yourself and having a healthy lifestyle can help reduce this risk. Try to:

• avoid smoking
• exercise regularly
• eat a healthy, balanced diet
• maintain a healthy weight.

Will I get pre-eclampsia in my next pregnancy?

If you have high blood pressure or pre-eclampsia during pregnancy, you are more likely to get it again when you’re next pregnant. This happens to about 1 in 5 people, but the risk varies depending on how early your baby needed to be born.

The chances of developing pre-eclampsia in a future pregnancy are:

• 1 in 3 for people who gave birth between 28 and 34 weeks
• 1 in 4 for people who gave birth between 34 and 37 weeks  
• 1 in 6 for people who gave birth after 37 weeks.

You should be told about your individual risk of getting pre-eclampsia in future and any extra care you may need.

If you have had pre-eclampsia and are planning for a future pregnancy, being a healthy weight can reduce your risk of having pre-eclampsia again. This isn’t always easy, but we have more information that may help.  

Find out more about planning for pregnancy.