Pre-eclampsia: More than just 'high blood pressure'
Posted on 20th February 2019 at 20:52
In days gone by, having a complication during pregnancy could trigger a train of thoughts about a difficult outcome…..but thankfully, times have changed.
We know a lot more about pregnancy, birth, the common risks, preceding 'warning signs' and, ultimately, what to do to treat the potentially serious conditions mothers might face during childbirth today ...and that's wonderful.
But it absolutely doesn't mean we should become complacent when it comes to watching out for anything 'abnormal' during childbirth.
The conditions and risk factors that made childbirth so perilous for our predecessors haven't disappeared - we just know more about them now; how to treat them.....what to look out for..... This is why your midwife, GP and Obstetrician are all vital to ensuring you and your baby stay safe throughout your pregnancy and birth.
They are the experts in checking everything is 'OK' - but they are also the people you REALLY want around when something is NOT 'OK'.
This week, we are going to spotlight on pre-eclampsia - a condition 'peculiar to pregnancy' (I hear my lecturer's voice ringing in my ears every time I say that!!!) which you may have heard of but don't really know much about. (That's OK. There's no exam at the end of this entry I promise!).
Suffice to say pre-eclampsia is one of the conditions which made childbearing so risky in days gone by; Downton Abbey fans may remember how devastating it can be, but don't be fooled - it is not just a historical threat - and it is not as rare as you might think.
It might surprise you to know that up to 6% of UK pregnancies are affected by pre-eclampsia, with as many as 2/100 pregnant women developing SEVERE pre-eclampsia and around 10/100 preterm births (before 37 weeks) resulting from such conditions.
SO WHAT IS IT?
Most people associate pre-eclampsia with the following symptoms; high blood pressure, protein in the mother's urine, swelling (of the feet, ankles, face, hands), with 'later' symptoms of severe headache, vision disturbances and epigastric pain (pain below the ribs which is usually right sided).
We diagnose pre-eclampsia when there are at least two of these characteristic symptoms and possibly signs of abnormal activity on blood testing, but there are numerous other symptoms we might see in mum or baby on further investigation - which is why it is essential to attend any appointments you are given in pregnancy.
There is much we still don't know about pre-eclampsia but it is thought to be related to early placental development and the blood vessels at the placental site. There is likely an abnormal development of the placental blood vessels which restricts the blood flow to the placenta and may also restrict the blood flow to the baby later in the pregnancy. During the second half of pregnancy (usually from 20 weeks) we see pre-eclampsia developing with increased frequency closer to term. Early on it may seem mild, but if left untreated the increase in blood pressure appears to 'snowball' throughout the pregnancy, eventually causing further symptoms, reduced growth of the fetus and (rarely) progressing to eclampsia, which is a very serious condition causing mothers to have life threatening seizures due to exceptionally high blood pressure.
Pre-eclampsia typically develops after 20 weeks or AFTER the baby is born and sadly it may even result in poor outcome for mum and baby if it is not treated properly.
WHO GETS IT?
Unfortunately everyone is at risk of developing the condition (which is why all women have routine checks throughout pregnancy) but we do see a higher incidence of pre-eclampsia in certain groups:
- women who have previously had pre-eclampsia (1:6 will have it again in a future pregnancy)
- first time mothers
- not a first baby, but this baby has a different father
- multiple pregnancy
- women with family history of Pre-eclampsia (maternal side)
HOW WILL I KNOW IF I HAVE IT?
Most women have no idea that they have started to develop pre-eclampsia or even in the later stages. Some women may have the complaints described above, swelling (of the feet, ankles, face, hands), headache, vision disturbances and epigastric pain. However your midwife should notice and pick up any symptoms way before you feel unwell. The most vital tests for pre-eclampsia are your routine blood pressure and urine tests which your midwife will do at every appointment (another reason to attend ALL of your appointments!).
Often a spike in blood pressure (more than 20 units above the 'booking' or first BP measurement) or protein in the urine is the first sign something might be amiss - your midwife will usually pick this up and send you to the hospital for further checks, even if you feel 'fine' these checks are crucial.
If the results seem normal we would then keep a close eye on you for further symptoms for the rest of the pregnancy, such as further raised blood pressure results or protein in the urine.
Protein is an important sign - it's molecules are too large to pass through the walls of the kidneys into the urine under normal conditions, however they ARE able to pass into the urine in pre-eclampsia because the associated high blood pressure can cause microscopic damage to the delicate kidneys, so the kidneys filter the protein into the urine.
Thus when we see high concentrations of protein in maternal urine we know there is a good chance something abnormal is going on. (Other causes of proteinuria include urine infection, known history of kidney problems, ruptured membranes, sample contamination). Usually we would send a sample to the lab to quantify and check for the cause of this protein in your urine, to be sure it isn't being caused by something unrelated.
IS THERE ANY TREATMENT?
Unfortunately we cannot cure pre-eclampsia.....but if you develop this condition we CAN manage it. Once you have been diagnosed with the condition your care will be managed by doctors - Obstetricians - in the hospital, regardless of whether you were seeing a doctor before being diagnosed. They will manage your condition and your pregnancy from this point on.
Ultimately delivering your baby (and his or her placenta) is the only way to 'get rid of' the condition, but if you are very early in your pregnancy (or your condition is mild) we will try and keep baby inside the safety of your uterus for as long as is .... Well, safe!
We can manage the blood pressure with a type of drug known as 'anti-hypertensive' (this should also limit the protein seen in your urine) and we will keep a very close eye on baby's growth, blood flow, and placenta using ultrasound scanning.
You should also keep a close eye on baby's movements and if there are any concerns call the hospital, who can arrange to do a CTG (Heart trace) to check on your baby's wellbeing. You might be offered these tests a few times a week towards the end of your pregnancy to make sure baby is safe and well.
We can deliver your baby by Caesarean section, early, if your doctor thinks necessary - but this is a decision which must be carefully considered and discussed with your Obstetrician.
WHAT CAN I DO TO PREVENT IT?
Unfortunately you cannot prevent yourself developing the condition, but there are some general measures you can take to protect yourself and your new baby;
- If you have had PE in a previous pregnancy your doctor may prescribe you medicine (such as aspirin) to take this time. Be sure to do so!
- always call your midwife or maternity unit if you develop ANY new or worrying symptoms - trust your instincts!
- keep an eye out for the following especially:
Pain
Excessive or unusual (for you) swelling anywhere on the body
Leaking of any kind of fluid or blood from the vagina
Severe headaches
Visual disturbances
Epigastric pain (under the ribs)
Baby isn't moving / is moving less (DO NOT WAIT. Call immediately)
And remember - don't get complacent, if In doubt, check anyway! There's no such thing as a silly question in maternity care.
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