Pre Eclampsia

What is pre-eclampsia?

Pre-eclampsia is a condition which affects some women during their pregnancy. It normally arises during the second half of their pregnancy from around 20 weeks or alternatively it can occur soon after the baby is born. This condition can lead to the mother developing high blood pressure (hypertension) and it can also result in protein in your urine (proteinuria). It is essential that this condition is diagnosed as soon as possible to ensure prompt treatment is instigated as this condition can be dangerous for both mother and baby.

Who is affected?

Pre-eclampsia affects up to 5% of pregnancies, and severe cases develop in about 1-2% of pregnancies. There are certain factors which increase the risk of developing pre-eclampsia during pregnancy such as:

  • If it is your first pregnancy
  • If you have suffered from this condition during other pregnancies there is an approximately 16% chance that you will develop the condition again in later pregnancies
  • There is a family history of pre-eclampsia, for example, your mother or sister has had pre-eclampsia
  • Being over 40 years of age
  • You are expecting more than one baby (twins, triplets, etc)
  • It has been at least 10 years since your last pregnancy
  • You have an existing medical problem – for example, high blood pressure, diabetes or kidney disease
  • You were obese at the start of your pregnancy

For some expectant mothers who are considered being at high risk of developing pre-eclampsia, they may be advised to take medication from early on in their pregnancy.

Causes of pre-eclampsia:  

The cause for this condition is still not fully understood. However, the main explanation put forward for this condition is that during the pregnancy the placenta does not develop properly due to problems with the blood vessels connected to the placenta.  The placenta is the organ which connects the unborn baby’s blood supply to that of the mother. The placenta enables food and oxygen to pass through the placenta from the mother to the baby. In order to support the baby during the pregnancy the placenta needs a large and constant supply of blood from the mother. When pre-eclampsia occurs the placenta does not get enough blood supply. As a result of this disruption of the blood supply between mother and baby it results in the mother developing high blood pressure. Further, problems may also develop with the mother’s kidneys which leads to proteins that should remain in the mother’s blood leaking into her urine which results in protein being present in the urine.

What are the symptoms of Pre-eclampsia?

  • Swelling of the feet, ankles, face and hands caused by fluid retention (oedema)
  • Severe headache
  • Vision problems
  • Pain just below the ribs
  • As pre-eclampsia progresses, it may cause:
  • Severe headaches
  • Vision problems, such as blurring or seeing flashing lights
  • Pain just below the ribs
  • Vomiting
  • Excessive weight gain caused by fluid retention
  • Feeling very unwell

The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby. This is called intra-uterine or foetal growth restriction. The placenta is basically the baby’s lifeline and enables it to obtain its own supply of oxygen and nutrients. If your baby is growing more slowly than usual, this should normally be picked up during antenatal appointments.

If these symptoms are occurring during the pregnancy it is essential that this condition is diagnosed to enable the mother and baby to receive appropriate treatment and monitoring. Failures to recognise the signs of this condition can lead to serious complications, and this could amount to negligent treatment.

Diagnosing pre-eclampsia:

During pregnancy you will have regular antenatal checks. During such attendances the mother’s blood pressure should be checked for signs of high blood pressure and a urine sample is tested to see if it contains protein. If these simple tests are performed it can lead to the diagnosis of this condition. If during an antenatal appointment pre-eclampsia is diagnosed a referral should be made to see a specialist for monitoring and treatment. In some situations the mother may be able to return home after an initial assessment, but they will require frequent monitoring. However, in severe cases it is necessary for the mother to be admitted to hospital for closer observation.

Treating pre-eclampsia:

If a diagnosis of pre-eclampsia is made then a referral should be made for the mother to be seen by a specialist. An assessment will have to take place to determine how severe the condition is and whether they need to be kept in hospital.

The only way to cure pre-eclampsia is for the baby to be delivered. Therefore, until it is safe for the baby to be delivered the mother and baby will be monitored on a regular basis. The baby will normally be delivered around 37-38 weeks, but when the pre-eclampsia is very severe the labour is normally induced or a caesarean section performed much earlier than that gestation period. Whilst waiting for the pregnancy to develop to enable labour to be induced medication can be prescribed to try to lower the mother’s blood pressure.

After the baby is born the pre-eclampsia will normally improve. However, in some instances complications can develop a few days after. Therefore, it is often necessary for the mother to remain in hospital for several days to enable the medical staff to monitor her. In addition, it is often necessary for the baby to be monitored in the neonatal unit if they are born prematurely.

Normally, after the mother is discharged from hospital it is still necessary to monitor her blood pressure and the medication prescribed to reduce high blood pressure will still need to be continued for a number of weeks after giving birth.

What can happen if Pre-eclampsia is not diagnosed?

If pre-eclampsia is not diagnosed and/or treated appropriately then the consequences can be very serious for both mother and baby. In the worst case scenarios it can result in the death of the mother and baby.

As pre-eclampsia is caused by the blood vessels to the placenta not operating properly it can lead to the baby growing more slowly than usual.

The mother is at risk of developing fits called eclampsia. These fits can be life threatening for both the mother and the baby.

As pre-eclampsia causes high blood pressure in the mother, if appropriate steps are not taken to reduce the high blood pressure then the mother is at an increased risk of developing a stroke.

Further, in some women pre-eclampsia can lead to problems with organs such as their kidneys, lungs and liver. Additionally, some women develop blood clotting disorders when they suffer from pre-eclampsia and this can result in damage to their organs occurring.

If the pre-eclampsia is severe and it is necessary to deliver the baby before they are fully developed it can lead to breathing problems for the baby as their lungs will not have developed fully. Therefore, it will be necessary for the baby to be treated for a period of time in the neonatal unit.

How can negligence occur when a mother has pre-eclampsia?

During your pregnancy women should have regular antenatal checks. During such attendances it is essential that the mother’s blood pressure is checked and a urine sample is taken and tested. Negligence can occur when a woman has pre-eclampsia if:

  • There is a failure to ensure the mother has regular antenatal appointments
  • There is a failure to recognise an expectant mother is at high risk of developing pre-eclampsia
  • There is a failure to undertake tests and investigations during antenatal appointments
  • There is a failure to refer the mother once she is diagnosed with pre-eclampsia
  • There is a failure to appropriately monitor and treat this condition once diagnosed.

If you have suffered from pre-eclampsia during your pregnancy and it was not diagnosed or managed appropriately please contact us for a free no obligation conversation.