Pre-Eclampsia and Pregnancy Hypertension

In short: Pre-eclampsia is high blood pressure (140/90 or more) after week 20 with protein in the urine, or with signs that the liver, kidneys, platelets, nervous system or the baby’s growth are affected; it occurs in 1–5 in 100 pregnancies. Symptoms are severe headache, blurred vision, pain under the ribs and rapid swelling of the face and hands. The cure is delivery, often at 37 weeks or earlier if mother or baby worsens; women at risk are advised to take low-dose aspirin from week 12.

-Affects 1-5 out of every 100 pregnant women

-It is usually diagnosed in the second half of pregnancy after the 20th week, during labor, or shortly after delivery.

-It is diagnosed when new high blood pressure (140/90 or more) appears after 20 weeks together with protein in the urine, or, even without protein, together with signs that other organs are affected (kidneys, liver, blood platelets, brain) or that the baby is not growing well.

-It can affect the liver and kidneys, lower the blood platelets and disturb blood clotting (as in HELLP syndrome), and may lead to seizures (eclampsia) or stroke.

What are the symptoms of preeclampsia?

• Severe headache
• Blurred vision
• Severe pain below the ribs
• Heartburn
• Rapid swelling of the face, hands, or feet
• Nausea and vomiting

What does this mean for the baby?

High blood pressure during pregnancy affects the placenta, which can lead to the baby being smaller than it should be, and in some cases, it can cause fetal death in utero.

Who is most at risk?

• Those who had high blood pressure before pregnancy.
• Those with high blood pressure in previous pregnancies.
• Those with kidney problems or autoimmune diseases such as lupus.
• Those with diabetes.
• First pregnancy.
• Age over 40.
• More than 10 years have passed since the last pregnancy.
• Body mass index (BMI) over 35.
• Multiple pregnancies.

Family history of pre-eclampsia (mother or sister). - Pregnancy achieved through IVF, especially with donor eggs.

When does delivery occur?

If the pregnancy is 37 weeks or more, delivery usually takes place. If the mother’s or fetus’s health deteriorates before week 37, delivery is recommended as it is safer than continuing the pregnancy. The only cure for preeclampsia is delivery of the baby and placenta. Until then, blood pressure is controlled with medicines that are safe in pregnancy (such as labetalol, nifedipine or methyldopa), aiming for a reading of about 135/85 or lower, and in severe cases magnesium sulphate is given to prevent seizures. Each case is assessed to determine whether a vaginal or cesarean delivery will be performed, regardless of the gestational age.

What is the likelihood of developing preeclampsia in future pregnancies?

It depends on which week of pregnancy the preeclampsia occurred during. - If the delivery occurred between weeks 28 and 34, one in three women who had preeclampsia will experience it again.

• If the delivery occurred between weeks 34 and 37, one in four women who had preeclampsia will experience it again
• If delivery occurs after 37 weeks, one in six women who have had PET will have it again.

Therefore, in the next pregnancy they are advised to take low-dose aspirin (75–150 mg daily, usually at night) starting from 12 weeks (and before 16 weeks) until late pregnancy, and to avoid smoking, adopt a healthy lifestyle, and maintain a healthy weight. Women who had preeclampsia also have a higher risk of high blood pressure and heart disease later in life, so a yearly blood pressure check is recommended.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist