Pre-eclampsia

Also called Pregnancy-induced hypertension, Eclampsia

A pregnancy complication that gets dangerous quickly and often has no symptoms until it does. This is why blood pressure and urine are checked at every appointment.

What it is

A condition of pregnancy involving high blood pressure and protein in the urine, usually after 20 weeks. It affects a few in every hundred pregnancies and is the reason antenatal appointments look repetitive.

The danger is that it is often silent. Blood pressure and urine are checked at every appointment precisely because a person can feel completely well while the condition is advancing.

Untreated it can progress to eclampsia, which is seizures, and to HELLP syndrome, which affects the liver and blood clotting. Both are life-threatening for mother and baby. The only cure is delivery, which is why the management is a balance between how unwell the mother is and how ready the baby is.

Aspirin from 12 weeks substantially reduces the risk in people who have risk factors, and it is under-prescribed. Risk factors include a previous pre-eclampsia, chronic kidney disease, type 1 or type 2 diabetes, lupus, existing high blood pressure, a first pregnancy, a multiple pregnancy, being over 40, and a family history.

Having had pre-eclampsia roughly doubles the lifetime risk of heart disease and stroke, and almost nobody is told this at discharge.

Signs you might notice

Often none, which is the point.

When present: a severe headache that will not go with paracetamol; vision problems, flashing lights or blurring; pain just below the ribs on the right side; sudden swelling of the face, hands or feet; vomiting; and feeling generally very unwell.

Reduced fetal movements.

Any of these in pregnancy or in the six weeks after birth is a same-day call to the maternity unit, not a GP appointment and not a wait until the next check.

Pre-eclampsia can appear for the first time AFTER delivery, up to six weeks later. That is a common and dangerous gap in what people are told.

How it can affect day-to-day life

The rhythm of it is frightening: repeated monitoring, bags packed, a possible early delivery, and no way to predict the timing.

Being told to come in for observation and then sent home again several times is normal management and feels like being messed about. Saying so in advance helps.

A premature birth may follow, with neonatal unit care, and the two things arrive together.

Afterwards, blood pressure needs following up, and the long-term cardiovascular risk needs to be on the GP record. Ask for it to be added; this is one of the clearest examples of information falling between maternity and general practice.

Supporting someone well

Go to every antenatal appointment. The checks are the whole detection system.

Ask at booking whether aspirin from 12 weeks is indicated. If any risk factor applies and it has not been offered, ask why.

Learn the warning symptoms and phone the maternity unit, not the GP, and not in the morning.

Keep watching for six weeks after birth. Headache, visual change or swelling in that period is the same emergency.

Ask for a postnatal blood pressure review and ask that the cardiovascular risk is recorded for the future.

For a later pregnancy, mention it at the first appointment; it changes the plan from the start.

Where to get help

The maternity unit or midwife, same day, for any warning symptom. Maternity triage takes calls 24 hours a day.

999 for a seizure, severe headache with visual changes, or collapse.

Action on Pre-eclampsia provide clear information and support, including after a traumatic pregnancy.

Tommy's midwives run a free line on 0800 014 7800.