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Pre-eclampsia

Before I was medically trained, eclampsia was a condition that instantly took me back to ‘Call the Midwife’, a BBC series about midwives set in the 1950s and 60s. In the series, this condition seemed prolific amongst pregnant women, often costing them, and their babies, their lives. A mysterious condition that everyone knew, but no one quite understood. I hope that this article helps demystify pre-eclampsia and eclampsia, and provides reassurance that receiving these diagnoses is far from being the death sentence they seem to be in ‘Call the Midwife’. 

What is eclampsia?

Eclampsia is a rare condition of pregnancy characterised by:

Images: Microsoft stock images (head), pixabay (blood pressure cuff)

Figure 1: Microsoft stock images (head), pixabay (blood pressure cuff)

A condition of pregnancy means that it is diagnosed 20 weeks or more into the pregnancy. (1)  In women with a placenta, the impact of high blood pressure on the body is different to someone who is not pregnant. The blood flow of nutrients and oxygen through the placenta to the baby is reduced, which can lead to a range of complications from low birth weight to, rarely, stillbirths. High blood pressure also causes the placenta to release inflammatory markers and toxins which have an effect throughout the mother’s body, including the kidneys and brain. (5) When very high blood pressure affects the brain, this can trigger seizures, which are the defining feature of eclampsia. 

Eclampsia is thankfully now extremely rare, with 5 in 10,000 (0.005%) pregnant women diagnosed yearly in the UK. (2) The consequences are also well managed: between 2015 and 2017, there were 3 deaths from eclampsia and pre-eclampsia. (2)

What is pre-eclampsia?

The definition of pre-eclampsia is present in its name: ‘pre’ – before – eclampsia. That’s right, it is a condition of high blood pressure in pregnancy that can develop into eclampsia. But that does not mean that it definitely will lead to seizures – in fact, it very rarely does, as indicated by the low incidence and death rates above. Women with pre-eclampsia can also have protein in their urine, a sign of kidney damage caused by high blood pressure. 

In some cases, pre-eclampsia can lead to HELLP syndrome (Haemolysis, Elevated Liver enzymes, and Low Platelets syndrome) (1), whereby the liver and blood are also affected. This requires urgent medical treatment.

Signs and symptoms to look out for 

Blood pressure and protein levels in the urine or blood are monitored at every antenatal visit to screen for pre-eclampsia, which is why it is so important to attend your appointments regularly. Early detection enables treatment and prevention of more serious consequences. There are also some signs and symptoms that you can look out for, during pregnancy and up to 4 weeks after delivery (1):

    • Swelling. Although swelling of the hands and feet are common in pregnancy, additional swelling of the legs, arms and face could be a sign of pre-eclampsia.
    • Seizures. Go to the emergency department immediately if you develop seizures while pregnant. 
    • Headaches. Severe, worsening headaches that are not relieved by painkillers. 
    • Vision problems (blurred vision, flashing lights, double vision, floating spots).
    • Persistent stomach pain particularly around the top right of your stomach. 
    • Vomiting.
    • Breathlessness. 

How can I reduce my risk of developing pre-eclampsia?

Women that had pre-eclampsia, eclampsia or high blood pressure in previous pregnancies are at higher risk of developing pre-eclampsia in future pregnancies. Having pre-existing high blood pressure, kidney disease, diabetes (types 1 and 2) and certain autoimmune diseases also increase your risk of developing pre-eclampsia. Information about other risk factors can be found here – Pre-eclampsia and Eclampsia. Late pregnancy complication | Patient.

Your doctor will screen for these risk factors during the course of your antenatal care. Although some of the risk factors above are not preventable, there are things you can do to reduce your risk of developing pre-eclampsia. Maintain a healthy weight and eat a well-balanced diet, as these are also protective against other complications in pregnancy. Good control of pre-existing high blood pressure is recommended before trying to get pregnant. As always, remember to take folic acid to reduce the risk of neural tube defects.

I’m at risk of developing pre-eclampsia – what next?

If you have one or more risk factors, your blood pressure and urine protein levels will be monitored more frequently, up to fortnightly from 24 weeks of pregnancy. (1) Depending on your risk, doctors may also recommend taking aspirin 75-150 mg daily from 12 weeks until the birth of the baby. (1)  If you have high blood pressure, you may be started on blood pressure tablets to protect the cardiovascular system, i.e. the other blood vessels and organs in the body. (5) Studies around the role of calcium supplementation are inconclusive. (3)

What’s the cure?

As pre-eclampsia and eclampsia develop due to the presence of a placenta, the only cure is the delivery of the placenta. (2) Ideally, delivery of the baby and placenta will be delayed until 34 weeks gestation to avoid complications associated with premature delivery. 

While pre-eclampsia and eclampsia are important conditions to be aware of, it is important to remember that they are rare conditions with rare adverse outcomes. As in all pregnancies, maintaining a healthy weight and lifestyle, as well as attending regular antenatal visits, are key steps to take in order to maximise the likelihood of an uncomplicated, healthy delivery for both mother and baby. 

References:

  1. CKS is only available in the UK [Internet]. NICE. Available from: https://cks.nice.org.uk/topics/hypertension-in-pregnancy/
  2. Pre-eclampsia and Eclampsia. Late pregnancy complication [Internet]. patient.info. Available from: https://patient.info/doctor/pre-eclampsia-and-eclampsia
  3. Hofmeyr GJ, Lawrie TA, Atallah ÁN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 2014 Jun 24;
  4. Smoking and pre-eclampsia may cause fertility problems for offspring [Internet]. ScienceDaily. [cited 2022 Jan 19]. Available from: https://www.sciencedaily.com/releases/2019/03/190329075917.htm
  5. Effects of preeclampsia on the mother, fetus and child [Internet]. Contemporary OB/GYN. [cited 2022 Jan 19]. Available from: https://www.contemporaryobgyn.net/view/effects-preeclampsia-mother-fetus-and-child

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