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Pre-eclampsia: improving awareness to prevent tragic outcomes

Posted: 20/05/2021

22 May 2021 marks World Pre-eclampsia Day and charities around the world are coming together to raise awareness and promote research into this condition.

Pre-eclampsia is a serious complication which can develop during pregnancy. Early signs include hypertension (raised blood pressure) and proteinuria (high protein levels detected in the urine). According to NHS figures, mild cases affect up to 6% of pregnancies, with severe cases developing in between 1% and 2% of pregnancies. The condition usually affects women in the second half of their pregnancy, after 20 weeks gestation or in the six weeks after their baby is born. In rare cases, pre-eclampsia can develop earlier.

It is unclear what causes pre-eclampsia but it is thought to be related to problems with the placenta and blood supply. Blood tests performed when a mother is 12 weeks pregnant can highlight potential placental problems that could develop later in pregnancy, so it is important that these tests are performed (even if the mother would prefer not to have screening for abnormalities) so potential problems can be identified and monitored.  

There are some women who are more at risk of developing pre-eclampsia and who therefore need to be monitored more closely during their pregnancy. Risk factors include:

  • existing medical problems in mothers such as high blood pressure/diabetes/kidney disease/lupus;
  • suffering from pre-eclampsia or fetal growth restriction (FGR) in a previous pregnancy;
  • a maternal family history of pre-eclampsia;
  • if it is a woman’s first pregnancy (or first pregnancy in ten years);
  • being over 40 years of age;
  • a BMI greater than 35;
  • a multiple pregnancy (twins/triplets etc); and
  • pregnancies involving egg donation/artificial insemination.

As part of regular antenatal care, pregnant women become familiar with undergoing routine blood pressure checks and urine tests but they will not necessarily associate these with ongoing screening for pre-eclampsia. It is vital to raise awareness amongst expectant mothers so that they fully appreciate the importance of these tests. Understandably, some women have become reluctant to attend appointments in healthcare settings during the Covid-19 pandemic but it remains of utmost importance that these regular checks are completed to help identify early signs of pre-eclampsia in women who may not be presenting with overt symptoms.

As pre-eclampsia develops, symptoms can include:

  • severe headache (that doesn’t get better with painkillers);
  • vision disturbance (blurring, loss of vision, flashes, spots);
  • nausea and vomiting (after mid-pregnancy);
  • heartburn (that doesn’t ease with medication);
  • swelling (of face, feet, ankles and hands caused by fluid retention);
  • feeling generally very unwell;
  • excessive weight gain;
  • difficulty breathing and gasping or panting; and
  • abdomen pain, just below the ribs.

Some of these symptoms, such as nausea and heartburn, are common to many pregnancies but nausea later in pregnancy and heartburn that is not responsive to medication can be signs of pre-eclampsia. It is therefore imperative that any expectant mother who experiences symptoms seeks urgent medical advice so that she can undergo the relevant tests. When a mother is suffering with pre-eclampsia, early detection and action by health care professionals is vital to prevent potentially devastating consequences for both mother and baby. The earlier pre-eclampsia is diagnosed, the better the outcome.

For babies, pre-eclampsia is associated with FGR and once diagnosed, additional ultrasound scans should be performed to monitor the baby’s growth. If necessary, the baby can be delivered early (before 37 weeks). Not properly monitoring a baby with FGR can lead to stillbirth as the baby may not have an adequate supply of oxygen or the nutrients that it needs from the placenta.

For the mother, if pre-eclampsia is severe, it can cause long-term health problems including chronic high blood pressure and cardiovascular disease. If left undiagnosed, pre-eclampsia can develop into eclampsia where the mother’s high blood pressure causes her to have seizures. Eclampsia, if not treated competently and quickly, can lead to life threatening complications including organ damage and even death. Women can also develop HELLP syndrome, which is a rare liver and blood clotting disorder more common in women with severe pre-eclampsia and most likely to develop immediately after a baby is born. It is important that women with HELLP syndrome receive appropriate treatment otherwise they can develop complications including liver and kidney failure, stroke (cerebral haemorrhage), fluid in the lungs (pulmonary oedema) and blood clotting disorders. 

Thankfully, most cases of pre-eclampsia are identified through routine antenatal testing and affected mothers and babies are carefully monitored until the baby can be delivered safely. Unfortunately, there is no direct treatment for pre-eclampsia so the condition only resolves when the baby is born and accordingly is a major cause of pre-term birth. If a woman is thought to be at high risk of developing pre-eclampsia, she may be advised to take a daily low-dose aspirin from the twelfth week of pregnancy until the baby is born. If pre-eclampsia is identified during pregnancy, the mother can be prescribed anti-hypertensive medication and should be referred to a specialist at the hospital so that she can be closely monitored and the baby can be delivered if either of their conditions deteriorate. Healthcare practitioners will need to assess each woman individually and treat her accordingly, but usually the baby will be delivered between 37 and 38 weeks through induced labour or via caesarean section.

Sarah Hibberd, an associate in the clinical negligence team who represents and supports families following pregnancy and birth complications, comments: “Most people have heard of pre-eclampsia, but many do not fully appreciate how severe and dangerous it can become if left untreated. World Pre-eclampsia Day helps to raise awareness and highlights the work that charities are doing to improve our understanding of the condition. We strongly support this campaign because, sadly, as part of our work, we investigate claims where mothers and babies have suffered injuries because there have been failures in the antenatal care during delivery or in the post-natal care provided.

“Pre-eclampsia, if unmonitored and untreated, can lead to devastating, and often avoidable, consequences that no family should have to experience. Improving awareness of this condition is vital to ensure that mothers and babies are better protected, that no woman is lost in the system and that medical practitioners follow the correct protocols to identify and deal with pre-eclampsia before injury occurs. Mothers should also be properly informed of the symptoms and risks so they can raise any concerns they might have about their pregnancy. Monitoring is key, so we urge mothers to keep their antenatal appointments, report any concerning symptoms and to seek a second opinion if they are worried that their needs are not being met.”

If you or a loved one have concerns over the management of pregnancy or labour and would like to speak to a member of our specialist team, please do get in contact. Our team is experienced in pregnancy and birth injury claims and can advise on the options available to you.

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