Pre-eclampsia

**Pre-eclampsia** (**PE**) is a disorder of pregnancy caused by the onset of high blood pressure. In it, there is a large amount of proteinuria, which means protein in the urine.

Usually PE happens during the second half of pregnancy (from 20 weeks) or soon after delivery. It can develop for the first time in the first 4 weeks after birth.

They are usually picked up as signs and symptoms in routine tests. Sometimes the patient is unaware of the symptoms themselves when its diagnosed.

### Risk

Factors have been identified that could increase chances of developing pre-eclampsia. Having previously had it is a risk factor. Genetics and being the first time delivering increases the chance by a small amount. Having an existing medical problem increases it by more. These medical problems are:
- diabetes
- kidney disease
- high blood pressure
- lupus or antiphospholipid syndrome
If a pregnant woman is considered to be at a high risk of developing pre-eclampsia, they might be advised to take a 75 to 150 mg dose of aspirin every day from 12 weeks pregnant until delivery. Evidence suggests this can lower the chances of developing the condition.

Other factors increasing the risk, but by a small amount:
- over the age of 40
- it has been at least 10 years since the last pregnancy
- a family history of the condition – for example, the mother or sister has had pre-eclampsia
- obese at the start of pregnancy – meaning they had a body mass index (BMI) of 35 or more
- if expecting twins or more, such as twins or triplets

### Placenta

Pre-eclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it. The exact cause isn't fully understood. It may be likely that inherited changes in the genes have some sort of role, as the condition often runs in families. But this only explains some cases if it is true.

Signals or substances (hormones) from the damaged placenta affect the mother's blood vessels, causing hypertension. At the same time, problems in the kidneys may cause important proteins that should remain in the mother's blood to leak into her urine, resulting in proteinuria.

The problem with the placenta means the blood supply between mother and baby is disrupted.

### Early stages of pregnancy

If the placenta will not develop properly because it does not get enough nutrients, it can cause issues. This may lead to pre-eclampsia.

It's still unclear why the blood vessels don't transform as they should.
The same as with earlier causes, pre-eclampsia can be caused by genetic factors. But this only explains one cause if it is true.

### Baby

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.

The growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intrauterine or foetal growth restriction.

If the baby is growing more slowly than usual, this will normally be picked up during antenatal appointments It will be picked up during measurements.

### Mother

Most people only experience mild symptoms, but it's important to manage the condition in case severe symptoms or complications develop.

### Severe case

Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated. Symptoms may be:
- red blood cell breakdown
- a low blood platelet count
- not as good liver function
- kidney dysfunction
- swelling
- shortness of breath, due to fluid in the lung
- visual disturbances. (blurring or flashing lights)

If left untreated, it may result in seizures.

### Early signs

Of pre-eclampsia include having high blood pressure (hypertension), proteinuria. In some cases, further symptoms can develop into the severe symptoms above, but also including:
- severe headache
- pain just below the ribs
- vomiting
- sudden swelling of the face, hands or feet

The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby. Symptoms of pre-eclampsia should mean: seek medical advice immediately by calling the midwife, GP surgery or emergency services (EMS).

## Diagnosis

Pre-eclampsia is easily diagnosed during the routine checks that happen throughout pregnancy. Signs of high blood pressure are regular, and a urine sample is tested to see if it contains protein, during antenatal appointments.

However, if any of the symptoms of pre-eclampsia between antenatal appointments show, a midwife or GP should be seen for advice.

### Tests: blood pressure, blood and urine test, other

- **Blood pressure** checked with an inflatable cuff and a scale as a pressure gauge (a sphygmomanometer) regularly
- **Urine sample.** This can easily be tested for protein using a dipstick, usually at every appointment
- **Blood test** may be checked between 20 weeks and 36 weeks and 6 days pregnant. It measures levels of a protein called placental growth factor (PIGF)

## Related pages

- hormones, oestrogen and cortisol
- Portal hypertension
- Lemon tea, tea

## Infobox (medical condition (new))

- **name**: Pre-eclampsia
- **image**: Hypertrophic decidual vasculopathy high mag.jpg
- **caption**: A micrograph showing hypertrophic decidual vasculopathy, a finding seen in gestational hypertension and pre-eclampsia. H&E stain.
- **field**: Obstetrics
- **synonyms**: Preeclampsia toxaemia (PET)
- **symptoms**: High blood pressure, proteinuria, protein in the urine
- **complications**: hemolysis, Red blood cell breakdown, thrombocytopenia, low blood platelet count, impaired liver function, kidney problems, edema, swelling, pulmonary edema, shortness of breath due to fluid in the lungs, eclampsia
- **onset**: After 20 Gestational age (obstetrics), weeks of pregnancy
- **risks**: Obesity, prior hypertension, older age, diabetes mellitus
- **diagnosis**: BP > 140 mmHg systolic blood pressure, systolic or 90 mmHg diastolic blood pressure, diastolic at two separate times
- **prevention**: Aspirin, calcium supplementation, treatment of prior hypertension
- **treatment**: Childbirth, Delivery, medications
- **medication**: Labetalol, methyldopa, magnesium sulfate
- **frequency**: 2–8% of pregnancies
- **deaths**: 46,900 hypertensive disorders in pregnancy (2015)