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Pre-eclampsia and Eclampsia

High blood pressure, fluid retention, and protein in the urine in pregnancy, which may lead to seizures and coma

  • Most common under the age of 19 or over the age of 35
  • Sometimes runs in families
  • Being overweight is a risk factor

Pre-eclampsia, also called pre-eclamptic toxaemia, develops in about 1–2 out of 20 pregnancies, most often in the second half of pregnancy. The condition is a combination of high blood pressure with excessive fluid retention and/or protein in the urine. Mild pre-eclampsia is common in the last weeks of pregnancy and is usually easy to treat. Severe pre-eclampsia may threaten the life of the mother and/or the fetus. If it is left untreated, severe pre-eclampsia may lead to a potentially fatal disorder known as eclampsia that causes seizures and may bring on a coma.

The cause of pre-eclampsia is not yet understood, but it may be due in part to the mother developing an immune reaction to the fetus. The condition is most likely to develop in a first pregnancy, a subsequent pregnancy with a new father, or a multiple pregnancy. Pre-eclampsia can run in families and is most common in women under the age of 19 or over 35. There is also an increased risk of pre-eclampsia in overweight women and in women who have chronic kidney disease, diabetes mellitus, or pre-existing high blood pressure (see Hypertension).

What are the symptoms?

Initially, pre-eclampsia may produce no symptoms. As the condition progresses, the symptoms tend to develop gradually, but occasionally the onset is rapid. Symptoms may include:

  • Swollen feet, ankles, and hands and excessive weight gain due to retention of fluid

  • Headaches.

  • Visual disturbances, such as blurred vision and seeing flashing lights.

  • Vomiting.

  • Upper abdominal pain.

You should consult your doctor or midwife immediately if you develop any of the above symptoms during pregnancy. Without immediate hospital supervision, the condition may worsen rapidly.

How is it diagnosed?

Your doctor or midwife will examine you for evidence of pre-eclampsia at every antenatal checkup. He or she will examine you for signs of fluid retention, take your blood pressure, and test your urine for protein. If pre-eclampsia is suspected, various blood tests may be arranged, including tests to check your kidney function and blood clotting.

What is the treatment?

Treatment for pre-eclampsia depends on the stage of your pregnancy and the severity of your symptoms. If you have mild to moderate pre-eclampsia and are less than 36 weeks pregnant, you will probably be advised to rest at home. Your blood pressure will be taken frequently to check that it is not raised. In some women, monitoring in hospital and bed rest may be needed.

If pre-eclampsia becomes severe and the fetus is mature enough to survive an early delivery, induction of labour or a caesarean section may be recommended. Before an early delivery, you may have injections of corticosteroids to help the lungs of the fetus to mature. In rare cases, severe pre-eclampsia that develops before the 24th week requires a termination of pregnancy to save the mother.

Regardless of the severity, if you have pre-eclampsia later than 36 weeks into your pregnancy, your doctor is likely to recommend that labour be induced at once or that a caesarean section be performed to deliver the baby.

If eclampsia develops, you may be given antihypertensive drugs to lower your blood pressure and intravenous anticonvulsant drugs to stop seizures. Delivery by emergency caesarean section is then performed.

What is the prognosis?

If pre-eclampsia is treated before it becomes severe, the outlook is usually good. If eclampsia develops, the lives of the mother and fetus are at risk. High blood pressure usually returns to normal within about a week of delivery, but there is an increased risk of the mother developing high blood pressure in later life. About 1 in 10 affected women has pre-eclampsia in a future pregnancy.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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