Pre-eclampsia is a potentially serious condition which is seen only in pregnancy. It will usually completely resolve after delivery of the pregnancy. It is generally accepted that pre-eclampsia refers to presence of new onset high blood pressure and protein in urine in a pregnancy beyond 20 weeks.
Who can it affect?
Up to 10 % of women in first pregnancy may be affected by pre-eclampsia. Pre-eclampsia tends to be seen less frequently in women who have had pregnancies in the past, affecting up to about 3% of these women. However, in a woman with past history of pre-eclampsia, the risk of recurrence is increased 2-fold to 5-fold. Pre-eclampsia may be complicated by its severe forms, with 10% to 20% developing HELLP syndrome (causing liver dysfunction, low platelet count) and 5% to 8% suffering eclampsia (causing generalised seizures).
In addition to first pregnancy, there is a higher predisposition to pre-eclampsia in women with pre-existing high blood pressure, obesity and medical conditions such as autoimmune diseases.
Pre-eclampsia can vary in its severity and its timing of onset. As a general rule, the early-onset pre-eclampsia (occurring before 34 weeks of pregnancy) tends to be more severe than the late-onset pre-eclamspia (occurring after 34 weeks of pregnancy).
What causes Pre-eclampsia? What are the symptoms, signs and risks involved.
The manifestations of pre-eclampsia can be seen in mother and/or baby. In the mother,
there may be observation of high blood pressure which may require treatment with high blood pressure medication. Stabilising the blood pressure is essential in minimising risk of the blood pressure going too high which has the associated risk of causing bleeding in the brain. Other symptoms a pregnant woman with pre-eclampsia may experience include swelling in hands/feet/legs/face, headache, visual disturbance (perceived as blurring of vision, flashing lights in visual field, “floaters” – black spots floating in the visual field), pain over the upper tummy, general unwellness, nausea/vomiting and breathlessness. Usually, when there is high blood pressure during pregnancy, the doctor will advise the pregnant woman regarding these warning symptoms which would warrant immediate medical attention.
As for the effects of pre-eclampsia on pregnancy, pre-eclampsia may cause problems such as growth restriction in the developing baby (occurring as result of abnormal function in placenta – “placental insufficiency”), bleeding behind the placenta (“placental abruption”) and fetal demise. The pregnant mother may not have symptoms to warn about these complications. However, there may be bleeding from the vagina, severe lower tummy pains or perception of the baby having less/no movements.
Is there any treatment for Pre-eclampsia?
The natural course of the condition of pre-eclampsia cannot be modified. A pregnant woman with pre-eclampsia cannot begin to recover until the baby is delivered. Hence, the definitive treatment of pre-eclampsia is delivery of pregnancy.
The general principles of managing a pregnant woman with pre-eclampsia are stabilising the blood pressure, prevention of seizures in the mother before and after delivery and optimising the condition of the baby in anticipation of delivery. Sometimes, delivery of the baby must be undertaken as a matter of urgency. This always applies in situations of HELLP syndrome and eclampsia. Delivery by caesarean section is required in situations of severe pre-eclampsia.
Following delivery, the mother will require a period of very close observation as there is still risk of complications in the immediate 24 – 48 hours after delivery. Sometimes, it is necessary to admit the mother into an intensive care ward. As for the baby, admission into the neonatal intensive care unit will be required if there are complications such as growth restriction and preterm birth.
By Dr Lim May Li
Consultant Obstetrician & Gynaecologist
Mount Elizabeth Medical Centre
Gynecology Associates Clinic & Surgery Pte Ltd
Address: 3 Mount Elizabeth, #12-16
Tel: 6235 2007