Pre-eclampsia is a serious pregnancy condition involving high blood pressure and protein in the urine, typically developing after 20 weeks. It affects 2 to 8% of pregnancies. Key warning signs include severe headaches, visual disturbances, sudden swelling, pain below the ribs, and feeling very unwell. Early detection through regular blood pressure checks is essential. The only cure is delivery of the baby.
Pre-eclampsia is a pregnancy-specific condition characterised by new high blood pressure (hypertension) and significant protein in the urine (proteinuria) developing after 20 weeks. It affects the blood vessels in the placenta and can impact multiple organs including the liver, kidneys, and brain.
According to the RCOG, pre-eclampsia affects 2 to 8% of pregnancies worldwide. In the UK, it is one of the leading causes of maternal and perinatal morbidity and mortality. The only definitive cure is delivery of the baby and placenta.
Many people with mild pre-eclampsia have no obvious symptoms, which is why regular blood pressure checks at antenatal appointments are so important. However, the following warning signs should prompt immediate medical attention:
Severe headache that does not respond to paracetamol. Visual disturbances including blurred vision, spots, or flashing lights. Sudden swelling of the face, hands, or feet. Pain just below the ribs on the right side (indicating liver involvement). Feeling very unwell, vomiting, or confusion. Reduced baby movements.
High-risk factors (one is enough): High blood pressure in a previous pregnancy, chronic kidney disease, autoimmune disease such as lupus, type 1 or type 2 diabetes.
Moderate-risk factors (two or more together): First pregnancy, age 40+, BMI 35+ at booking, family history of pre-eclampsia, multiple pregnancy, gap of more than 10 years between pregnancies.
If you have one high-risk or two+ moderate-risk factors, NICE recommends low-dose aspirin (75 to 150mg daily) from 12 weeks until delivery.
High blood pressure: 140/90 mmHg or above on two occasions at least 4 hours apart, or 160/110 mmHg or above on a single reading.
Proteinuria: Significant protein in the urine, detected via urine dipstick and confirmed by lab analysis.
Additional blood tests check liver function, kidney function, and platelet count. You may be offered a PlGF-based blood test, which many NHS trusts now use as a screening tool.
Mild: More frequent monitoring, antihypertensive medication (labetalol or nifedipine).
Severe: Hospitalisation, magnesium sulphate to prevent eclampsia (seizures), corticosteroids for the baby''s lungs if delivery may be needed before 34 weeks.
Delivery: The only definitive treatment. After 37 weeks, NICE recommends delivery within 24 to 48 hours of diagnosis. Before 37 weeks, the clinical team balances risks of continuing pregnancy against premature delivery.
Eclampsia: Life-threatening seizures. HELLP syndrome: Haemolysis, elevated liver enzymes, low platelets — requires urgent delivery. Placental abruption: Placenta separates from the uterine wall. Fetal growth restriction: Reduced blood flow limits the baby''s growth.
These complications are rare when pre-eclampsia is detected and managed early.
Pre-eclampsia usually resolves within days to weeks after delivery. Blood pressure monitoring continues in the postnatal period. Having pre-eclampsia increases the risk in future pregnancies. The RCOG recommends a postnatal review at 6 to 8 weeks to assess cardiovascular risk factors.
Pre-eclampsia often has no early symptoms. When symptoms appear, they may include severe headache, visual disturbances, sudden swelling of the face or hands, and pain below the ribs.
Not completely, but low-dose aspirin (75-150mg daily) from 12 weeks reduces the risk for those at higher risk. Regular antenatal care ensures early detection.
It can reduce blood flow through the placenta, affecting growth and oxygen supply. Early detection and management significantly reduce risks.
Typically after 20 weeks of pregnancy, most commonly in the third trimester. It can occasionally develop after delivery (postpartum pre-eclampsia).
The risk is increased but many people have uncomplicated subsequent pregnancies. Your doctor may recommend preventive aspirin from 12 weeks.
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