What is Pre-Eclampsia?
Pre-Eclampsia is a condition that affects some pregnant women, Pre-Eclampsia rarely happens before the 20th week of pregnancy. Most cases occur in the third trimester, after 24-26 weeks the condition can also develop for the first time during the first six weeks after the birth. Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated.
The earlier Pre-Eclampsia is diagnosed and monitored, the better the outlook for mother and baby. Generally, the earlier Pre-Eclampsia develops the more severe the condition will be.
If diagnosed with Pre-Eclampsia, they should be referred to a specialist working in a hospital for further tests and more frequent monitoring. Depending on the severity of the condition, they may be able to go home after an initial assessment and have frequent outpatient appointments. In severe cases, they may need to stay in hospital for closer observation.
The only way to cure Pre-Eclampsia is to deliver the baby, so they will be monitored regularly until it is possible for the baby to be delivered. This will normally be at around 37-38 weeks of pregnancy. If the condition becomes more severe before 37 weeks and there are serious concerns about the health of mother or their baby, earlier delivery may be necessary. Deliveries before 37 weeks are known as premature births and babies born before this point may not be fully developed. At this point, labour may be started artificially (induced) or a caesarean may be performed. This is recommended because research suggests there is no benefit in waiting for labour to start by after this point. Delivering the baby early can also reduce the risk of complications from Pre-Eclampsia.
What is Eclampsia?
Eclampsia is a term that describes a type of convulsion or fit (involuntary contraction of that pregnant women can experience), usually from week 20 of the pregnancy or immediately after the birth. In the UK, there is an estimated 1 case for every 4,000 pregnancies.
During an eclamptic fit, the mother’s arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements. She may lose consciousness. The fits usually last less than a minute. While most make a full recovery after having Eclampsia, there is a small risk of permanent disability or brain damage if the fits are severe. Of those who have Eclampsia, around 1 in 50 will die from the condition. The unborn babies can suffocate during a seizure and 1 in 14 may die.
Research has found that a medication called magnesium sulphate can halve the risk of Eclampsia and reduce the risk of the mother dying. It is now widely used to treat Eclampsia after it has occurred, and to treat women who may be at risk of developing it.
What treatment should you be receiving?
If you are diagnosed with Pre-eclampsia you and your baby should be monitored in hospital. There will be many tests done regularly to make sure that your medication is helping and that your baby is developing without more worry.
While you are in hospital, you and your baby will be monitored in the following ways:
Your blood pressure will be checked regularly for any abnormal increases. Urine samples may be taken regularly to measure protein levels. Your blood may be tested for the proteins which show signs of liver damage if found in the blood. A blood test may be taken to provide information about the blood cells. You may have ultrasound scans to check blood flow through the placenta, measure the growth of the baby, and observe the baby’s breathing and movements. The baby’s heart rate may be monitored electronically in a process called cardiotocography, which can detect any distress in the baby. Medication for high blood pressure – medication is recommended to help lower your blood pressure. These medications will reduce the likelihood of serious complications such as a stroke.
Anticonvulsant medication may be prescribed to prevent fits if you have severe Pre-Eclampsia and your baby is due within 24 hours, or if you have had convulsions (fits). They can also be used to treat fits if they occur.
What causes the problems with placenta?
In Pre-Eclampsia, the placenta does not get enough blood to support the growing baby. The placenta needs a large and constant supply of blood from the mother and if the placenta did not develop properly as it was forming during the first half of the pregnancy this may be the cause. The problem with the placenta means that the blood supply between mother and baby is disrupted. Signals from the damaged placenta affect the mother’s blood vessels, causing high blood pressure (hypertension). At the same time, problems in the kidneys may cause valuable proteins that should remain in the mother’s blood to leak into her urine, resulting in protein in the urine (proteinuria).
In the initial stages of pregnancy, the fertilised egg implants itself into the wall of the womb (uterus). The womb is a hollow organ a baby grows inside during pregnancy. The fertilised egg produces root-like growths called villi, which help to anchor it to the lining of the womb.
The villi are fed nutrients through blood vessels in the womb and will eventually grow into the placenta. During the early stages of pregnancy, these blood vessels change shape and become wider. If the blood vessels do not fully transform, it is likely that the placenta will not develop properly because it will not get enough nutrients. This may then lead to Pre-Eclampsia. It is still unclear why the blood vessels do not transform as they should. It is likely that inherited changes in the mother’s genes have some sort of role, as the condition often runs in families.