Pre-eclampsia
Also known as: preeclampsia, pre eclampsia, pregnancy-induced hypertension
Pre-eclampsia is a condition that can develop in pregnancy, with high blood pressure and protein in the urine as its early signs.
When to seek care
The NHS says anyone who is pregnant, or has given birth in the last few weeks, and has symptoms of pre-eclampsia such as a severe headache that painkillers do not ease, vision problems, pain just below the ribs or sudden swelling should get urgent medical help. A pregnant person is advised to call the maternity unit if they have the number. After a recent birth, or if the unit cannot be reached, the advice is to call NHS 111. For a life-threatening emergency at any stage of pregnancy, the NHS says to call 999.
Overview
Pre-eclampsia is a condition that can develop during pregnancy, and its early signs are high blood pressure and protein in the urine. The NHS says the exact cause is not fully understood, but it is thought to involve a problem with the placenta. It often has no noticeable symptoms and is usually found at routine antenatal appointments. It can cause serious problems for the pregnant person or the baby, and it usually goes away after the birth.
Causes
- The placenta is thought not to develop properly because of a problem with the blood vessels that supply it
- The exact cause is not fully understood
Risk factors
- A first pregnancy
- More than ten years since the last pregnancy
- Pre-eclampsia in an earlier pregnancy
- A close family member, such as a mother or sister, who had pre-eclampsia
- Existing high blood pressure
- Diabetes
- Kidney disease
- Autoimmune disorders
- Being overweight or obese before pregnancy
- Older age
- A multiple pregnancy, such as twins
Symptoms
What a clinician may find
- High blood pressure
- Protein in the urine
Complications
- Premature birth
- Seizures, known as eclampsia
- Stroke
- Problems with the liver, lungs, kidneys, brain, blood-clotting system and heart
- Slower growth of the baby in the womb
- A higher long-term risk of high blood pressure, stroke and heart disease
Diagnosis
The NHS says pre-eclampsia is usually found through blood pressure and urine checks at routine antenatal appointments. If doctors think it may be present, a blood test measuring placental growth factor may be offered to help rule it out. A low level could be a sign of pre-eclampsia, but further tests are needed to confirm the diagnosis.
Treatment
The NHS says the only way to cure pre-eclampsia is to deliver the baby, so the person is usually monitored regularly until delivery is possible. Medicine to lower blood pressure is offered while waiting. Delivery can be induced or done by caesarean section, and it may happen earlier in more severe cases.
Prevention
The NHS says pre-eclampsia cannot be prevented, but people at high risk may be advised to take low-dose aspirin during pregnancy. NHS trust leaflets say aspirin does not prevent every case, and Tommy's says there is good evidence that it slightly reduces the risk.
Key facts
| Fact | Detail |
|---|---|
| Also called | Preeclampsia (the US spelling) |
| Early signs | High blood pressure and protein in the urine |
| Usually found by | Routine blood pressure and urine checks at antenatal appointments |
| Cause | Not fully understood; thought to involve the placenta |
| Treatment | Regular monitoring and blood pressure medicine; the NHS says delivering the baby is the only cure |
| After the birth | Usually goes away after the birth |
| Who to contact | Maternity unit or NHS 111 for symptoms; 999 for a life-threatening emergency |
What are the symptoms of pre-eclampsia?
The NHS says pre-eclampsia often has no noticeable symptoms, and that its early signs, high blood pressure and protein in the urine, are usually found at routine antenatal appointments. Tommy's says these signs usually appear after 20 weeks of pregnancy, although pre-eclampsia can start earlier or soon after delivery. NHS inform lists blood pressure rising in mid or late pregnancy, and a baby who is not growing well, as key indicators.
Later symptoms listed by the NHS include a severe headache that simple painkillers do not ease, vision problems such as blurring or flashing lights, pain just below the ribs, vomiting, heartburn that does not settle with heartburn medicines, feeling very unwell, and sudden swelling of the face, hands or feet. Tommy's notes that swollen hands and feet are common in late pregnancy but can also be a sign of pre-eclampsia.
When should urgent help be sought?
The NHS says anyone who is pregnant, or who has given birth in the last few weeks, and has symptoms of pre-eclampsia should get urgent medical help. A pregnant person is advised to call the maternity unit if they have the number. Someone who has recently given birth, or who cannot reach the maternity unit, is advised to call NHS 111. The NHS symptoms page also says to get medical advice immediately by calling the GP surgery or NHS 111.
For a life-threatening emergency at any stage of pregnancy, the NHS says to call 999. NHS inform advises contacting a midwife or GP immediately for very swollen ankles, fingers, hands or face. Severe pre-eclampsia can progress to seizures, called eclampsia, which need emergency care. The NHS says pre-eclampsia usually improves soon after the birth, but complications can sometimes develop a few days later, so the same symptoms still matter after delivery.
What causes pre-eclampsia and who is more likely to get it?
The NHS says the cause of pre-eclampsia is not fully understood. It is thought to happen when there is a problem with the placenta, the organ that connects the pregnancy to the pregnant person's blood supply and feeds the baby.
Risk factors listed by the NHS include a first pregnancy, more than ten years since the last pregnancy, a previous pregnancy with pre-eclampsia, and a close family member, such as a mother or sister, who had it. Diabetes, high blood pressure and kidney disease are also listed. NHS inform adds being overweight or obese before pregnancy. Local NHS trust guidance also lists older age and a multiple pregnancy, such as twins, and a research review includes autoimmune disorders among the risk factors. Having a risk factor does not mean pre-eclampsia will develop.
How is pre-eclampsia diagnosed?
The NHS says pre-eclampsia is usually found through blood pressure and urine checks at routine antenatal appointments. If doctors think it may be present, they may offer a blood test that measures a protein called placental growth factor, or PlGF, to help rule it out during part of pregnancy. The NHS says that if PlGF levels are high, it is highly likely that the person does not have pre-eclampsia. If levels are low, it could be a sign of pre-eclampsia, but further tests are needed to confirm the diagnosis.
A Scottish health technologies group says the PlGF-based test can help clinicians make a diagnosis when used alongside standard clinical assessment. It adds that the test does not show how severe the condition is, and that its results should not be used to make decisions about the timing of birth in preterm pre-eclampsia.
How is pre-eclampsia treated?
The NHS says the only way to cure pre-eclampsia is to deliver the baby, so the person is usually monitored regularly until delivery is possible. This is normally close to full term, but it may be earlier in more severe cases. Delivery can be induced or done by caesarean section, and blood pressure medicine is offered while waiting. NHS inform says moderate or severe cases may mean an earlier delivery.
The NHS says medicines for high blood pressure reduce the likelihood of serious complications, such as stroke. NHS trust guidance says blood pressure medicine can be given as tablets or through a drip. People diagnosed earlier in pregnancy may need to be admitted to hospital for blood pressure treatment and monitoring for complications while the birth is planned. Trial summaries describe magnesium sulfate as the standard medicine used to prevent and treat seizures in severe pre-eclampsia.
What complications can it cause, and can it be prevented?
NHS inform says pre-eclampsia can affect the liver, lungs, kidneys, brain, blood-clotting system and heart, and that moderate or severe cases may need an earlier delivery. A baby may not grow as well as expected, and an NHS trust leaflet notes that the baby may be smaller and may need to be born early. The NHS names stroke as a serious complication that blood pressure medicine helps to reduce.
The NHS says pre-eclampsia cannot be prevented, but people at high risk may be advised to take low-dose aspirin during pregnancy. NHS trust leaflets say aspirin will not prevent every case, and Tommy's says there is good evidence that it slightly reduces the risk. Trust guidance based on NICE guidance recommends it for people with one or more high-risk factors, or with more than one moderate risk factor.
What happens after the birth and what is the outlook?
Action on Pre-eclampsia says pre-eclampsia always goes away eventually after the baby is born, which may happen within hours or take up to six months. Blood pressure typically falls straight after birth and then rises to a peak a few days later. After discharge, blood pressure is measured regularly by the community midwife or GP until the high blood pressure has resolved, and medication is reduced gradually. If high blood pressure persists after the birth, the charity says it is diagnosed as non-pregnancy hypertension, which needs treatment to control cardiovascular problems in later life.
Tommy's says giving birth resolves the symptoms in most cases, although in a small number they continue. NHS inform says women who have had pre-eclampsia have a higher risk of high blood pressure, stroke or heart disease later in life.
Frequently asked questions
Can pre-eclampsia be cured?
The NHS says the only way to cure pre-eclampsia is to deliver the baby. Until delivery is possible, the person is usually monitored regularly, and blood pressure medicine is offered while waiting. Action on Pre-eclampsia says the condition always goes away eventually after the birth, which may happen within hours or take up to six months.
Can pre-eclampsia happen after the baby is born?
Tommy's says pre-eclampsia can start soon after delivery, and the NHS says complications can develop a few days after the birth. Action on Pre-eclampsia says women should be told which symptoms to look out for and who to contact if unwell. The NHS says anyone who has recently given birth and has symptoms is advised to call NHS 111.
Who is more likely to get pre-eclampsia?
The NHS lists a first pregnancy, more than ten years since the last pregnancy, a previous pregnancy with pre-eclampsia, a close family member who had it, diabetes, high blood pressure and kidney disease. NHS inform adds being overweight or obese before pregnancy. Having a risk factor is not a diagnosis, and the condition is found through antenatal checks.
Who should be contacted if symptoms of pre-eclampsia appear?
The NHS says symptoms of pre-eclampsia in someone who is pregnant, or who has given birth in the last few weeks, need urgent medical help. A pregnant person is advised to call the maternity unit if they have the number. NHS 111 is the route after a recent birth or if the unit cannot be reached, and the NHS says to call 999 for a life-threatening emergency.
Is existing high blood pressure linked to pre-eclampsia?
The NHS lists existing high blood pressure as a risk factor for pre-eclampsia, alongside diabetes and kidney disease. People at high risk may be advised to take low-dose aspirin during pregnancy, and the NHS says pre-eclampsia cannot be prevented. NHS trust leaflets say aspirin does not prevent every case of pre-eclampsia.
Does pre-eclampsia affect health later in life?
NHS inform says women who have had pre-eclampsia have a higher risk of high blood pressure, stroke or heart disease later in life. Action on Pre-eclampsia says that if high blood pressure persists after the birth, it is diagnosed as non-pregnancy hypertension, which needs treatment to control cardiovascular problems in later life.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Pre-eclampsia.
Conditions
- High blood pressure (hypertension) Persistently raised arterial pressure, usually defined as 140/90 mmHg or more in the clinic (135/85 on home readings).
Symptoms
- Headache Pain felt anywhere in the head.
- Vomiting Forceful emptying of the stomach through the mouth, a protective reflex run by the brainstem that closes the airway.
- Swelling (oedema) Excess fluid in the tissues.
Medical tests
- Blood pressure measurement The pressure of blood against the artery walls, recorded as two numbers: the systolic pressure when the heart contracts and the diastolic pressure…
- Urine protein Healthy kidney filters hold back almost all protein.
- Urinalysis A plastic strip with chemical pads dipped into a fresh urine sample.
Imaging
- Ultrasound High-frequency sound waves bounced off tissue give real-time, radiation-free images, used for pregnancy, the abdomen, the heart (echocardiography).
Procedures
- Caesarean section Birth of a baby through a cut in the lower abdomen and in the lower segment of the uterus.
Medications
- Aspirin A low-dose antiplatelet that stops platelets clumping into clots, used long term after heart attacks and strokes.