Pre-Eclampsia in a Previous Pregnancy

woman having her blood pressure measured

What is pre-eclampsia?

Pre-eclampsia is a complication of pregnancy.  The main feature is high blood pressure. It also affects the mum’s organs, for example the liver, kidney and brain. It can also affect the baby in the womb.

Pre-eclampsia occurs in the second half of pregnancy (after 20 weeks).

 

How common is pre-eclampsia?

Pre-eclampsia is one of the most common pregnancy complications, affecting around 5-8% of pregnant women overall.

 

I had pre-eclampsia in my last pregnancy – will it come back in my current pregnancy?

Unfortunately pre-eclampsia often comes back in subsequent pregnancies. This risk seems to be particularly high if pre-eclampsia developed early (before 34 weeks) in a previous pregnancy.

 

Do you see many cases of women who had pre-eclampsia in a previous pregnancy?

Yes, this is a very common reason for women to see a high risk obstetrician. I’ve looked after hundreds of women who had pre-eclampsia or other blood pressure problems in an earlier pregnancy. You’d be surprised how many women this affects!

 

If I had pre-eclampsia last time, what extra treatment do you recommend in this pregnancy?

Women who have had pre-eclampsia in the past should have pre-pregnancy counselling, so they are aware of the extra recommendations for their next pregnancy.

Women who had severe pre-eclampsia, needed early delivery of their baby, or who have underlying medical problems should give serious thought to seeing a Maternal-Fetal Medicine specialist.

Lots of scientific studies have looked at whether vitamins and supplements reduce a woman’s risk for pre-eclampsia. The one which has been shown to reduce the risk in an otherwise healthy woman is a daily low-dose aspirin tablet, which should be started early in pregnancy.

Women should have their blood pressure monitored regularly during pregnancy. Increased blood pressure should be investigated and treated promptly.

 

Does my baby need extra monitoring?

Yes. Women with a history of pre-eclampsia need extra ultrasound scans to keep a close eye on their unborn baby. The placenta may not work very well in pre-eclampsia, stopping the baby from thriving in the womb. This can be seen on ultrasound scans as failure to grow properly (called fetal growth restriction) or as abnormal blood flow (Dopplers).

 

What symptoms should I tell my obstetrician about?

Pre-eclampsia can occur without any obvious symptoms. However, the most common symptoms are:

  • Persistent, new headache
  • Spots, flashes or other changes in your vision
  • Pain in your upper abdomen
  • Rapid swelling of feet, face and hands
  • New onset nausea and vomiting

 

How is pre-eclampsia diagnosed?

We diagnose pre-eclampsia using a combination of tests and clinical findings. All women with pre-eclampsia have high blood pressure. However, the other tests and clinical findings vary – not all women will have every sign. Features include:

  • High blood pressure measurements
  • Abnormal urine and blood tests – involvement of the kidneys, liver and blood system
  • Ultrasound – a baby that is abnormally small or growing too slowly, abnormal blood flow (Dopplers) or reduced amniotic fluid (the waters)
  • Physical examination – abnormal reflexes, very swollen ankles, fluid on the lungs

 

If I get pre-eclampsia what treatment will I need?

We treat the high blood pressure with blood pressure medication. Depending on the severity of the pre-eclampsia, you may also need admission to hospital for other treatments.

Blood pressure medication only buys us time – it doesn’t cure pre-eclampsia. The only cure for pre-eclampsia is to deliver the baby. Women with pre-eclampsia often need early delivery of their baby. Both North Shore Private Hospital and The Mater Hospital have Special Care Nurseries and can look after babies born as early as 32 weeks.

 

What other problems can pre-eclampsia lead to?

We take pre-eclampsia very seriously because it can lead to other complications, including:

  • HELLP syndrome (a very severe, rapidly progressing form of pre-eclampsia)
  • Seizures (called eclampsia – this is what killed Lady Sybil in Downton Abbey)
  • Blood clots
  • Placental abruption
  • Abnormal bleeding
  • Kidney damage
  • Liver damage
  • Lung problems
  • Stroke
  • Harm to the unborn baby

 

What about after pregnancy?

Women who have had pre-eclampsia are at increased risk of high blood pressure, heart and blood vessel disease, kidney disease and Type 2 diabetes in later life. Outside of pregnancy, they should have an annual blood pressure check with their GP. They should also have other markers like their lipids and blood glucose checked regularly (every 5 years or more often if the GP feels it is indicated).