During your pregnancy check-up, your blood pressure will be checked at every visit. This is because a rise in blood pressure can be the first sign of a condition known as pre-eclampsia-also called pregnancy- induced hypertension (PIH) or pre-eclamptic toxaemia (PET).

Pre-eclampsia is much more common than most people think –in fact it is the commonest of the serious complications of pregnancy.

Pre-eclampsia can be a dangerous, even life threatening if not treated promptly at right time.

What is it?

It is an illness with raised blood pressure which occurs only in pregnancy and can affect both mother and her unborn baby. Usually this condition occurs in second half of pregnancy. On rare occasion this condition may develop immediately after delivery. Most cases are mild, but there is a severe form which can be dangereous.Among most serious complications are convulsions known as eclampsia –hence the term pre-eclampsia. 

Who gets it?

The mild form affects 10% (about 1 in 10) of pregnancies and the severe form affects 1 in every 50 pregnancies.

Although it’s hard to predict which women will develop pre-eclampsia,The chances of getting this condition is high if

-This is your first pregnancy

-Any close relatives (mother, sister) have had it

-you are 35 years old or more

-you already have high blood pressure

-you are expecting twins, triplets or more

-you had it before (during your earlier pregnancy)

-you are overweight –BMI of 35 or more

-It’s 10 years or more since your last baby

-you have a medical condition such as renal disease, diabetes or antiphospolipid syndrome.

What causes it?

The problem is in the placenta which restricts the flow of blood to the baby. The exact reason for this placental dysfunction is not known. This develops in early on during pregnancy but doesn’t cause illness much later-usually in the last few weeks.

What are the symptoms and signs?

In the early stages of the disease there may not be any symptoms. At this point it can only be detected by checking the weight, blood pressure and testing the urine for protein. These checks are a routine part of all antenatal appointments, and it’s important all pregnant women attend these.

Another early sign of pre-eclampsia is swelling of the ankles or oedema and sometimes swelling in hands and face and this causes excessive weight gain.  Even though swelling is common in pregnancy (often due to physiological changes in pregnancy and nothing needs to be done), women should report any swelling earliest to check their blood pressure and urine protein.

Symptoms of more serious problems may develop as pre-eclampsia progresses. These include:

-bad headaches

-problems with vision, such as blurred vision or lights flashing before the eyes

-vomiting (not the morning sickness of early pregnancy)

-Bad pain just below the ribs, especially on the right side

– Confusion

If you’re worried about any symptoms, see your doctor as soon as possible.

Complications:

Very high blood pressure can be dangerous to mother and her baby. In severe cases complications in mother are- fits, coma, blindness, and multi organ failures (kidney, heart etc.)

Pre-eclampsia can stop your baby getting enough food or oxygen. Therefore baby may grow more slowly and can develop other problems.

How it is treated?

• Finding pre-eclampsia early makes it easier to keep you and your baby safe
• Treatment aims to lower blood pressure and includes strict bed rest, low salt intake and drugs (medications) to control blood pressure.
• You may be asked to stay in hospital so that doctors can keep close watch on the health of you and your baby
• You may be delivered early. 

Can it be cured?

Pre-eclampsia will not get better until after your baby is born. Therefore the cure is only by delivery of the baby, and with it the placenta that is causing the problem. That is why most women with pre-eclapmsia have an induced delivery (often early).

Does it happen again?

Chances of getting in subsequent pregnancies are  higher.

Can it be predicted in early pregnancy?

As mentioned earlier the main fault in the condition is in the placenta. Normally during pregnancy the blood flow from mother to placenta will be very smooth and low resistance flow in the uterine blood vessel (so as to supply more and more blood to the placenta).In pre-eclampsia all the small blood vessels inside the placenta are blocked hence blood flow from mother through uterine artery has to flow with very high resistance.

By ultrasound scan it is possible to study the blood flow to the placenta (uterine artery Doppler) and therefore it would be possible to identify majority of the women who are more likely to get this condition. However this test is not very sensitive as, this test will not identify all the cases and also if the blood flow is abnormal it does not mean all will develop preeclampsia.

Can it be prevented?

Not reliably –although small doses of aspirin taken from early on in pregnancy under medical supervision are thought to help.

Why pre-eclampsia has come to you?

It is important to remember you have not done anything wrong; therefore it is not your fault. As mentioned earlier the exact cause is unknown and it is not caused by work, travel, worry etc. 

What is white coat hypertension?

This is a transient raise in B.P because of anxiety and common at the time of consulting doctor (therefore called as white coat hypertension) and is mainly because of anxiety and fear. It will be useful to check the BP again when lady is well relaxed and BP will returns to normal. This will not adversely affect pregnancy.