In brief — the direct answer
Pre-eclampsia is a pregnancy-associated disorder involving high blood pressure and organ or placental dysfunction. It generally develops after 20 weeks and can also first appear after birth. Assessment and treatment depend on the maternal and fetal findings and gestation. Severe headache, visual symptoms, upper abdominal pain or breathlessness needs urgent assessment, including postpartum.
What is Pre-eclampsia & Hypertension?
Pre-eclampsia is more than just high blood pressure. It is rooted in the early development of the placenta. When the placenta's blood vessels don't develop correctly, they cannot deliver enough oxygen to the baby. This causes the placenta to release substances into the mother's bloodstream that 'irritate' her blood vessels, leading to high blood pressure and potential damage to her kidneys, liver, brain, and blood-clotting system.
Who is at risk?
While pre-eclampsia can happen to anyone, the risk is higher for:
- First-time mothers or those with a new partner.
- History of Pre-eclampsia: In a previous pregnancy.
- Medical Conditions: Existing high blood pressure, diabetes, kidney disease, or autoimmune conditions (like Lupus).
- Multifetal Pregnancy: Carrying twins or triplets.
- Advanced Maternal Age: Women over 40.
How we diagnose it
We use a combination of tools to monitor and diagnose the condition:
- Blood Pressure Monitoring: Two readings of 140/90 or higher, taken four hours apart.
- Proteinuria: Checking for protein in the urine, which indicates the kidneys are under stress.
- Blood Tests: Checking liver enzymes, platelet counts, and kidney function.
- sFlt-1/PlGF Ratio: A modern blood test that helps predict who is likely to develop pre-eclampsia in the coming weeks.
What does management involve?
Care depends on maternal and fetal findings and gestation. It can include blood-pressure treatment, laboratory and fetal surveillance, hospital admission and magnesium sulphate for seizure prevention when indicated. Aspirin is used for prevention in eligible pregnancies, not as treatment for established pre-eclampsia. Decisions about birth balance the risks of continuing pregnancy against prematurity, with urgent delivery when maternal or fetal safety requires it.
What are the outcomes?
Delivery of the placenta is central to management, but pre-eclampsia can first appear or worsen after birth and does not resolve instantly. Continue the prescribed blood-pressure checks, medication and postnatal review. Severe headache, visual symptoms, breathlessness or upper abdominal pain needs urgent assessment after birth as well as during pregnancy. A history of pre-eclampsia also warrants discussion of longer-term cardiovascular health.
When to see a subspecialist
If you experience any 'Red Flag' symptoms, you must contact your doctor or visit the emergency room immediately:
- Severe Headaches that don't go away with paracetamol.
- Vision Changes: Blurring, flashing lights, or spots.
- Upper Abdominal Pain: Often felt under the ribs on the right side.
- Sudden Swelling: Especially in the face and hands.
At the MFM Unit, Dr. Leanne Bricker specializes in the management of hypertensive disorders. We provide a comprehensive screening and surveillance program to keep you and your baby safe.