Pre-eclampsia
Pregnancy-specific multisystem disorder defined by new hypertension and organ dysfunction — a leading cause of maternal and perinatal death.
Overview
Pre-eclampsia complicates 2–8% of pregnancies. It arises from abnormal placentation, with widespread maternal endothelial dysfunction. It can present at any gestation ≥20 weeks and into the puerperium. Magnesium sulfate and timely delivery remain the cornerstones; aspirin prophylaxis halves risk in high-risk women.
Symptoms
- • Often asymptomatic — detected on routine BP/urine check
- • Severe headache, visual disturbance, flashing lights
- • Right upper quadrant or epigastric pain
- • Sudden swelling of face, hands or feet
- • Reduced fetal movements
Risk factors
- • Previous pre-eclampsia, chronic hypertension, chronic kidney disease, diabetes, autoimmune disease (SLE, APS)
- • First pregnancy, age ≥40, BMI ≥35, multiple pregnancy
- • Family history (mother/sister)
- • IVF, interval >10 years between pregnancies
Causes
- • Abnormal trophoblast invasion of spiral arteries → placental ischaemia
- • Release of anti-angiogenic factors (sFlt-1, soluble endoglin)
- • Maternal endothelial dysfunction
🚨 Red flags — seek urgent care
- • BP ≥160/110, severe headache, visual disturbance, RUQ pain
- • Convulsions (eclampsia)
- • Falling platelets, rising transaminases, deranged renal function (HELLP)
- • Placental abruption
- • Reduced fetal movements or abnormal CTG
When to seek care
- • Severe persistent headache, visual change, epigastric pain — same-day assessment
- • BP ≥140/90 at home — contact maternity
- • Reduced fetal movements at any time
Diagnosis
- • New-onset hypertension (≥140/90) after 20 weeks, AND
- • Proteinuria (≥30 mg/mmol PCR or 300 mg/24h), or organ dysfunction (renal, hepatic, neurological, haematological), or uteroplacental dysfunction (IUGR, abnormal Doppler)
- • PlGF / sFlt-1:PlGF ratio aids diagnosis and rule-out (NICE DG23)
- • Bloods: FBC, U&E, LFTs, urate, coagulation
Treatment
- • Antihypertensive: labetalol first-line (nifedipine MR if asthmatic; methyldopa as alternative)
- • Magnesium sulfate (4 g IV bolus then 1 g/hour) for severe pre-eclampsia or eclampsia — prevents/treats seizures
- • Antenatal corticosteroids 24–34 weeks, magnesium sulfate <30 weeks for neuroprotection
- • Plan delivery: ≥37 weeks recommended; earlier for severe disease/maternal-fetal compromise
- • Continuous BP and bloods monitoring during/after delivery
- • Postnatal antihypertensives often required for weeks — BP can peak day 3–5 postpartum
Prevention
- • Aspirin 75–150 mg daily from 12 weeks until birth in high-risk women (one major or two moderate risk factors)
- • Calcium supplementation in low-calcium-intake populations
- • Optimise BP, weight and chronic conditions pre-pregnancy
Complications
- • Eclampsia, stroke, HELLP syndrome, DIC
- • Placental abruption, IUGR, preterm birth, stillbirth
- • Pulmonary oedema, AKI, liver haematoma/rupture
- • Long-term: doubled lifetime cardiovascular risk
Prognosis
Most women recover fully postpartum but require careful BP follow-up. Long-term cardiovascular risk is doubled — lifestyle and BP surveillance matter for decades.
Education & self-care
Know the warning signs: severe headache, visual changes, upper abdominal pain, sudden swelling, or reduced fetal movements. Acting fast saves lives.
Frequently asked questions
Will I get pre-eclampsia again?
Recurrence is around 15–20%, higher with early-onset/severe disease. Aspirin from 12 weeks reduces risk.
Is delivery the only cure?
Yes — pre-eclampsia resolves after the placenta is delivered, though postpartum BP control is still essential.
Does mild hypertension matter?
Yes — it can progress quickly. All new pregnancy hypertension needs urgent assessment.