About 30 years ago one of my friends, with whom I did my midwifery training, very sadly, tragically and unexpectedly died of pre-eclampsia.

Nicky was a happy, warm, kind person and together with her husband they were looking forward to the birth of their first baby. One night Nicky was feeling unwell when her husband was working away from home. He was anxious to come back home straight away, but Nicky reassured him that she was ‘pregnant, not ill’ and went off to bed. The next morning he was unable to get a reply on the phone. He quickly returned home, discovering that Nicky had suffered an eclamptic fit and died in the night.

Over the past three decades as a midwife I have seen huge advances in the close monitoring of women with pre-eclampsia, their unborn babies and the timely delivery of babies when it is deemed that they are safer outside the womb, rather than within.

We also know that some women are more pre-disposed to develop pre-eclampsia in their pregnancies. For example, those;

  • having an existing medical problem (such as diabetes, high blood pressure, kidney disease)
  • women who have previously had pre-eclampsia (approximately 16% chance of developing the condition again in future pregnancies)
  • in their first pregnancy
  • with a family history of the condition (such as mother or sister)
  • with a BMI over 35 at the beginning of pregnancy
  • women over the age of 40

Women at high risk of pre-eclampsia now take low dose aspirin (75mg), prescribed by the GP, from 12 weeks of pregnancy. Evidence suggests that this can lower the chances of women developing the condition.

It is thought that about 6% of women develop mild pre-eclampsia in their pregnancy, whilst severe cases develop in about 1-2% of pregnancies.

Pre-eclampsia rarely happens before 20 weeks of pregnancy. Most cases occur after 26 weeks, and usually towards the end of pregnancy, hence one of the reasons why expectant women are seen more frequently during this stage.

The main checks for pre-eclampsia are:

– Blood pressure checks to pick up high blood pressure are important, always comparing readings to the measurements at the very first ‘booking’ appointment. Using the correct size blood pressure cuff is also necessary.

– Urine tests to pick up protein in the urine (normally there is none, however high blood pressure forces protein molecules through the kidneys into the urine).

– Observing for generalised oedema may also occur, affecting the whole body (including the face and hands), rather than the common pregnancy symptom of slightly swollen feet and ankles in late pregnancy.

Pre-eclampsia symptoms can include;

  • severe headaches
  • visual disturbances
  • severe heartburn
  • pain just below the ribs (‘epigastric pain’)
  • nausea and vomiting
  • feeling very unwell
  • sudden increase in generalised oedema

Management of pre-eclampsia includes;

  • regular blood tests
  • ultrasound scans to monitor the growth of the baby and placental function
  • BP checks
  • urine tests
  • CTG monitoring to assess baby’s well being
  • women promptly escalating any concerns about any reduction or change in fetal movements
  • women and their partners having an awareness of the symptoms of pre-eclampsia

Medication to control women’s blood pressure has a key role in controlling the condition and often allowing the pregnancy to progress to a later gestation, although induction of labour before the due date is common, and in severe cases an emergency caesarian section can occasionally be necessary.

Pre-eclampsia can continue to affect women beyond the birth, so the condition needs to be monitored till around about 6 weeks postpartum.

I will never forget Nicky. It is so, so sad that her life and that of her unborn baby ended because of pre-eclampsia. Lets raise awareness, knowledge and understanding so that we can ensure that all women have the safest pregnancies and the very best outcomes for them, their babies and their families.

1988

Nicky – second from left

(Me – third from left)