How early can pre eclampsia start

Pre-eclampsia - Symptoms - NHS

Pre-eclampsia rarely happens before the 20th week of pregnancy.

Although less common, the condition can also develop for the first time in the first 4 weeks after birth.

Most people only experience mild symptoms, but it's important to manage the condition in case severe symptoms or complications develop.

Generally, the earlier pre-eclampsia develops, the more severe the condition will be.

Early signs and symptoms

Initially, pre-eclampsia causes:

high blood pressure (hypertension)
protein in urine (proteinuria)

You probably won't notice any symptoms of either of these, but your GP or midwife should pick them up during your routine antenatal appointments.

High blood pressure alone doesn't suggest pre-eclampsia.

But if protein in the urine is found at the same time as high blood pressure, it's a good indicator of the condition.

Read more about diagnosing pre-eclampsia.

Further symptoms

As pre-eclampsia progresses, it may cause:

severe headaches
vision problems, such as blurring or seeing flashing lights
pain just below the ribs
vomiting
sudden swelling of the feet, ankles, face and hands

If you notice any symptoms of pre-eclampsia, get medical advice immediately by calling your GP surgery or NHS 111.

Without immediate treatment, pre-eclampsia may lead to a number of serious complications, including:

convulsions (eclampsia)
HELLP syndrome (a combined liver and blood clotting disorder)
stroke

But these complications are rare.

Read more about the complications of pre-eclampsia.

Signs in the unborn baby

The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby.

The growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intra-uterine or foetal growth restriction.

If your baby is growing more slowly than usual, this will normally be picked up during your antenatal appointments, when the midwife or doctor measures you.

Page last reviewed: 28 September 2021
Next review due: 28 September 2024

Preeclampsia - Symptoms and causes

Overview

Preeclampsia is a complication of pregnancy. With preeclampsia, you might have high blood pressure, high levels of protein in urine that indicate kidney damage (proteinuria), or other signs of organ damage. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.

Left untreated, preeclampsia can lead to serious — even fatal — complications for both the mother and baby.

Early delivery of the baby is often recommended. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are. Before delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications.

Preeclampsia may develop after delivery of a baby, a condition known as postpartum preeclampsia.

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Symptoms

The defining feature of preeclampsia is high blood pressure, proteinuria, or other signs of damage to the kidneys or other organs. You may have no noticeable symptoms. The first signs of preeclampsia are often detected during routine prenatal visits with a health care provider.

Along with high blood pressure, preeclampsia signs and symptoms may include:

Excess protein in urine (proteinuria) or other signs of kidney problems
Decreased levels of platelets in blood (thrombocytopenia)
Increased liver enzymes that indicate liver problems
Severe headaches
Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
Shortness of breath, caused by fluid in the lungs
Pain in the upper belly, usually under the ribs on the right side
Nausea or vomiting

Weight gain and swelling (edema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of edema — particularly in your face and hands — may be a sign of preeclampsia.

When to see a doctor

Make sure you attend your prenatal visits so that your health care provider can monitor your blood pressure. Contact your provider immediately or go to an emergency room if you have severe headaches, blurred vision or other visual disturbances, severe belly pain, or severe shortness of breath.

Because headaches, nausea, and aches and pains are common pregnancy complaints, it's difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem — especially if it's your first pregnancy. If you're concerned about your symptoms, contact your doctor.

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Causes

The exact cause of preeclampsia likely involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.

In women with preeclampsia, these blood vessels don't seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.

Other high blood pressure disorders during pregnancy

Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Other disorders can happen, too:

Gestational hypertension is high blood pressure that begins after 20 weeks without problems in the kidneys or other organs. Some women with gestational hypertension may develop preeclampsia.
Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. High blood pressure that continues more than three months after a pregnancy also is called chronic hypertension.
Chronic hypertension with superimposed preeclampsia occurs in women diagnosed with chronic high blood pressure before pregnancy, who then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.

Risk factors

Conditions that are linked to a higher risk of preeclampsia include:

Preeclampsia in a previous pregnancy
Being pregnant with more than one baby
Chronic high blood pressure (hypertension)
Type 1 or type 2 diabetes before pregnancy
Kidney disease
Autoimmune disorders
Use of in vitro fertilization

Conditions that are associated with a moderate risk of developing preeclampsia include:

First pregnancy with current partner
Obesity
Family history of preeclampsia
Maternal age of 35 or older
Complications in a previous pregnancy
More than 10 years since previous pregnancy

Other risk factors

Several studies have shown a greater risk of preeclampsia among Black women compared with other women. There's also some evidence of an increased risk among indigenous women in North America.

A growing body of evidence suggests that these differences in risk may not necessarily be based on biology. A greater risk may be related to inequities in access to prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and well-being.

Lower income also is associated with a greater risk of preeclampsia likely because of access to health care and social factors affecting health.

For the purposes of making decisions about prevention strategies, a Black woman or a woman with a low income has a moderately increased risk of developing preeclampsia.

Complications

Complications of preeclampsia may include:

Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction.
Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks.
Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.
HELLP syndrome. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.

Signs and symptoms include nausea and vomiting, headache, upper right belly pain, and a general feeling of illness or being unwell. Sometimes, it develops suddenly, even before high blood pressure is detected. It also may develop without any symptoms.
Eclampsia. Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can happen without any previously observed signs or symptoms of preeclampsia.

Signs and symptoms that may appear before seizures include severe headaches, vision problems, mental confusion or altered behaviors. But, there are often no symptoms or warning signs. Eclampsia may occur before, during or after delivery.
Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is.
Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery.

Prevention

Medication

The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your primary care provider may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor.

It's important that you talk with your provider before taking any medications, vitamins or supplements to make sure it's safe for you.

Lifestyle and healthy choices

Before you become pregnant, especially if you've had preeclampsia before, it's a good idea to be as healthy as you can be. Talk to your provider about managing any conditions that increase the risk of preeclampsia.

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Preeclampsia and pregnancy | Ida-Tallinna Keskhaigla

The purpose of this leaflet is to provide the patient with information about the nature, occurrence, risk factors, symptoms and treatment of preeclampsia.

What is preeclampsia?

Pre-eclampsia is a disease that occurs during pregnancy and is characterized by high blood pressure and protein in the urine. Preeclampsia is one of the most common complications of pregnancy. Epilepsy-like seizures occur in severe preeclampsia and are life-threatening.

What symptoms may indicate the development of preeclampsia?

High blood pressure - blood pressure values are 140/90 mmHg. Art. or higher. If systolic (upper) or diastolic (lower) blood pressure rises by 30 mm Hg. Art. or more, then such an increase cannot be ignored.

Protein in urine - 300 mg in urine collected over 24 hours, or +1 value on a rapid test.

Swelling of the arms, legs or face , especially under the eyes or if the swelling leaves a depression in the skin when pressed. Edema can occur in all pregnant women and is generally harmless, but rapidly developing edema should be taken into account.

Headache that does not improve after taking pain medication.

Visual disturbances - double vision or blurred vision, dots or flashes before the eyes, auras.

Nausea or pain in the upper abdomen - These symptoms are often mistaken for indigestion or gallbladder pain. Nausea in the second half of pregnancy is not normal.

Sudden weight gain - 2 kg or more per week.

As a rule, there is a mild course of the disease that occurs at the end of pregnancy and has a good prognosis. Sometimes, preeclampsia can worsen quickly and be dangerous to both mother and fetus. In such cases, rapid diagnosis and careful monitoring of the mother and child are of paramount importance.

Unfortunately, most women show symptoms in the final stages of the disease. If you experience any of the above symptoms, you should contact your midwife, gynecologist, or the Women's Clinic emergency department.

Is preeclampsia called toxemia of pregnancy?

Previously, pre-eclampsia was really called toxicosis, or toxemia, since it was believed that the cause of the disease was toxins, that is, poisons in the blood of a pregnant woman.

What is the difference between preeclampsia and gestational hypertension?

Pregnancy hypertension is an increase in blood pressure above normal after the 20th week of pregnancy. With hypertension of pregnant women, protein in the urine is not observed.

What is HELLP syndrome?

HELLP syndrome is one of the most severe forms of preeclampsia. HELLP syndrome is rare and sometimes develops before symptoms of preeclampsia appear. Sometimes the syndrome is difficult to diagnose, as the symptoms resemble gallbladder colic or a cold.

When does preeclampsia occur?

Preeclampsia usually occurs after the 20th week of pregnancy. As a rule, preeclampsia goes away after delivery, but complications can occur up to six weeks after delivery, during which careful monitoring of the condition is necessary. If by the sixth week after birth, blood pressure does not return to normal, then you need to contact a cardiologist, who will begin treatment against hypertension.

What is the cause of preeclampsia?

The causes of the disease are still not clear, there are only unproven hypotheses.

How does the disease affect pregnant women and pregnancy?

Most preeclamptic pregnancies have a favorable outcome and a healthy baby is born. However, the disease is very serious and is one of the most common causes of death of the child and mother. Preeclampsia affects a woman's kidneys, liver, and other vital organs, and if left untreated, it can cause seizures (eclampsia), cerebral hemorrhage, multiple organ failure, and death.

How does the disease affect the fetus?

In preeclampsia, the fetus does not receive enough oxygen and nutrients to grow, and intrauterine growth retardation may occur. In addition, the placenta may separate from the uterine wall before the baby is born. Since the only treatment for preeclampsia is childbirth, sometimes a pregnancy has to be terminated prematurely. Until the 34th week of pregnancy, the lungs of the fetus have not yet matured, and steroid hormones are administered intravenously to the pregnant woman to prepare her lungs. In addition to the immaturity of the lungs, the health of a premature baby is threatened by many other diseases.

Who is at risk of developing preeclampsia?

Preeclampsia occurs in approximately 8% of pregnant women, many of whom have no known risk factors.

What are the risk factors for preeclampsia?

Patient-related risk factors

First pregnancy
Pre-eclampsia during a previous pregnancy
Age over 40 or under 18
High blood pressure before pregnancy
Diabetes before or during pregnancy
Multiple pregnancy
Overweight (BMI> 30)
Systemic lupus erythematosus or other autoimmune disease
Polycystic ovary syndrome
Long interval between two pregnancies

Risk factors associated with the patient's family

What is the prevention and treatment of preeclampsia

During the first trimester screening, or Oscar test, in addition to the most common chromosomal diseases, the risk of preeclampsia is also calculated. In case of high risk, pregnant women are advised to take aspirin (acetylsalicylic acid) at a dose of 150 mg in the evenings until the 36th week of pregnancy. This helps reduce the chance of preeclampsia by the 34th week of pregnancy by up to 80%.

Childbirth is the only treatment for preeclampsia. Sometimes a child can be born naturally, but sometimes, if the disease is very acute, an emergency caesarean section is necessary. The best time to have a baby is after the 37th week of pregnancy. Bed rest, medications, and, if necessary, hospitalization can sometimes help bring the condition under control and prolong the pregnancy. Often, a doctor will refer a woman with preeclampsia to the hospital for observation, as the condition of the fetus and pregnant woman may suddenly worsen.

Does bed rest help?

Sometimes bed rest is enough to bring mild preeclampsia under control. In this case, the patient often visits a doctor who measures blood pressure, does blood and urine tests, and monitors the course of the disease. The condition of the fetus is also often examined using a cardiotocogram (CTG) and ultrasound.

Are drugs used to treat preeclampsia?

High blood pressure sometimes requires medication. The medications used have few side effects, the drugs prescribed do not have much effect on the fetus, but are very important in the treatment of maternal high blood pressure.

Seizures are a rare but very serious complication of preeclampsia. Magnesium sulfate is sometimes given intravenously to prevent seizures in a pregnant woman with preeclampsia both during and after childbirth. It is safe for the fetus, but the mother may experience side effects such as hot flashes, sweating, thirst, visual disturbances, mild confusion, muscle weakness, and shortness of breath. All these side effects disappear when the drug is discontinued.

Can preeclampsia recur?

Preeclampsia does not necessarily recur in the next pregnancy, but the main risk factor for preeclampsia is the presence of preeclampsia in a previous pregnancy(s). Risk factors for relapse include the severity of the previous case and the woman's overall health during pregnancy. A woman who has previously had preeclampsia should consult a gynecologist during a new pregnancy or when planning a pregnancy.

ITK1013
The information material was approved by the Health Care Quality Committee of East-Tallinn Central Hospital on 27.01.2021 (Minutes No. 2-21).

What is preeclampsia and why is it dangerous?

What is preeclampsia

Preeclampsia is a disease in which pregnant women have high blood pressure and protein in the urine. This happens in about 8% of expectant mothers and less often in the first weeks after childbirth. This condition can lead to severe complications for the mother or child, and sometimes threatens their lives.

Many obstetrician-gynecologists in Russia and neighboring countries refer to preeclampsia as preeclampsia, which creates confusion. But don't worry. This is not a sign of the doctor's incompetence, but simply the peculiarities of the historical development of medicine in the countries of the former USSR, where obsolete names of diseases often continue to be used.

What is the danger of preeclampsia

The disease occurs in a mild, moderate or severe form. Any of these can lead to complications. These include:

intrauterine growth retardation, due to which the child is born with an underweight;
preterm birth, with higher risk if preeclampsia occurs before 34 weeks of gestation;
placental abruption accompanied by severe bleeding;
stroke in pregnancy;
pulmonary edema;
renal or hepatic insufficiency;
bleeding disorder.

A pregnant woman sometimes has convulsions, she loses consciousness - this is a dangerous condition that indicates the transition from preeclampsia to eclampsia.

If an ambulance is not called immediately, the woman may fall into a coma or die.

To prevent this from happening, you need to carefully monitor the appearance of the first signs of the disease.

What are the symptoms of preeclampsia

The disease makes itself felt after 20 weeks of pregnancy. Usually the first thing women notice is the appearance of edema. This is due to the fact that the kidneys intensively excrete protein in the urine, which normally should retain water in the bloodstream. Due to swelling in the legs, shoes are difficult to put on, and if you press on the shin with your finger, pits will remain on the skin. When the hands swell, it is impossible to remove the ring. Sometimes fluid accumulates under the skin of the face, especially after a night, so bags are noticeable under the eyes.

Edema may be hidden and cannot be seen on the skin. But you can be suspicious if the weight gain per week is more than 900 grams.

Another sign of preeclampsia is high blood pressure. At the same time, the pregnant woman feels a headache, dizziness, weakness, and her vision becomes cloudy or spots flash before her eyes.

The next important symptom is protein in the urine. But this can only be noticed by passing tests. That is why the urine of pregnant women is checked before each of their visits to the obstetrician-gynecologist.

For any degree of severity of the disease, the symptoms listed above are characteristic, only they are expressed in different ways. But if the disease becomes severe, additional symptoms appear:

labored breathing;
heartburn-like pain in the middle of the abdomen or under the ribs on the right;
nausea and vomiting;
infrequent urination;
temporary blindness or eye sensitivity to light.

Why preeclampsia occurs

Doctors don't know exactly where preeclampsia comes from. But there are factors that significantly increase the risk of developing the disease. Here they are:

Pre-eclampsia or high blood pressure in a previous pregnancy.
Diabetes mellitus.
Arterial hypertension that occurred before conception. In this case, the risk increases five times.
Autoimmune diseases such as systemic lupus erythematosus and antiphospholipid syndrome.
Overweight or obese. Moreover, the greater the body weight, the higher the chance of developing preeclampsia.
Chronic kidney disease. Often they are accompanied by high blood pressure and can provoke preeclampsia.
Bearing several children.
Woman's first pregnancy.
Age over 35 years.
Placental insufficiency in a previous pregnancy.
IVF.
Heredity. If the mother had preeclampsia, the risk of such a violation in the daughter increases.

How preeclampsia is treated

The only way to get rid of preeclampsia is to have a baby. If the term is long or the condition allows, the woman gives birth herself. In severe cases, a caesarean section is performed.

But if the gestational age is up to 37 weeks, obstetrician-gynecologists try to improve the woman's condition and prevent complications. There are several ways.

Lifestyle changes

Doctors advise expectant mothers to stay in bed and rest more, lie on their right side, breathe fresh air. Stress can increase blood pressure, so a woman should not worry over trifles.

For mild cases, special exercises for pregnant women can be done. For example, tilting to the sides, circular movements of the arms, swinging the legs. Sometimes it is recommended to practice on a fitball, swim and walk.

Dieting

It is important for women with preeclampsia to eat a balanced diet. They, like all pregnant women, are advised:

There are foods rich in simple protein. In preeclampsia, it is lost in the urine, so you need to restore its level with food.
Eat lean meat, poultry or fish, legumes.
Eat vegetables and fruits every day. They are a source of vitamins and minerals, fiber, and therefore help maintain bowel function and normal weight.
Avoid alcohol, coffee and other caffeinated drinks, fast food, fatty foods.
Eat less sweets.
Include fermented milk products, nuts, vegetable oils in the menu.
Reduce the amount of salt in the diet.

Taking medication

To improve the condition of the pregnant woman and the baby, the doctor may prescribe medication. For example, magnesium preparations are used to reduce pressure and prevent seizures.

If there is a risk of preterm delivery, the pregnant woman is given glucocorticoid hormones. They will help accelerate the maturation of the lungs of the fetus and improve its adaptation after birth.