By: Dr Denise O’Brien
During pregnancy every woman’s blood pressure is checked for a very important reason at every antenatal appointment. In approximately 10% of pregnancies in Ireland a rise in blood pressure can occur and this is the first sign of a condition known as pre-eclampsia – also called pregnancy-induced hypertension (PIH) or pre-eclampsia toxaemia (PET). It has a tendency to be inherited in families and usually occurs in first pregnancies but not always. In addition, it is seen more commonly in women over 35 and women expecting twins. Smoking during pregnancy also increases your risk of developing this disease. Because of the seriousness of the condition on both you and your baby’s health your urine is checked for protein at every visit, as this is also a sign or diagnosis of pre-eclampsia.
Some of the symptoms of pre-eclampsia are:
Severe headaches often considered similar to a bad migraine headache
Problems with vision, such as blurred vision or lights flashing before the eyes and sensitivity to light.
Bad pain just below the ribs, around the liver
Significant nausea and sometimes vomiting
Sudden swelling of the face, hands or feet. Restlessness or a feeling that something is wrong
Snoring during sleep.
However, you can also have severe pre-eclampsia without any symptoms at all. Although most cases are mild and cause no trouble, it can be serious for both mother and baby. It can cause fits or seizures in the mother (called eclampsia) and can affects the baby’s growth. It is life-threatening if left untreated. It is more common towards the end of pregnancy, but it may happen as early as 24 weeks. It can also happen in the first week after the birth of your baby. It is usually more severe if it begins earlier in pregnancy. Treatment may start with rest at home, but some women need admission to hospital and medicines that lower high blood pressure. Occasionally, pre-eclampsia is a reason to deliver the baby early this may be either by induction of labour or by caesarean section.
Nicola tells her experience of Pre-eclampsia (PET)
“Whilst I had a few complications in the early weeks, the remainder of my pregnancy until 34 weeks’ gestation was, for the most part trouble free. I had the usual complaints of tiredness, heartburn and nausea but nothing exceptional. At 34 weeks, I complained of being tired and feeling hot but assumed this was due to the nice spell of weather we were experiencing. A very astute colleague asked if she could measure my blood pressure (I work in a healthcare setting), she was concerned that it was a little high and advised me to rest for the afternoon. Next morning, she repeated the measurement and advised me to contact the hospital as it was still a little high. I contacted my consultant’s secretary who advised to attend the hospital. I wasn’t at all alarmed as I’d had an appointment the previous week and all had been well. I was well looked after at the hospital and all the necessary checks, traced and scans were carried out. The doctor on call was very reassuring and contacted my obstetrician who said he was happy for me to go home as it was very late and to attend his clinic the following morning. I didn’t feel in any way unwell and was glad to be allowed home. I attended the clinic the following morning where my blood pressure and urine checks revealed that I was developing pre-eclampsia. Immediately I had lots of questions but I was completely reassured and my consultant told me he’d be keeping a very close eye on me and my baby from now on. He told me to rest and come back in 2 more days. I returned in 2 days and my blood pressure hadn’t worsened but the amount of protein in my urine had increased. He said he felt I needed to be admitted for closer observation. This was arranged for the following morning.
I was admitted to the wonderful care of the midwives on the ante-natal ward. Everybody was so friendly and caring and patient. I felt so reassured by the calm confident way in which all of my concerns were addressed. The consultant visited a couple of times each day. I felt that I had built up a relationship with him and that he knew my story. He made all the decisions in relation to my care and I was very confident that my baby and I were in safe hands. Although I wasn’t overly happy with the idea of spending my last few weeks of pregnancy in hospital, I knew it was the best place for me. I was on medication to control my blood pressure and the plan was made to induce my labour at 37 weeks if all remained stable. I felt so safe and I knew that if anything changed there was help close by. I was a little bit more symptomatic with headaches and a small bit of swelling but otherwise I felt well. I didn’t know very much about pre-eclampsia but the midwives were on hand to explain everything. The induction process was explained in great detail and I was given an information leaflet too. I would be lying if I said I wasn’t nervous, I was extremely anxious, it was a big venture into the unknown, as all first time experiences are! The consultant was so reassuring and confident that it really helped. The midwives were so comforting to my husband as he had no idea what to expect. The stepwise approach to induction of labour was explained to us so we felt we would know what was happening”.
Dr Denise O’Brien is a lecturer in Midwifery in UCD and Programme Director MSc Midwifery Practice