What to know about severe pre-eclampsia

ACOG is the American College of Obstetricians and Gynecologists. Its patient guidance uses the term pre-eclampsia with severe features for disease accompanied by very high blood pressure or signs that organs such as the brain, lungs, liver, kidneys or blood-clotting system are affected.

A person may feel unwell, but severe disease can also be found through blood-pressure checks, urine testing or blood tests. Concerning findings include a persistent severe headache, vision changes, upper abdominal pain, breathing difficulty, abnormal liver or kidney function, a low platelet count, or fluid in the lungs. Protein in the urine may support the diagnosis, but organ involvement can establish severe disease even when urine protein is not prominent.

The condition can reduce blood flow through the placenta and can affect the pregnant person's brain, heart, lungs, liver, kidneys and clotting. It may first appear during pregnancy, during labour or after the baby is born. Eclampsia means seizures associated with pre-eclampsia; HELLP syndrome is a serious related pattern involving red blood cells, liver enzymes and platelets.

Assessment usually takes place in a maternity hospital. The team may repeat blood-pressure measurements, test urine and blood, check reflexes and symptoms, and monitor the baby's heart rate, growth and wellbeing. Monitoring is repeated because the picture can change over a short period.

Treatment may include medicine to lower dangerously high blood pressure and magnesium sulfate to reduce seizure risk. If early birth is likely, corticosteroid medicine may be offered to support the baby's lung development. Delivery is the only way to end the pregnancy-related disease process, but symptoms and blood pressure can persist or worsen after birth, so monitoring continues.

The timing and method of birth depend on the pregnant person's stability, the baby's wellbeing, stage of pregnancy, cervical readiness and response to treatment. Induction may be possible; a caesarean birth may be advised when labour is unsuitable or urgent delivery is needed. Do not start aspirin, blood-pressure medicine or supplements unless your maternity clinician has recommended them for you.

Contact your maternity assessment unit urgently for a severe or persistent headache, blurred vision or flashing lights, pain beneath the ribs or in the upper abdomen, sudden swelling of the face or hands, vomiting later in pregnancy, breathing difficulty, or a home blood-pressure result at or above the threshold your care team gave you. These symptoms need assessment during pregnancy and after birth, even if an earlier check was reassuring.

Call emergency services for a seizure, collapse, severe breathing difficulty, severe chest pain or heavy bleeding. Reduced or changed fetal movement also needs prompt maternity assessment. Do not drive yourself if you feel faint, have disturbed vision or think a seizure may occur.

Ask which finding qualifies as a severe feature in your case, whether your blood tests are changing, how the baby is being monitored, and what would trigger delivery. You can also ask what each medicine is for, whether induction or caesarean birth is more likely, how long blood-pressure monitoring will continue after birth, and which symptoms should bring you straight back to hospital.