Pre-eclampsia and high blood pressure in pregnancy

Symptoms and signs of pre-eclampsia

The symptoms of pre-eclampsia are varied. Sometimes they are hidden and women do not experience anything significant until they are very unwell. For doctors and midwives, it can be a case of trying to piece together a jigsaw of symptoms that might include:
  • headaches,
  • swelling, 
  • nausea, 
  • disturbed vision, 
  • for severe types of pre-eclampsia, pain near the ribs (epigastric pain). 
Sometimes the only sign something was ‘wrong’ came from a blood pressure reading or a result from testing a urine or blood sample. This is why routine blood pressure, urine and blood testing at medical appointments throughout pregnancy is so important. Some women we spoke to also self-monitored their blood pressures at home during their pregnancies.
 
Not everyone we talked to who developed a high blood pressure problem (like hypertension, pre-eclampsia or HELLP syndrome) noticed any particular symptoms. Some women knew they were feeling unwell but couldn’t pin-point why they were “groggy” or “not quite right”. Sometimes they dismissed their symptoms as ‘normal’ for pregnancy. However, some women were aware of being very poorly and had severe symptoms.
Medical tests
 
Most of the women we spoke to did not directly notice the ‘signs’ of pre-eclampsia or HELLP syndrome. Instead they showed up in tests:
  • High blood pressure readings
  • Proteinuria (protein in the urine)
  • Poor kidney function (based on testing a blood sample)
Slightly high blood pressure and proteinuria results are not necessarily a cause for immediate concern. Sometimes the pregnant woman was just asked to have more tests, either at their GP surgery or at the hospital. This sometimes meant staying in hospital for monitoring.
 
In other cases, no action was taken right away but the results noted for follow-up at the next routine appointment. Doctors were looking for possible patterns developing over time. Some of those we interviewed felt that if a closer eye on their health had been given when there were early signs it could have stopped them from becoming so ill later on, for example if they had been started on blood pressure medicine earlier.
 
Sometimes medical tests showed problems, but women didn’t notice any symptoms. In other cases, pregnant women started to feel poorly very quickly.
The main pre-eclampsia symptoms women experienced were:
  • Swelling (looking and feeling “puffy”) – swelling often affected the hands and feet but could be all over, including the face.
  • Headaches (ranging from “a bit of a headache” through to “really severe” and “splitting” headaches “a bit like migraine”) – these could be quite short-lived or last for several days.
  • Visual disturbance (“blinding flashes”, “bright lights”, “black spots in front of your eyes”, “everything had just gone black”, seeing “sparkles”) – these sometimes happened briefly and periodically, other times the problem lasted for a while.
Other pre-eclampsia and HELLP syndrome symptoms included:
  • Weeing less frequently (reduced urine output)
  • Feeling sick and vomiting
  • ‘Quick’ reflexes and spasms/twitching (called hyperreflexia, indicating increased likelihood of a fit)
  • Bleeding (e.g. nose bleeds)
  • Feeling very hot and ‘overheated’
  • Pain at the top of the abdomen or ribs (sometimes called epigastric pain)
  • Difficulties breathing/feeling breathless
In addition, HELLP syndrome (thought to be a severe type of pre-eclampsia) can affect the liver and included other symptoms, such as:
  • Itchy skin
  • Problems with blood clotting
  • Liver damage (including risk of the liver bursting)
Symptoms could start suddenly or quite gradually. Julie’s symptoms developed quickly – a severe pain like “someone had hit me over the head”. Although she felt very unwell, she was unsure what to think: “I didn’t know if these were just quite normal”. It could be difficult to notice or interpret symptoms that developed slowly over time, especially when the symptoms were similar to common pregnancy side-effects, such as swelling. One clue was women finding they could no longer wear jewellery such as rings or watches because their hands had become so swollen. Partners, family members and friends sometimes picked up on these physical changes, even if the pregnant woman hadn’t noticed the change. Hanna remembered a work colleague suggesting she had pre-eclampsia because her feet were so swollen. Stewart and Claire think partners should be given information about the symptoms to look out for. They might spot things, especially if the pregnant woman might otherwise “play it down”.
 
Some women felt torn between wanting their pregnancy over as soon as possible (because they felt so ill) and wanting to continue the pregnancy for as long as they could (to give the baby more time to develop). Kay remembered reaching a point where she felt that “I don’t even want to be here anymore, this is pretty horrific”.
 
Combinations of symptoms and signs
 
A diagnosis of pre-eclampsia or HELLP syndrome was usually made on the basis of multiple signs and symptoms coming together. In this way, each symptom and sign can be one piece of a bigger jigsaw. Sometimes test results—e.g. a high blood pressure reading—then brought other sensations and symptoms into focus as relevant. 
 
Some of the women we interviewed felt no particular symptoms, even though tests showed they were very unwell. It was confusing and even annoying if a doctor insisted that a woman was seriously ill but she felt well. Some women were asked to stay in hospital for more monitoring, even if they didn’t feel unwell. On the other hand, it could be upsetting and frustrating if doctors or midwives did not appear to be taking concerns seriously when a women told them about symptoms.
Not everyone experiences all the signs and symptoms. Any one of the major three indicators of pre-eclampsia (high blood pressure, proteinuria, extreme swelling) may be the basis on which a diagnosis is made. It is sometimes hard for doctors to make a firm diagnosis and decide how to best medicate/treat pregnant women who do not ‘tick all the boxes’ of symptoms for a particular condition.
 
Awareness of symptoms and signs
 
Many symptoms of pre-eclampsia are experienced in milder forms throughout most pregnancies. Some women said they expected to feel quite tired and be a bit swollen at points during their pregnancy. So they dismissed these symptoms or didn’t think they were anything to worry about. A few women described themselves as “migraine sufferers” and so intense headaches (sometimes with visual disturbance) were often put down to this rather than a significant symptom. Samantha X initially thought some pain in her abdomen was “just sort of normal indigestion and heartburn that pregnant ladies get”. Kay thought she just had a cold with “flu-like symptoms” at first.
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Because women were initially unaware of high blood pressure conditions in pregnancy, they hadn’t known what symptoms to look out for. Being asked about possible symptoms alerted some women to things to be aware of. Only with hindsight did some realise they did have symptoms and that these had been warning signs.
 
Some women said they “played down” symptoms as they didn’t want to worry others or be an inconvenience. Some had mentioned symptoms they were concerned about to medical professionals. In some cases, more tests were done. In others, doctors or midwives didn’t seem too concerned. A few felt they had been dismissed when they raised concerns and this put them off mentioning it again in the future, even if they were very worried. Dominie remembered being told that “oh, there’s nothing wrong” which “knocked my confidence in my knowledge”.
 
Those taking part in the BuMP study checked their reading if they had a headache or felt a bit unwell, to find out if it was related to high blood pressure or not. A ‘normal’ blood pressure reading could be reassuring and getting a high blood pressure reading meant they felt more confident about seeking medical help. Abigail explained, “the fact that you can monitor it yourself at any time gives you that reassurance that you don’t have to wait for the next appointment”. However, blood pressure is only one ‘jigsaw piece’ of pre-eclampsia and there are other signs and symptoms.
 
Problems developing after giving birth
 
Pre-eclampsia can happen at any point in a pregnancy and during labour/delivery; it can also continue or develop after the birth (late onset pre-eclampsia). But most women we spoke to didn’t know that pre-eclampsia can still affect them for several weeks after giving birth. Some women did have problems with their blood pressure after giving birth and they wanted to encouraged others to keep looking for any new symptoms or symptoms becoming more severe and to seek help if this happens.

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