- David Williams, consultant obstetric physician1,
- Naomi Craft, general practitioner2
- 1University College London Hospital, London WC1E 6AU, UK
- 253 New Cavendish Street, London W1G 9TQ
- Correspondence to: D Williams
A 36 year old primigravida woman attended for antenatal care at 10 weeks’ gestation with a blood pressure 120/80 mm Hg and no proteinuria. At 28 weeks, she presented to her general practitioner with urinary frequency and mild dysuria. Urine analysis showed 3+ proteinuria, and her blood pressure was 144/90 mm Hg. The fundal height measured 3 cm less than expected for this gestation. A midstream urine sample was sent for culture and a review arranged for a week later. At 29 weeks, her blood pressure was 175/115 mm Hg, proteinuria was 3+, and no urinary infection had been isolated. She was urgently admitted to hospital, but on arrival no fetal heartbeat could be detected. Labour was induced and a growth restricted, stillborn infant was delivered. Maternal hypertension persisted postpartum.
What is pre-eclampsia?
Pre-eclampsia is defined by the gestational onset of hypertension and proteinuria.1 It is, however, a multisystem disorder that can affect all maternal organs.1 2 Delivery of the fetus and placenta remains the only cure, but preterm delivery may adversely affect neonatal outcome, with complications resulting from prematurity and low birth weight.3 Pre-eclampsia evolves into eclampsia when maternal seizures develop. Eclampsia is rare in well resourced countries—just 1% of all women with pre-eclampsia develop eclampsia.4 A severe form of pre-eclampsia characterised by microangiopathic haemolytic anaemia is often termed the HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome.2
How common is pre-eclampsia?
Pre-eclampsia predominantly affects women in their first pregnancy (2-8% of first pregnancies)5 and has a variable incidence across nations, being most common in Latin America and the Caribbean.6 In the United Kingdom, about one in 200 pregnancies is affected by severe pre-eclampsia (about 3500 cases a year).7
Why is pre-eclampsia missed?
Pre-eclampsia is usually asymptomatic until it is in an advanced state,2 8 9 10 and so it …