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Pregnancy Bliss | Reproductive Health Hub

Pre-eclamsia (APEC) + Miscarriage (MA) + Postnatal Illness (APNI) + Breast Feeding (ABM) + Active Birth (ABC)

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I had pre-eclampsia in my last pregnancy. Will I get it again?
For the majority, the answer here is that it is unlikely. On average, less than a quarter of those who have pre-eclampsia have a recurrence in subsequent pregnancies. Most cases of pre-eclampsia occur in the first pregnancy. However, when it occurs for the first time in a later pregnancy, the risk of recurrence subsequently is increased, probably to one in two. This may be because there is a latent hypertensive disease, where the pregnancy is only helping to unmask it.

Such people should also be counseled of an increased possibility of chronic hypertension later on in life, to enable an effective surveillance and early diagnosis, if this turns out to be the case. As you can see, no standard answer can be given to this question. Each individual's chances of a recurrence should be quantified on the basis of her circumstances.

If I have pre-eclampsia, will I need to be induced or have a caesarean section?
When you have this condition, the chances of having labour induced or having a caesarean section are increased quite considerably. It is important to remember two things: One, that there is no cure for pre-eclampsia. The only effective and definitive treatment is delivery. Two, that all the measures taken during pregnancy are meant to lead to a stage when delivery can be achieved, ideally without putting the baby in jeopardy but with the mother's well-being remaining the primary priority.

If the condition appears to be getting out of control, delivery will have to be effected. If induction of labour is deemed to be feasible and it won't cause undue delay, this may be opted for. If not, then caesarean section will be advised. On the other hand, things may remain under control and you may get to term and go into labour spontaneously, thus obviating the need for intervention.

Will my baby be alright?
Pre-eclampsia will not have any direct effect on the fetus as such. However, because of its effect on the circulation, the baby's growth may be restricted and it may be small. Moreover, there is an increased risk of premature delivery, usually as a result of intervention by doctors. This is done to save the mother or the growth-restricted baby, sometimes both. Babies born small or prematurely (or both) suffer more illness. Pre-eclampsia does not cause abnormalities.

My doctor disagrees with my midwife about how often I need to be monitored. Who is right?
When such disagreements occur, the patient feels trapped in the middle and it can be alarming. Fortunately, this is uncommon. Any monitoring regime should be individualized. If, for instance, you have a blood pressure that has remained more or less stable over three or four weeks and there is little change in the test results, both of your blood and urine and the pregnancy is also progressing satisfactorily, you can be managed at home with the midwife checking your blood pressure and urine once, at most twice a week.

On the other hand, if your blood pressure is fluctuating, and therefore unpredictable and there is significant loss of protein in the urine and the fetal growth rate is also sub-optimal, the monitoring may be more intensive. An allowance may be made for you to stay at home, on the proviso that you rest and the midwife comes to see you daily. In addition, arrangements may be made for you to go to the hospital once or more every week for special monitoring of the baby.

As you can see, there is a lot of room for individual tailoring of the monitoring regime. As such, sometimes the professionals differ in opinion on the suitability of a particular regime for a particular patient. If this happens, you should insist on knowing why a particular regime is recommended and not "the other". In any case, most antenatal units have a protocol which guides the professionals on how to manage each individual case. As such, disagreements are uncommon.