Pre-eclampsia - Treating pre-eclampsia

Pre-eclampsia can only be cured by delivering the baby. If you have pre-eclampsia, you will be closely monitored until it is possible to deliver the baby.

Once diagnosed, you will be referred to a hospital specialist for further assessment and any necessary treatment.

If you only have high blood pressure without any signs of pre-eclampsia, you can usually return home afterwards and will attend regular (possibly daily) follow-up appointments.

If pre-eclampsia is confirmed, you will usually need to stay in hospital until your baby can be delivered.

Monitoring in hospital

While you are in hospital, you and your baby will be monitored in the following ways:

• your blood pressure will be checked regularly for any abnormal increases
• urine samples may be taken regularly to measure protein levels
• your blood may be tested for the proteins aspartate aminotransferase (AST) or alanine aminotransferase (ALT), which can be a sign of liver damage if found in the blood
• a blood test may be taken to provide information about the blood cells
• you may have ultrasound scans to check blood flow through the placenta, measure the growth of the baby, and observe the baby's breathing and movements
• the baby's heart rate may be monitored electronically in a process called cardiotocography, which can detect any distress in the baby

Medication for high blood pressure

Medication is recommended to help lower your blood pressure. These medications will reduce the likelihood of serious complications, such as stroke. Some of the medications used regularly in the UK include labetalol, nifedipine or methyldopa.

Of these medications, only labetalol is specifically licensed for use in pregnant women with high blood pressure. This means the medication has undergone clinical trials that have found it to be safe and effective for this use.

However, while methyldopa and nifedipine are not licensed for use in pregnancy, they can be used ‘off-label’ (outside their licence) if it is felt that the benefits of treatment are likely to outweigh the risks of harm to you or your baby.

These medications have been used by doctors in the UK for many years to treat pregnant women with high blood pressure and they are recommended as possible alternatives to labetalol in guidelines produced by the National Institute for Health and Care Excellence (NICE). Therefore, your doctors may recommend one of them if they think it is the most suitable medication for you. 

If your doctors recommend treatment with one of these medications, you should be made aware that the medication is unlicensed in pregnancy and any risks should be explained before you agree to treatment, unless immediate treatment is needed in an emergency.

Other medications

Anticonvulsant medication may be prescribed to prevent fits if you have severe pre-eclampsia and your baby is due within 24 hours, or if you have had convulsions (fits). They can also be used to treat fits if they occur.

Delivering your baby

In most cases of pre-eclampsia, having your baby at about the 37th to 38th week of pregnancy is recommended. This may mean labour needs to be started artificially (induced labour) or you may need to have a caesarean section (delivery through an incision in the stomach).

This is recommended because research suggests there is no benefit in waiting for labour to start by itself after this point. Delivering the baby early can also reduce the risk of complications from pre-eclampsia.

If your condition becomes more severe before 37 weeks and there are serious concerns about the health of you or your baby, earlier delivery may be necessary. Deliveries before 37 weeks are known as premature births and babies born before this point may not be fully developed.

You should be given information about the risks of both premature birth and pre-eclampsia so that the best decision can be made about your treatment.

After the delivery

Although pre-eclampsia will usually improve soon after your baby is born, complications can sometimes develop a few days later. You may therefore need to stay in hospital after the delivery so you can be monitored.

Your baby may also need to be monitored and may need to stay in a hospital neonatal intensive care unit if born prematurely. These units have facilities that can replicate the functions of the womb and allow your baby to develop fully. Once it is safe to do so, you will be able to take your baby home.

You will usually need to have your blood pressure checked regularly after leaving hospital, and you may need to continue taking medication to lower your blood pressure for several weeks.

You should be offered a postnatal appointment six to eight weeks after your baby is born to check your progress and decide if any treatment needs to continue.