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Pre-Eclampsia & Eclampsia (Nigeria Guide)

High blood pressure in pregnancy — recognising and preventing the leading cause of maternal death in Nigeria

Pre-eclampsia is a serious complication of pregnancy characterised by new-onset high blood pressure (≥140/90 mmHg) after 20 weeks' gestation, accompanied by proteinuria or other organ damage. Eclampsia is pre-eclampsia that progresses to convulsions (seizures) — a life-threatening obstetric emergency. Hypertensive disorders of pregnancy are the leading cause of maternal death in Nigeria. Early detection through regular blood pressure monitoring at antenatal visits and prompt treatment can be life-saving.

Signs and Symptoms

✓ High blood pressure ≥140/90 mmHg on two readings taken 4 hours apart — after 20 weeks
✓ Proteinuria — frothy urine or protein on urine dipstick
✓ Severe headache — not relieved by paracetamol
✓ Visual disturbances — blurred vision, seeing flashing lights or spots
✓ Upper abdominal or epigastric pain — liver capsule stretching
✓ Sudden severe facial, hand, or ankle swelling — beyond normal pregnancy oedema
✓ Nausea and vomiting in late pregnancy (not first trimester)
✓ Seizures — eclampsia; may occur without warning signs

Risk Factors

When to Seek Help

Emergency — call or go immediatelySeizures (fits) during pregnancy or within 7 days of delivery — eclampsia. Ensure airway, breathing, and circulation; give magnesium sulphate if available; immediate hospital transfer
EmergencySevere headache, visual changes, or epigastric pain with high blood pressure in pregnancy
Same dayBlood pressure ≥140/90 at any antenatal visit — do not wait for next scheduled appointment
UrgentAny systolic BP ≥160 mmHg or diastolic ≥110 mmHg in pregnancy — severe pre-eclampsia, needs immediate antihypertensive treatment
Routine monitoringAll women with known pre-eclampsia risk factors — aspirin prophylaxis from 12 weeks and more frequent BP monitoring from 20 weeks

Tests & Diagnosis

🧪 Blood pressure
At every antenatal visit. Home BP monitoring recommended for high-risk women — systolic ≥140 or diastolic ≥90 on two occasions 4 hours apart = pre-eclampsia by definition
🧪 Urine protein (dipstick, then protein:creatinine ratio)
Proteinuria ≥0.3 g/24 hours (or protein:creatinine ratio ≥30 mg/mmol) confirms the diagnosis in the presence of hypertension
🧪 Full blood count
Thrombocytopenia (falling platelets) — sign of HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets) — a severe variant
🧪 Liver function tests (AST, ALT)
Elevated in HELLP syndrome. Epigastric pain + elevated LFTs = HELLP until proven otherwise
🧪 Serum creatinine and uric acid
Renal involvement and severity assessment
🧪 Fetal assessment — ultrasound and CTG
Fetal growth restriction and placental insufficiency are common in pre-eclampsia. Cardiotocograph (CTG) monitors fetal heart rate

Treatment Options

1
Aspirin 75 mg daily from 12 weeks (prevention)
For ALL women with ≥1 high-risk factor or ≥2 moderate risk factors for pre-eclampsia. Reduces pre-eclampsia risk by ~15–20%. Inexpensive and widely available in Nigeria
2
Antihypertensive treatment for moderate pre-eclampsia (BP 140–159/90–109)
Labetalol 200 mg twice daily (first choice) — safe and effective. Methyldopa 250–500 mg 3 times daily — alternative, widely used in Nigeria. Nifedipine modified-release 30 mg daily — third option. Avoid ACE inhibitors, ARBs, atenolol
3
Severe pre-eclampsia (BP ≥160/110) — emergency treatment
IV labetalol or IV hydralazine — titrate until BP <150/100. Oral nifedipine (not sublingual — causes precipitous BP drop) as an alternative. Aim for gradual BP reduction — rapid drop causes fetal distress
4
Magnesium sulphate — prevention of eclampsia
4 g IV loading dose over 15–20 minutes, then 1 g/hour IV infusion. Reduces eclampsia risk by 50% in severe pre-eclampsia. Essential drug in every Nigerian maternity unit. Monitor for toxicity: respiratory rate, urine output, reflexes. Antidote: calcium gluconate
5
Eclampsia management
Secure airway, left lateral position, oxygen. IV magnesium sulphate (as above). IV antihypertensive. Urgent delivery — the only cure. Transfer to a facility with obstetric and neonatal intensive care
6
Delivery — the only cure for pre-eclampsia
Timing depends on gestational age and severity. Severe features at ≥37 weeks: deliver. 34–37 weeks: weigh risks of prematurity vs. maternal danger. <34 weeks: corticosteroids for fetal lung maturity, then deliver if maternal condition deteriorating
7
Postpartum monitoring
Pre-eclampsia can worsen in the first 48–72 hours after delivery. BP monitoring for at least 72 hours postnatally. Magnesium sulphate continued for 24 hours postpartum if eclampsia occurred
8
Long-term follow-up
Women with pre-eclampsia have 4x higher risk of hypertension and stroke later in life. Annual BP check, cardiovascular risk assessment. Discuss pre-conception planning and aspirin for future pregnancies

Frequently Asked Questions

What is the difference between pre-eclampsia and eclampsia?
Pre-eclampsia is high blood pressure in pregnancy with protein in the urine or other organ involvement. Eclampsia is when pre-eclampsia progresses to seizures (fits). Eclampsia is a life-threatening emergency requiring immediate magnesium sulphate and urgent delivery.
Can pre-eclampsia come back in future pregnancies?
Yes — the recurrence risk is 15–25% for women with severe or early-onset pre-eclampsia. Start low-dose aspirin (75 mg daily) from 12 weeks in all subsequent pregnancies. Attend antenatal care from the first trimester. Pre-conception optimisation of blood pressure and weight reduces risk.
Is my baby at risk if I have pre-eclampsia?
Pre-eclampsia causes placental insufficiency, which can restrict fetal growth and reduce oxygen delivery. Regular ultrasound and CTG monitoring are essential. Preterm delivery is often needed — this is why delivery suites should have neonatal care facilities. Preterm babies have much better outcomes with good neonatal care.
Can pre-eclampsia occur after delivery?
Yes — up to 44% of eclampsia occurs in the first week after delivery, most within 48 hours. Postpartum pre-eclampsia presents with headache, visual symptoms, and high BP. It can be mistaken for a normal postpartum headache. Any new headache or BP >140/90 in the first week after delivery needs urgent assessment.

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