Pre-eclampsia

Patricia Gibson Excerpts

Thursday 9th May 2019 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I beg to move,

That this House has considered pre-eclampsia.

I am delighted to have secured a debate on this important issue, and I thank my colleagues on the Backbench Business Committee for supporting it. The debate is timely because we are approaching World Pre-Eclampsia Day on 22 May. According to the House of Commons Library, the House has never had a debate about this extremely important matter, which affects every constituency, and every country in the world. Although I am surprised that there has been no previous debate, I am delighted that we are here today to put that right and to have what I hope will be a constructive, illuminating and considered debate. Before I proceed, however, I must say that I am extremely disappointed by the apparent lack of concern about this issue across the House, as we can see from the number of Members in the Chamber. Women and families who are concerned about pre-eclampsia will be equally disappointed by the poor turnout.

I want to pay particular tribute to Marcus Green, the chief executive of Action on Pre-Eclampsia, and all his team for all the support and information they have provided to me and all Members to help ensure that this debate is as well-informed as it needs to be. I applaud the work of Marcus, his team and others, including at the University of Liverpool, who expend huge personal and professional effort to combat and better understand the appalling condition of pre-eclampsia. I thank those who research this illness to help us better treat and manage it, because their work is ultimately about improving survival rates for mothers and babies when this condition occurs.

Pre-eclampsia is a very serious disease related to high blood pressure. It can strike out of the blue with no apparent warning—the word “eclampsia” is Greek for lightning. It can strike any pregnant woman, most notably in the second half of pregnancy, or up to six weeks after delivery. It is a symptom of new-onset hypertension and significant protein in the urine after the 20th week of pregnancy. There is no cure for pre-eclampsia, which is why treatment and management of the condition matter so much.

Identifying pre-eclampsia early is so important for mothers and babies; it can literally mean the difference between life and death. Globally, pre-eclampsia accounts for 14% of all maternal deaths, killing 40,000 women every year. Five women every hour die from pregnancy complications related to pre-eclampsia. Not surprisingly, poor outcomes for mother and baby are associated with poor care, which is most often found in low-income countries. Across the United Kingdom, our NHS services still face significant challenges with regards to pre-eclampsia.

The hon. Member for Banbury (Victoria Prentis), who is very sorry not to be here, suffered a stillbirth due to pre-eclampsia. My personal interest in this issue was sparked by the death of my son Kenneth, who was stillborn two days after his due date, after his birth was delayed while he was still alive and healthy. No reason was given for that delay; in fact, when I reported back to the hospital the same day in terrible pain—a few hours after being told my baby would not be delivered that day as planned—I faced obstruction and argument. I was repeatedly told to go home as there was nothing wrong. How that could have been established when I had not been examined was a question that was never answered, then or since. My husband insisted that I be admitted to hospital. I was later informed that had he not done so, I would certainly have died.

According to a leading consultant obstetrician, Professor Edward Shaxted of Northampton General Hospital, had NHS Greater Glasgow and Clyde reacted to the clear signs of my pre-eclampsia when I attended the maternity unity in pain, our otherwise healthy 8 lb 7 oz son would in all likelihood have survived. My husband and I commissioned a report from Professor Edward Shaxted after waiting for over a year in vain for NHS Greater Glasgow and Clyde to engage with us after the stillbirth.

When I reported to the hospital, I was neither examined, tested nor treated, but I was—bizarrely—injected with morphine twice. By the following morning, baby Kenneth was dead. I had developed a very severe form of pre-eclampsia called HELLP syndrome, a condition that is life-threatening to mother and baby. Not only did my baby die, but my husband was summoned to be told to say his goodbyes to me, as I was not expected to survive following a rupture of the liver. I was in a critical condition, and spent a number of weeks in a high-dependency unit.

While the mortality rate for HELLP syndrome is estimated by some to be as high as a massive 30%, Professor Shaxted’s report described the errors made in my case as “extraordinary”. He said:

“With a little thought it would have been recognised that Mrs Gibson had developed pre-eclampsia.”

My concerns were ignored despite the fact that my baby was due for delivery. The professor went on to say:

“Delivery of Mrs Gibson’s baby while still alive”—

on my due date, as planned—

“would more likely than not have led to the birth of a live child who would have survived intact.”

His conclusion was echoed by Professor Benjamin Stenson of the Royal Infirmary of Edinburgh, from whom we also commissioned a report. Anecdotally, I know that this experience is not unique to me.

We must continue to strive to do better at monitoring pregnant women and to listen to what they tell us, because being aware of, looking out for and dealing with pre-eclampsia must be on the radar of all professionals dealing with expectant mothers on the frontline. Recognition of the condition and early intervention are vital. When the signs are present, it is important they are not missed. Overall, maternal mortality across the UK has much reduced over the generations, but there must be no room for complacency, as there appeared to be in my case, and as I know there has been in others. I was labelled high risk, having undergone five years of in vitro fertilisation and being over 40.

When mistakes are made, they cannot be undone, but if we do not learn from them, that is disgraceful and completely unacceptable. Despite low levels of maternal deaths, there are still unacceptable levels of stillbirths and babies born being prematurely and/or underweight because of pre-eclampsia. Significant numbers of women suffer from pre-eclampsia in pregnancy. We know that screening and diagnosis are the cornerstones of safe management, and that deaths are preventable with good-quality routine antenatal care in pregnancy and evidence-based guidelines for antenatal care and the management of hypertension in pregnancy.

However, according to the Library, no NHS in the UK collects official statistics on the number of women who develop pre-eclampsia during pregnancy. We do know that there are around two maternal deaths due to pre-eclampsia every year in the UK, but no figures are recorded for how many babies die due to pre-eclampsia-related issues, although research by Imperial College London puts the figure at around 1,000 babies each year across the UK.

There is also no information published about how much pre-eclampsia costs the NHS across the UK. The lack of detailed information on this issue is quite staggering. I urge the Minister to ensure that such information is collected and recorded. I will lobby the Scottish Government to do the same. We need clear information to know the true scale of the challenge we are facing. One of the keys to meeting such a significant challenge is clear information.

This is a complex illness. It cannot be predicted with certainty who will develop pre-eclampsia or what causes it, although risk factors can be identified, including having a strong family history of pre-eclampsia, being over 40 years old, and being overweight or obese. Evidence appears to suggest that black and Asian women are more likely than white women to develop pre-eclampsia, which requires further investigation. It seems that black women are five times more likely than white women to develop pre-eclampsia, and that Asian women are twice as likely to develop it. We need to understand better why that is and to treat such patients accordingly.

There is also evidence that women who develop pre-eclampsia in pregnancy are at greater risk of developing cardiovascular disease and kidney disease in the longer term, shortening their life expectancy. At the moment, no part of the UK has standard care pathways to monitor the long-term health of women who have had pre-eclampsia. That needs to change. I urge the Minister to address that, and I will continue my conversations on that matter with the Cabinet Secretary for Health in Scotland, Jeane Freeman MSP.

The only cure for pre-eclampsia—if we can call it a cure—is the delivery of the baby, but that often means the baby being delivered dangerously prematurely, which throws up all kinds of moral dilemmas and is not always straightforward. Of course, pre-eclampsia is a progressive condition, which gets worse, so mother and baby need close and careful monitoring. We know that babies born underweight or prematurely are at greater risk of cardiovascular disease and diabetes in later life. We need ongoing research to find better treatments that reduce the risks to children whose mothers suffer from pre-eclampsia.

Let me say a little about the placental growth factor test. The symptoms and signs of pre-eclampsia are not always reliable or consistent, meaning that women may be admitted to hospital unnecessarily or have a severe case of pre-eclampsia that goes undiagnosed. Like too many other women, I know how tragic that can be. The PLGF test is a new blood test that indicates whether an expectant mother has the disease. When it is used on a woman with suspected pre-eclampsia, it can reliably indicate whether they will need delivery soon and whether the baby is at risk. It can also show whether the woman needs to be admitted to hospital and requires intensive monitoring to determine when delivery should take place, or whether it is safe to discharge her. Its use means that several other tests, which may not be so reliable, do not need to be done, saving our hospitals time and other resources. The PLGF test is available, and it must be provided regardless of where in the UK people live. I urge the Minister to do all she can to ensure that that is the case.

The PLGF test is an important tool that will help us make progress in combating pre-eclampsia by improving its diagnosis and treatment. NHS England will soon make the test available, and I am in negotiations with Jeane Freeman about it being made available in Scotland, too. The test is too important and too accurate, and the information it can yield too informative, for it not to be made available where necessary by health services across the UK. It will not just save lives; it will save money, and it will offer expectant parents huge reassurance about the health of their baby.

The Lancet published a study of implementation in England, which demonstrated that the test improved cost and clinical outcomes, with a 64% reduction in time to diagnosis, a 37% reduction in out-patient visits, and a 35% reduction in the use of bed nights for neonatal care. It seems that it is something of a breakthrough, and I think it has the potential to save many lives. With around 1,000 babies dying every year in the UK due to complications related to pre-eclampsia, this simple test offers real hope and gives us cause for optimism. It is a real milestone in how we treat this horrible condition, which can strike expectant mothers with no warning but with devastating, life-changing consequences for families. I hope that, one day, it offers real hope to women across the world—especially those in poorer countries—that mothers and their babies need no longer die.

World Pre-Eclampsia Day on 22 May deserves a place on our calendars. It deserves to be recognised this year and every year. More than 30 organisations recognise it, including Action on Pre-Eclampsia, Save the Children, the Preeclampsia Foundation and a whole range of others around the world. I urge the Government to ensure that more research is carried out into the condition so that better preventive work, as well as more and better treatments, can be developed. I urge the Minister to do all she can to ensure that women are educated about the condition and about how they might recognise and mitigate it.

As we approach World Pre-Eclampsia Day, this debate matters. Pre-eclampsia is killing our babies, and I believe we can and should be able to detect and treat it more effectively. I absolutely support the call from Action on Pre-Eclampsia to prioritise research into stillbirths from pre-eclampsia and to increase resources to support parents through the trauma of that. The UK has the lowest incidence of maternal mortality from pre-eclampsia in the world—that is not an accident; it is down to better care and attentive clinicians—but we have not found a cure. Until we do, and until we completely stop babies dying from this condition, we need to do more.

This is the very first debate on pre-eclampsia, and it is long overdue. I urge the Minister and the Government to commit to doing all they can to improve research, treatment and detection. We have come some way—we can see that from the number of deaths of mothers—but we must remember that 1,000 babies are stillborn as a result of this condition every year, so we certainly are not there yet. Let us work together to make as much progress as we possibly can.

--- Later in debate ---

[Patricia Gibson]

We clearly have a lot of work to do to raise awareness of this condition. The poor attendance in this Chamber is a clear testament to that, although I extend heartfelt thanks to my colleagues who have made the effort to come here today and speak.

As we have said—we cannot say this too often— 1,000 babies across the UK die each year from pre-eclampsia-related complications. That demands our attention and requires our action. We know and have heard today that diagnosis and treatment are not what they could be and often not what they should be. If we do not talk about difficult issues, we are extremely unlikely to tackle them or, indeed, prioritise them. With pre-eclampsia affecting about—this is an estimate —6% of pregnancies in the UK, it affects every single constituency. I say this to all constituents who are watching the debate now or who may watch it later if they catch a bit of the news on social media about it: if this is an issue about which you are concerned, I urge you to contact your MP and ask them to raise it at every opportunity, because that is how change happens.

I welcome the Minister’s constructive response to the debate, and I look forward to continuing to work with her through the all-party parliamentary group on baby loss, which deals with neonatal death. As she says, we know which women are likely to be at risk, so we need to ensure that the treatment of those women takes pre-eclampsia into account—that it is on the radar—so that we can better monitor them, and their babies’ lives can be saved as a result. It is also extremely important that women are listened to when they present to any medical professional. That cannot be stressed enough.

It is also important that the placental growth factor test is delivered, especially to those women we know are in at-risk groups. I am encouraged by the Minister’s mentioning the PHOENIX study, because I am hopeful that that will yield additional understanding that will improve treatment for pre-eclampsia.

As the Minister said at the close of her remarks, this is the first debate on pre-eclampsia, but I am pretty confident that it will not be the last.

Question put and agreed to.

Resolved,

That this House has considered pre-eclampsia.