Hypertension During Pregnancy

Posted by Kingsway Hospitals-The Best Multispecialty hospital on January 20th, 2021

Hypertension During Pregnancy!

Pregnancy is a wonderful and joyful experience in life for the parents to be. A woman experiences a lot many changes during pregnancy. There are physical changes, hormonal changes as well as emotional changes. 

Hypertension is the most common medical problem in pregnancy, High blood pressure during pregnancy is one of the complications for which close monitoring is required during pregnancy. If it is well managed and under control, high blood pressure during pregnancy is not always harmful and the mother and the baby are more likely to stay healthy. However, it can sometimes cause severe health complications for both the mother and the developing baby. Appropriate treatment for high blood pressure is very important before, during, and after pregnancy.

Some women may have high blood pressure before they get pregnant; while some have high blood pressure for the first time during pregnancy. 

High blood pressure, or hypertension, is defined as blood pressure greater than or equal to 140/90 mm Hg during pregnancy.

PREGNANCY-RELATED BLOOD PRESSURE CONDITIONS:

High blood pressure during pregnancy can be divided into four different conditions:

i) Chronic hypertension

Chronic hypertension can be considered as preexisting hypertension before pregnancy or which occurs in the first 20 weeks of pregnancy.

ii) Gestational hypertension:

Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy. It usually resolves after delivery. Some women with gestational hypertension can eventually develop preeclampsia.

iii) Preeclampsia

Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy and is associated with signs of damage to other organ systems, including the kidneys, liver, blood, or brain. Untreated preeclampsia can lead to serious — even fatal — complications for mother and baby, including the development of seizures (eclampsia).

iv) Chronic hypertension with superimposed preeclampsia:

It occurs in women with chronic hypertension before pregnancy who develop worsening high blood pressure and experience protein in the urine or additional blood pressure-related complications during pregnancy.

 Who is at risk for preeclampsia?

You are at higher risk of preeclampsia if you

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• First-time pregnancy
• Have obesity
• Are over age 40
• Are pregnant with more than one baby
• Have a family history of preeclampsia
• Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder that raises your risk of blood clots)
• assistive reproductive technology (such as in-vitro fertilization)

Presentation

Signs and symptoms of preeclampsia may include: 

i. having protein in the urine

ii. changes in vision

iii. severe headaches

iv. abnormal swelling in hands and face

v. upper abdominal pain

vi. nausea or vomiting later in pregnancy

vii. difficulty breathing

Untreated preeclampsia can lead to serious or even fatal complications for mother and baby, 

· the development of seizures (eclampsia) which can lead to coma. 

· Rarely, it can lead to a life-threatening condition called HELLP syndrome. HELLP stands for hemolysis (H), elevated liver enzymes (EL), low platelet count (LP). Symptoms related to HELLP may include nausea, vomiting, headache, upper abdominal pain.

· Pulmonary Edema (Fluid in the lungs)     

 As preeclampsia can be dangerous for both the mother and baby, one should call the doctor if they have any of these symptoms. Regular doctor visits and informing the doctor about any changes that can help them identify and treat preeclampsia early.

COMPLICATIONS OF HIGH BLOOD PRESSURE DURING PREGNANCY:

High blood pressure during pregnancy poses various risks, including:

Decreased blood flow to the placenta - Decreased blood flow to the placenta may lead to a lack of oxygen and nutrients to the baby. This can lead to slow growth (intrauterine growth restriction), low birth weight, or premature birth. Premature birth can lead to breathing problems, increased risk of infection, and other complications for the baby.

Intrauterine growth restriction - Hypertension might result in slowed or decreased growth of the baby due to decreased blood flow to the placenta.

Premature delivery - Sometimes an early delivery is needed to prevent potentially life-threatening complications to the mother and/or baby due to the high blood pressure and its complications

 Placental abruption. The placenta separates from the inner wall of the uterus before delivery. The baby may not get enough oxygen and nutrients in the womb. Severe abruption may cause heavy bleeding, which can be life-threatening for mother and baby both

Injury to other organs. Poorly controlled hypertension can result in injury to the brain, heart, lungs, kidneys, liver, and other major organs. In severe cases, it can be life-threatening.

Future cardiovascular disease. Having preeclampsia might increase the risk of future heart and blood vessel (cardiovascular) disease. 

MANAGEMENT OF HIGH BLOOD PRESSURE DURING PREGNANCY:

· Regular prenatal checkups.

· Monitoring of blood pressure at home.

 Follow a healthy diet. Consult with a nutritionist for a meal plan if required.

· Stay active. Follow your doctor's recommendations for physical activity.

· Avoid smoking, drinking alcohol or using street drugs, or abusing prescription drugs.

 Possible treatment for preeclampsia may include:

• Medications to lower blood pressure. These medications, called antihypertensives, are used to lower blood pressure if it's dangerously high.

Although there are many different types of antihypertensive medications, a number of them aren't safe to use during pregnancy. 

1.  Corticosteroids can also help the baby's lungs become more mature— an important step in preparing a premature baby for life outside the womb.

• Anticonvulsant medications. If preeclampsia is severe, an anticonvulsant medication, such as magnesium sulfate MAY BE PRESCRIBED to prevent a first seizure.

 Careful monitoring and some lifestyle changes can lower the risk of developing complications from high blood pressure during pregnancy. It is equally important to talk to the doctor about any symptoms or concerns. Excellent gynecologists can be found at Kingsway Hospitals, Nagpur. Under their 'WOWMOM' program plan a safe and healthy delivery.