We see many pregnant patients with the diagnosis of high blood pressure in pregnancy. Most have mild disease but some may have severe disease and complications. To a Obstetrician, it is the single most important diagnosis in the antenatal period which requires regular and close monitoring. It also requires good patient counselling for a healthy and safe pregnancy.
Everytime you go for an antenatal checkup your doctor measures your blood pressure. Normal blood pressure in pregnancy or non pregnant state is a sign of good well-being.
Blood pressure is the pressure exerted by blood on the walls of arteries which are the vessels carrying pure or oxygenated blood to body parts. A blood pressure > or = 140/90 mm Hg is considered to be high. High blood pressure is called hypertension.
Types of hypertension in pregnancy
Pregnancy induced hypertension or gestational hypertension or PIH
Chronic hypertension
Preclampsia
Eclampsia
The pathology is believed to be in the placental development. Placenta is the organ of nutrients and waste exchange through blood between mother and baby.
Symptoms
Swelling in feet
Edema in body or puffy face
Rapid weight gain
Blurring of vision
Pain in upper abdomen
Vomiting
Headache
A single reading of high blood pressure cannot be stamped as hypertension. It may be elevated if you are anxious, excited, after exercise etc. Two to three readings at least a few hours or days apart are needed.
Gestational hypertension or pregnancy induced hypertension (PIH).
When high blood pressure is first detected after the 20th week of pregnancy, it is known as gestational hypertension. This type of blood pressure usually returns to normal once the baby is born. Better and frequent monitoring is required once it is detected.
Preeclampsia
When gestational hypertension is associated with one or more of the following signs, then the condition is called preeclampsia.
Protein (albumin)in the urine is the most important
Persistent headache
Visual problems like blurring of vision
Pain in the upper right part of the abdomen
It can develop till 6 weeks after delivery also.
Risk factors for preclampsia
First time moms
Elderly mother more than 35 years age
History of preeclampsia in a previous pregnancy Have chronic hypertension
Multiple pregnancies like twins
Diabetes
Obesity
Chronic hypertension
When high blood pressure is present before pregnancy or is diagnosed before the 20th week of pregnancy, it is called chronic hypertension or essential hypertension.
It can also affect the growth of the baby.
It can be superimposed with preeclampsia and cause additional complications.
Preconceptional counseling
Before planning pregnancy in patients with chronic hypertension following points should be considered.
Normalize blood pressure
Switch to other drug which doesn't affect baby
Routine blood tests including kidney tests
Complications in Mother
Eclampsia
When preeclampsia is accompanied by fits or seizures it is called eclampsia.
Multiple organ damage can occur.
Life threatening situation for mom and baby.
Immediate delivery is the answer.
It is best avoided by regular antenatal care.
Kidney damage
Like Acute renal failure may occur
Hellp syndrome
HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome is a dangerous complication.
Require Multispeciality care and immediate delivery. It may also develop in postpartum period
Abruption
Placenta seperation tion due to large blood clots. Disastrous complication for mom and baby.
Recurrence in next pregnancy
Chances of recurrence are high if preeclampsia occurs before 32 weeks in first pregnancy.
Complications in Baby
If it occurs before 32 weeks chances of complications are more
Fetal growth restriction
Abnormal placentation in preeclampsia causes decreased blood supply to the baby so growth restriction.
Sudden Intrauterine death
Prematurity and problems with preterm babies
Monitoring
Good antenatal care and close monitoring is required depending on the case.
Apart from frequent examination by doctor and blood pressure recording, Ultrasound and doppler monitoring may be required for fetal growth, amount of fluid around baby, blood supply to baby and wellbeing.
Biophysical profile or baby heart beat testing like Nonstress test/ CTG may be advised.
Special blood tests for mom may be required.
Treatment
General outline of treatment, once the patient is diagnosed with hypertension in pregnancy includes the following
Salt restricted diet
Adequate rest in left lateral position
Antihypertensive treatment
Steroid cover for fetal lung maturity
Delivery
If there is only a mild increase in blood pressure, and you are not close to your due date, you might
be advised to rest at home.
Rest more in left lateral position or on any side.
Avoid added salt and high salt items like pickles, papad, chips etc.
You may be started on blood pressure tablets which are safe for you and the baby.
If the blood pressure reading is very high, then doctor may admit you. You may be started on medication and tests can be done to check mom and baby well-being. If blood pressure is well controlled, pregnancy may be continued with good and frequent monitoring till atleast 37 weeks.
Delivery
Decision for early delivery may be taken depending on blood pressure control, baby condition or decreased blood supply to baby, complications in the mother etc.
Normal or Ceserean delivery decision depends on clinical examination findings, maturity of baby or fetal growth restriction, whether baby can tolerate labour and other obstetric factors.
Steroids for fetal lung maturity will be given if preterm delivery is anticipated to lessen respiratory problems in the baby after birth.
Clinical scenarios
Most of the patients or relatives are not aware of the seriousness of this condition.
They don't want to accept the following facts
That they have a problem in pregnancy like high blood pressure and try to find irrelevant reasons like stress, overwork etc even in abnormally high blood pressure readings.
The need to take medication to treat this condition
There may be a emergency delivery even before term if the need arises to save mother and baby.
Prevention
Uterine artery doppler in early scans that is at 12 and 20 weeks sonography can predict preeclampsia.
Even some blood tests like papp-a can.
Low dose aspirin (150 mg) started after urine pregnancy test positive is proved to prevent recurrence of high blood pressure in the present pregnancy. Also used in women with chronic hypertension.
All the pregnant women and their families should know about the need for extra care and monitoring in patients with high blood pressure in pregnancy. It is must to prevent innumerable complications and dreadful clinical scenarios.
Go to link below for video in Hindi on YouTube by Dr Harita Kothia on this topic.
Take care. Enjoy your pregnancy!!
Disclaimer - These are the views of a qualified doctor and author. These are general suggestions and do not replace actual check up by a doctor. Any resemblance to anybody is coincidental.
Author information - Dr Harita N Kothia, Obstetrician and gynecologist, Mumbai.
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