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High blood pressure During Pregnancy

HIGHLIGHTS:

  • High blood pressure during pregnancy is one of the three main causes of death in pregnant mothers, with 10-15% of maternal deaths attributed to preeclampsia.
  • High blood pressure has the potential to affect one repeatedly, with each subsequent episode likely to increase in severity. Therefore, if you have previously suffered from high blood pressure and become pregnant, it is best to place your pregnancy under the care of a doctor at your earliest opportunity.
  • Treatment for high blood pressure during pregnancy depends entirely on the severity and underlying conditions causing the problem. In cases where the underlying condition is particularly severe, mothers may have their pregnancy induced for the safety of both mother and child.

High blood pressure During Pregnancy

When a woman becomes pregnant, it is crucial that she adheres strictly to medical advice aimed at keeping her in the best health possible, in order to prevent against complications arising from the pregnancy. The focus on self-care is especially important in mothers with underlying health disorders, with one particularly dangerous condition being hypertension during pregnancy. This condition is one of the three main causes of fatalities in pregnant mothers, with 10-15% of fatalities attributed to preeclampsia.

What is considered hypertension during pregnancy?

Blood pressure with systolic blood pressure  ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg on two occasions at least 4 hours apart, can be categorized into the following 6 main conditions.

1. Gestational Hypertension: Blood pressure of ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic, on two occasions at least 4 hours after 20 weeks of gestation, and blood pressure levels return to normal in the 12th week after birth.

2. Preeclampsia (with and without severe features)

2.1 Gestational hypertension with proteinuria

  • The presence of protein or albumin in urine amounting to 300 mg or more in 24 hours.

2.2 Without proteinuria, gestational hypertension with the new onset of any of the following:

  • Thrombocytopenia
  • Renal insufficiency
  • Impaired liver function
  • Pulmonary edema

2.3 Preeclampsia with severe feature

  • Systolic blood pressure of ≥ 160 mm Hg or diastolic blood pressure of ≥ 110 mm Hg
  • Thrombocytopenia
  • Renal insufficiency
  • Impaired liver function
  • Pulmonary edema
  • Visual disturbance
  • Headache unresponsive to medication

3. HELLP syndrome: Increase rates of maternal morbidity and mortality

  • Hemolysis, elevated liver enzymes, and low platelet count

4. Eclampsia: The convulsion

  • Significant cause of maternal death

5. Chronic hypertension: Having high blood pressure that was present prior to the pregnancy or which occurred before the 20th week of pregnancy.

6. Chronic hypertension with superimposed preeclampsia: A chronic hypertension in associated with preeclampsia

 Methods of treatment for high blood pressure during pregnancy

  1. Treatment depends on the severity of the condition and gestational age. When high blood pressure is identified, doctors may admit the mother to the hospital in order to assess the severity of the condition, while also closely monitoring the symptoms and health of both mother and child. In cases where symptoms of preeclampsia are displayed, doctors will prescribe the necessary medication designed to prevent against severe features of preeclampsia or eclampsia alongside blood pressure drugs. Where the pregnancy has reached its full term or the mother’s underlying health disorders appear to be worsening, an induced birth may be required in women whose pregnancy is nearing its full term, and the cervix is already preparing to induce labor. In cases where the cervix is not yet ready, or there are other significant indicators present, such as placenta previa or fetal macrosomia, then a caesarean birth may be considered instead.
  2. However, for those who have not yet neared the pregnancy’s full term and for whom their underlying health disorders are difficult to manage, consideration may be given to terminating the pregnancy, especially in cases where doctors believe that the continuation of the current pregnancy may carry risk for both mother and child.

Advice for women suffering from high blood pressure during pregnancy

  • Get plenty of rest and avoid stress
  • Count the number of fetal movements per day
  • Keep an eye out for signs that your condition may be deteriorating (headache, visual disturbance and epigastric pain)
  • Monitor the situation by attending appointments with your doctor

In any case, if you experience any abnormalities or you observe that your infant has made less than 10 movements in a day, you should seek medical attention immediately.

Screening and monitoring postnatal high blood pressure

The increase in blood pressure that comes with this condition may not return to normal levels immediately after birth. New mothers should, therefore, undertake postnatal blood pressure screening. Generally, high blood pressure that comes with a pregnancy will return to normal no more than 12 weeks after the birth. Where the blood pressure remains high subsequent to this period of time, it could be a signifier of pre-existing hypertension, for which treatment from a qualified physician should be sought.

Hypertension has the potential to affect one repeatedly, with each subsequent episode likely to increase in severity. For this reason, any subsequent pregnancies should be placed under the care of a doctor as soon as the pregnancy is known because of the associated health risks and possibility of preeclampsia occurring. To find out more about preeclampsia, click here.

Placing your pregnancy under the care of a medical team is of great importance. It is also essential that you attend all doctor consultations as each one will involve measuring your weight and taking your blood pressure, as well as screening for proteins and glucose in your urine. In cases where doctors identify risk factors or high blood pressure during pregnancy, they will be able to offer treatment and/or prevention against numerous other health complications, including preeclampsia.


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Anyarin Preechapornprasert, M.D. Summary: Obstetrics And Gynaecology Maternal And Fetal Medicine