Updated: Oct 4, 2020
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
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.
Swelling in feet
Edema in body or puffy face
Rapid weight gain
Blurring of vision
Pain in upper abdomen
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.
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
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
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.
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
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.
Like Acute renal failure may occur
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
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
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.
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
Steroid cover for fetal lung maturity
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.