High blood pressure in pregnancy : What you should know!!

Updated: Oct 4



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


  1. Pregnancy induced hypertension or gestational hypertension or PIH

  2. Chronic hypertension

  3. Preclampsia

  4. 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.


https://youtu.be/GPwjJ7tbBng


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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