Hypertension in Pregnancy: High Blood Pressure

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What is Hypertension in Pregnancy?

Pregnancy induced hypertension is the elevation of blood pressure during pregnancy. Diagnosis of a hypertension pregnancy is determined if during the later half of your pregnancy, your blood pressure is higher than 140/90 mmHg.

High blood pressure in pregnancy is found in around 5 to 10% of all pregnancies in the U.S. Although there is no known cause or cure, it is the most common condition associated with pregnancy.

Other names for hypertension in pregnancy are: Pregnancy induced hypertension, toxemia and gestational hypertension.

Some pregnant women can develop severe cases of hypertension called preeclampsia and eclampsia. In these cases, there is a risk of maternal and fetal death.

What is the cause?

Although there is no known cause, it is however believed that the condition may begin during early stages of pregnancy; during implantation of the embryo. In normal pregnancies, the blood vessels in the uterus are relaxed during implantation. With a pregnancy induced hypertension, the blood vessels appear to be constricted.

Who is at risk?

Pregnant women with a history of diabetes
Pregnant women with a history of high blood pressure before pregnancy
Pregnant women having multiple births: ie: Twins, triplets
Pregnant women of African descent
Pregnant women who are having their first baby before age 20 or after age 35

What are the symptoms of pregnancy induced hypertension?

  • blood pressure readings above 140/90, or significantly higher than normal
    • protein found in the urine
    • edema (swelling) particularly in the face and neck
    • sudden weight gain
    • double or blurred vision
    • headaches
    • seeing flashing lights or spots
    • urinating only in small amounts

  • abdominal pain
    • nausea and dizziness

Complications involved with pregnancy hypertension are:

Blood vessels can leak, will cause swelling and gaining of weight.
Having blood vessels leak in the lungs, shortness of breath takes place.
Leaking of the vessels in the liver causes liver damage. Leaking of protein in the kidney, can lead to low birth weight in babies.

More severe situations that can occur are:

  • Blindness, kidney failure, and liver rupture
  • Hellp syndrome: Destroys red blood cells, liver, and prevents the blood from clotting.
  • Swelling can cause brain damage in mom and coma
  • Placental abruption, separation of the placenta from the uterus

Additional Notes:

In pregnancy there are three conditions that involve hypertension:

  • CHRONIC HYPERTENSION (the most manageable of the three.)
    • GESTATIONAL HYPERTENSION (PIH, pre-eclampsia, or “toxemia”), which is much more dangerous, and
    • COMBINED: chronic hypertension + gestational hypertension (the worst possibility)

The cure for gestational hypertension is delivery. Years ago, when we called it “pre” eclampsia, what we really feared was “eclampsia.” Before advanced, quality prenatal care was introduced, women would show up at the hospital having seizures or they just finished having one. Since the seizures were from swelling of the brain, eclampsia could cause brain damage or even death.

If a pregnant woman is being followed for gestational hypertension, this is considered a high risk situation that needs to be closely watched.

Management of hypertension in pregnancy in a “Mild” case:

Conservative approaches can be followed in mild cases. Many believe there is no such thing as “mild” gestational hypertension. They press for delivery of the baby as soon as the lungs are mature enough. A low salt diet, bed rest and relaxation are pre-delivery treatment. Close observation with frequent checks of blood pressure, liver and coagulation tests and 24 hour urine collections are also ways of conservatively keeping track, meanwhile, non-stress tests and biophysical profiles are done to keep a watch on the baby.

Management of hypertension in pregnancy in a “Severe” case:

In a severe case, delivery is definite regardless of the gestational age of the baby. Of course this could ultimately be unfortunate and harmful for the baby.

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