Pregnancy Hypertension

Increased Blood Pressure During Pregnancy

Increased blood pressure during pregnancy is a high risk life threatening condition both for the mother and the baby. Hypertension description is resting blood pressure measured to be over 140/90 mm Hg during pregnancy.

What is chronic hypertension?

Chronic hypertension is the presence of increased blood pressure either before pregnancy or before 20th gestational week of pregnancy.

What is pregnancy induced (gestational) hypertension?

Pregnancy induced hypertension is described as increased blood pressure after 20th gestational week of pregnancy. The condition may get better after birth, but some patients may live with hypertension after pregnancy.

What are the problems caused by pregnancy induced hypertension?

Pregnancy induced hypertension (PIH) increases the load on the heart and kidneys, therefore increasing the risk of cardiac and renal diseases and stroke.

The risk of following complications is increased in patients with PIH:

• Fetal intrauterine growth restriction due to compromised placental circulation.
• Preeclampsia
• Preterm birth: Either spontaneous or induced pretem labour risk increases, because there may be life threatening complications for the pregnant patient or the fetus which necessitate delivery
• Ablatio placenta-it is the seperation of placenta from uterine wall before labour and it necessitates an emergency C-section
• There is an increased risk of C-section in patients with PIH.

How is hypertension managed during pregnancy?

It is necessary to follow up these patients very closely during pregnancy. Pregnant patients may be asked to measure their resting blood pressure several times a day at home and record them in charts. It is also important to watch normal fetal growth and fetal well being by serial ultrasonography examinations.

Patients may be given anti-hypertensive medications during pregnancy. When there is severe hypertension, they may be hospitalised.

What is preeclampsia?

Preeclampsia is increased blood pressure accompanied by incresed protein excretion in urine during pregnancy.

Preclampsia is a multiorgan disease, which means it affects all the organs in the body. Severe preeclampsia is diagnosed when the condition worsens due to higher blood pressure values and additional complications.

Such complications may be decreased thrombocytes, worsened kidney and liver function tests, upper right quadrant abdominal pain, blurred vision, lung edema and severe headache.

When does preeclampsia develop?

It develops after 20th gestational week of pregnancy, commonly during the third trimester. When it develops before 32 weeks, it is called early preeclampsia and it is a more severe condition. It may also be seen during several weeks after birth.

Which patients are at higher risk for preeclampsia?

• First pregnancies
• Patients with a history of preeclampsia in previous pregnancies or their family history
• Patients with chronic hypertension or kidney disease
• Pregnant patients over 40 years of age
• Multiple pregnancies
• Patients with chronic diseases such as diabetes, thrombophilia and lupus
• Obese patients
• IVF or ICSI pregnancies

What are the fetal risks of preeclampsia?

The risk of intrauterine growth restriction is increased in pregnancies with preeclampsia. Conditions may develop during a pregnancy with preeclampsia that may necessitate premature delivery and complications related to prematurity may develop.

What are the maternal risks of preeclampsia?

Pregnant patients with preeclampsia have an increased risk of cardiovascular diasease and kidney disease in the future. Therefore they have an increased risk of hypertension, myocardial infarction and stroke in the future. They have an increased risk of preeclampsia in future pregnancies.

They may have convulsions during pregnancy as a complication which is named as ecclampsia. Another complication is HELLP Syndrome which is a severe life threatening condition.

What is HELLP Syndome?

HELLP Syndrome is a very severe condition characterised by hemolysis, elevated liver enzymes and low platelet count.

Red blood cells are damaged, blood clotting is disturbed, there may be liver bleeding which leads to chest and right upper quadrant abdominal pain. It is a life threatening emergency and must be managed seriously.

What are the signs of preeclampsia?

• Hand and face edema
• Intractable headache
• Blurred vision
• Shoulder and right upper quadrant abdominal pain.
• Sudden weight gain
• Nausea and vomitting
• Shortness of breath

How is mild gestational hypertension/preeclampsia treated?

The patient can be followed up in the outpatient clinic or hospitalised. If the patient is followed up in the outpatient clinic, visits should be planned to be twice weekly. These patients should be delivered at 37 th week of gestation. However if there are non-reassuring fetal well being test results, delivery may be planned earlier than 37th week.

How is severe preeclampsia treated?

Patients with severe preeclampsia should be hospitalised. Patients who have completed 34 weeks of gestation should be delivered as soon as their condition is stabilised.

Patients <34 weeks of gestation should be followed up very closely if their condition is stable. Corticosteroid injection may be administered for fetal lung maturation in case premature delivery may be necessary.

Patients may be administered anti hypertensive medications or iv magnesium for the prevention of convulsions. If there is a deterioration in maternal or fetal condition, emergency delivery may be necessary.

Can preeclampsia be prevented?

Any women with hypertension who is planning to conceive should have preconceptional counselling. She should start a regular diet and exercise program and her medications should be revised before pregnancy.

For women with diabetes, blood sugar meticulous control is necessary preconceptionally. Low dose aspirin treatment starting preconceptionally in high risk patients is known to decrease the incidence of preeclampsia.