Hypertension During Pregnancy
Hypertension is the presence of high pressure of the blood against the walls of the arteries Hypertension During Pregnancy. It is a serious disease, yet it has no noticeable symptoms in its early stages. For most people with hypertension, there is no specific cause and it is likely to be associated with a combination of genetic and environmental factors.
During pregnancy, there is an increased risk of suffering from “temporary” hypertension, which can persist for weeks following childbirth. Pregnancy hypertension, which occurs in about 10% (1 in 10) of pregnancies, is more common with a family history of hypertension, if suffering diabetes or renal disease, or if having a multiple-birth pregnancy.
During all neonatal check-ups, blood pressure is monitored and treated if present. Hypertension is a risk factor for developing pre-eclampsia.
Pre-Eclampsia
Pre-eclampsia is a condition characterized by increasing blood pressure (hypertension), proteins in the urine (called “albuminuria”) due to kidney damage, headaches and edema (swelling) of the face, feet, and legs. It affects about 5% (1 in 20) of all pregnant women.
The cause of pre-eclampsia is unknown, however, major risk factors include the presence of high blood pressure (hypertension), diabetes, kidney disease, and multiple-birth pregnancy.
Pre-eclampsia has the risk of developing into eclampsia; also, the developing baby is also at risk from decreased blood and oxygen flow.
Eclampsia
Eclampsia is a potentially fatal condition in which convulsive seizures and coma occur during or just the following pregnancy. The effects of eclampsia occur due to the spasming of blood vessels, which decreases blood flow to organs and deprives them of oxygen. This leads to heightened brain sensitivity (causing headache, seizures and coma), kidney failure (causing edema and increased blood pressure) and other organ problems. It is also potentially fatal for the baby, as the blood vessels in the uterus also go into spasm, cutting off blood flow and depriving the fetus of oxygen.
Eclampsia occurs any time from the 20th week of pregnancy to a week following childbirth.
The cause of eclampsia is also unknown, although it is more common in women having their first baby, and is directly related to pre-eclampsia and pregnancy hypertension (high blood pressure).
Eclampsia occurs in 0.5% (1 in 200) of pregnant women with pre-eclampsia.
ECLAMPSIA SYMPTOMS
Initial: dizziness, excessive weight gain, hypertension, nausea, edema of the legs and feet, puffiness of the face, proteins in the urine, severe headaches, spots before the eyes, stomach pain.
Developed: convulsions (rolling of the eyes, twitching of the face, hands, and arms, and whole body spasms), coma, possible death if untreated.
DIAGNOSIS
A medical history will be taken including questions on location and severity of symptoms, past obstetric history, current and previous problems during the pregnancy, any other diseases, occupation, workload, and family history of hypertension and pregnancy problems.
A physical assessment will include blood pressure measurement, an examination of the retina and reflexes of the eye.
Medical tests will generally include urine protein measurement (see urine analysis), renal function test and glucose measurement.
TREATMENT
When hypertension is detected during pregnancy, the pregnant woman will have her blood pressure, urine and weight regularly monitored. Generally, raised blood pressure is first treated with rest and reduced physical activity, often bed rest. In cases where hypertension cannot be controlled with rest, or if there is an increased risk of developing pre-eclampsia, antihypertension medication will be prescribed.
Pre-eclampsia
Treatment depends on the time of onset and severity of the condition.
The only treatment is ending the pregnancy; if the fetus is considered to be relatively mature then delivery is the treatment of choice. If the fetus is immature, treatment will involve bed rest and the use of antihypertension medication to control blood pressure. If the mother or baby is considered to be is a risk, deliver will be induced irrespectively of the duration of the pregnancy. In this case, the baby may not survive.
Eclampsia
The pregnant woman will require immediate hospitalization. Hypertension and convulsions will be treated with intravenous magnesium sulfate. The baby will usually be delivered once the mother’s blood pressure and other symptoms are stabilized, or immediately if fetal distress occurs (detected by monitoring the fetal heartbeat).
Following the birth, the mother is monitored for at least 7 days. If hypertension persists, antihypertension medication may be prescribed.
OUTCOMES
Eclampsia is a potentially fatal condition for both mother and baby. However, recovery following birth is usually rapid, although the high blood pressure (hypertension) may persist for 6 to 8 weeks.
PREVENTION
A pregnant woman requires a good balanced and nutritious diet. They should also have reduced physical activity and get plenty of rest.
Hypertension should be treated as soon as diagnosed.
IMPORTANT NOTES
It is essential that all women are monitored during pregnancy as pre-eclampsia may begin with few or no obvious symptoms. Generally, pregnant women have a check-up every 4 to 6 weeks up to 28 weeks of pregnancy, then each 2 to 3 weeks to 36 weeks, and then weekly until the baby is born. See the health bulletin entitled “Tests during pregnancy” in the Pregnancy & New Motherhood section on the Health Network.
25% (1 in 4) of cases of eclampsia occur after the birth of the child, so women should be monitored for a week after birth if pre-eclamptic.
A number of antihypertension drugs are not to be used by pregnant women
