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Hypertension in Expecting Mothers

Hypertension or high blood pressure during pregnancy is medically termed as pre-eclampsia. In this condition, the blood pressure is above normal (≥ 140/90). The condition can be with or without oedema (swelling of feet), with or without protein in urine, after 20 weeks of gestation.

However, women with pre-existing hypertension can present earlier with pre-eclampsia. It is always advisable to go through a pre-pregnancy counselling at Apollo Cradle wherein the doctors and experts can suggest appropriate medication and also prepare for the delivery date according to the patient's condition.

Who gets it?

Pre-eclampsia is a condition that is mostly seen during pregnancy. This is probably due to the changes experienced by a mother’s body because of the presence of a foetus. However, pre-eclampsia can recur in subsequent pregnancies also, depending on the severity or time of onset in the first pregnancy. Pre-existing kidney or heart problems, auto-immune conditions or obesity can lead to a recurrence of the condition. Normally, women expecting twins tend to get pre-eclampsia.

Risk Factors

 

  • Elderly or teenage mothers
  • Family history
  • Twins
  • Obesity
  • History of hypertension, kidney problems
  • History of heart disease
  • Auto-immune conditions like SLE (Systemic Lupus Erythematosus)
  • Women who have had IVF
  • Women with diabetes

 

Diagnosis

BP recordings in sitting or lying position should be measured at every visit along with regular check-ups and documentation for protein in urine. BP ≥ 140/90 is termed as hypertension in pregnancy. Women tend to have swollen feet and hands during pregnancy. Routine questioning/counselling regarding other symptoms such as headache, floaters in front of their eyes, upper abdominal pain and flu like symptoms, urine output and colour, should be assessed regularly to gauge the severity of the problem.

Impact on Pregnancy

Pre-eclampsia, if left untreated, can be detrimental to both the mother as well as the unborn child.

High BP can cause swelling in the brain of the mother and if unchecked can lead to brain haemorrhage. The same condition of high blood pressure may also result in convulsions called eclampsia. High blood pressure can impair blood flow to the placenta, to the foetus and can cause:

  • Low birth weight
  • Pre-term labour
  • Sudden death inside the womb
  • Distress and hypoxia
  • Premature separation of placenta

When faced with such situations, the obstetrician would have to deliver the baby much before the expected due date. In many cases, delivery is the only way to treat pre-eclampsia definitely.

Treatment and Prevention of Complications

The treatment of pre-eclampsia concentrates on wellbeing of mother and preventing any kind of complications to mother and her unborn child. The preventive and treatment steps being:

  • Keeping blood pressure below 140/90, this can be achieved through medications.
  • Avoiding blood pressure of ≥ 160/90, which is important to prevent epilepsy or brain haemorrhage and treating it as a medical emergency.
  • Regular blood investigation for functioning of liver, kidneys, keeping track of blood platelets.
  • Regular scans to assess growth and blood flow to the foetus to ensure its wellbeing.
  • Appropriate timing of delivery in an appropriate place with good neonatal facilities and ICU backup should be planned and elective delivery should be carried out to improve and optimize both maternal and neonatal outcomes.

All the above steps call for multi-disciplinary teamwork of medical personnel associated in different disciplines to achieve good results.

During Labour

Regular blood pressure monitoring is important. Avoiding an overload of fluid intake, maintaining adequate pain relief, low threshold for C-section, focusing on maternal well-being and continuous monitoring of the foetus will help achieve good results.

Postnatal Care

Women with pre-eclampsia should have 2 to 4 hourly BP monitoring after delivery. Elevated BP may be found in patients during 10 days of postnatal duration that in turn may cause complications. Thus, treatment targeted towards keeping BP ≤ 140/90 is vital and necessary all throughout.

Postnatal Visit

Pre-eclampsia tends to disappear after delivery. So, women who have persistent raised BP 6 weeks after delivery are candidates who have chronic essential hypertension and will need long term BP medication.