Home Forums Obstetrics & Gynaecology High Blood Pressure during Pregnancy

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    Anonymous
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    Blood Pressure over 140/90 mm Hg should be considered as high blood pressure. If the pressure continues after the 20th week of pregnancy preeclampsia can develop. We are not entirely sure what causes increased pressure during pregnancy.
    According to the National Heart, Lung, and Blood Institute (NHLBI), the following can cause hypertension during pregnancy:

    • Obesity
    • Smoking
    • Alcohol consumption
    • Pregnant for the 1st time
    • Pregnant with more than one baby
    • Family history of kidney disease, hypertension or preeclampsia
    • Being pregnant after 40.
    • IVF treatment

    Increased Blood Pressure during Pregnancy can lead to Preeclampsia which in turn can lead to Eclampsia causing seizures, kidney damage, cerebrovascular complications and maternal death. It can also cause abruptio placentae and foetal distress.

    Prevention of Preeclampsia

    During prenatal checks blood pressure is routinely checked and if necessary treated. Urine is also checked for proteins. Protein in the urine is the 1st sign that kidney is being affected from preeclamsia. Oedema of hands and feet and persistent headache may also be a pointer to developing preeclampsia. If the woman is already on an antihypertensive because of preexistent hypertension, according to Mayo Clinic, ACE inhibitors, renin inhibitors and angiotensin receptor blockers should be avoided as they pass through the bloodstream to the developing baby affecting the infant’s health.

    Methyldopa and labetalol are both drugs that have been deemed safe for use to manage blood pressure during pregnancy.

    Treatment of Preeclampsia:

    Apart from medication to control the blood pressure treatment may also require emergency preterm delivery to prevent a serious outcome to baby and mother. In most cases of pre-eclampsia, it is recommended that the baby is delivered at 37th or 38th week of pregnancy. Magnesium sulfate should be considered when there is a risk of seizures (eclampsia) developing. Magnesium sulfate reduces the risk of eclampsia by more than half. Fluid balance must also be monitored carefully to avoid the risk of overload and pulmonary oedema.
    High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in a low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:

    • preterm delivery (defined as delivery prior to 38 weeks of pregnancy)
    • caesarean sections

    Controlling Blood Pressure during pregnancy:

    Apart from drugs, blood pressure can also be controlled during pregnancy by Yoga, simple exercises like walking, avoiding any stressful activity, meditation and listening to relaxing music. Of course alcohol and tobacco must be strictly avoided.

    Postpartum preeclampsia:

    Postpartum Preeclampsia is a rare condition when high blood pressure develops with excess protein in the urine soon after childbirth. They usually develop within 48 hours of childbirth but can occur up to six weeks after childbirth. It is therefore important to instruct women at the time of discharge from hospital regarding the risks of pre-eclampsia. They should be advised to seek urgent medical assessment if they develop any of the symptoms mentioned below.

    Symptoms

    Symptoms and signs are similar to those which occurs during pregnancy. They include High blood pressure, proteinuria oliguria, severe headaches, oedema of face and limbs, visual disturbance, abdominal pain with vomitting.

    Complications of Postpartum preeclampsia:
    Complications of postpartum preeclampsia include: Eclampsia with all its complications, pulmonary oedema, cerebrovascular events, thromboembolism, low platelet count and haemolysis and altered liver function.

    Treatment:

    Women developing symptoms after discharge must be readmitted for monitoring and getting the blood pressure under control. Treatment of postpartum preeclampsia is similar to prenatal preeclampsia. BP and Urine for protein must be checked every other day for two weeks and then at weekly intervals for 6 weeks. Liver function test and platelet count must also be checked. Medication is adjusted according to the level of BP and can gradually be discontinued once the BP is stable (normal) and no proteinuria is detected.

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