Introduction
Hypertension in pregnancy is a condition where a woman's blood pressure becomes elevated during pregnancy, typically after the 20th week of gestation, without the presence of proteinuria (protein in the urine). Hypertension during pregnancy can be categorized as:
Gestational hypertension: Blood pressure higher than 140/90 mmHg without the presence of proteinuria after the 20th week of gestation in a previously normotensive woman.
Pre-eclampsia: Gestational hypertension accompanied by proteinuria and/or signs of organ dysfunction, such as impaired liver function, kidney dysfunction, neurological symptoms, or fetal growth restriction.
Chronic hypertension: Hypertension present before pregnancy or diagnosed before the 20th week of gestation.
Hypertension is a common problem during pregnancy. Approximately one in three of pregnant women are believed to experience elevated blood pressure.
Essential hypertension is the most prevalent form of high blood pressure, which results from abnormalities in the blood vessels. Although approximately 50% of pregnant women suffer from high blood pressure, only about 33% of them have essential hypertension, with the remaining 67% experiencing other types of hypertension.
Various factors can contribute to high blood pressure during pregnancy, with the most frequent causes being fetal growth and maternal weight.
Signs and symptoms of hypertension in pregnancy
There are certain indications that a pregnant woman might have hypertension. These signs could be commonly observed and could be used to identify whether the woman has high blood pressure during pregnancy.
• headaches
• fatigue
• dizziness
• chest pain
• increased urination
• nausea
• constipation
• changes in appetite
• Alterations in the appearance of the skin, such as increased dryness or reddening.
• Variations in emotional state, such as feeling easily annoyed or anxious.
Hypertensive diseases in pregnancy may be :
• chronic (pre-existing) hypertension
• pregnancy- induced hypertension
• pre-eclampsia
• Eclampsia
Chronic hypertension
This refers to a blood pressure reading of 140/90 mmHg that was taken before the beginning of pregnancy or before the pregnancy reached 20 weeks.
Causes:
• Essential hypertension
• collagen vascular disease
• coarctation of the aorta
• Renal disease
Complications:
Maternal complications of hypertension
• pre-eclampsia
• placental abruption
• heart failure
• Intracerebral hemorrhage
Fetal complication
• placental insufficiency
• Growth restriction
• preterm delivery
• increased morbidity and mortality
Investigations:
•Creatinine, Urea & Electrolyte
•LFTS
•24- hour urinary protein/ creatinine clearance
•Renal scan
•Autoantibody screen
•ECG and Echocardiography
Management
Mild cases i.e. BP< 150/100
• No immediate indicayion to treat.
• Serial sonograms and antenatal testing
• Serial Bp and urine protein assessment
• If a woman is at term and her cervix is in a favorable condition, it may be recommended to induce labor.
Severe cases:
•To treat high blood pressure during pregnancy, the recommended medication is "methyldopa".
• If methyldopa is not suitable, then Labetalol (which blocks both alpha and beta receptors) or Nifedipine (which blocks calcium channels) can be used as alternatives.
• The goal of taking antihypertensive medication is to keep the blood pressure below 160/100 mmHg.
• Regular monitoring of blood pressure and checking urine for protein levels is important to detect any signs of pre-eclampsia that may develop during the pregnancy.
Mode of delivery:
• It is recommended to wait for spontaneous onset of labor.
• Vaginal delivery can be attempted at 38 weeks of pregnancy.
• If delivery is planned before 34 weeks of gestation, the mother should be given steroids to help the baby's lungs mature.
• Continuous monitoring of the baby's heart rate is necessary during labor if the baby is not growing as expected..
2.gestational hypertension
Gestational hypertension also known as pregnancy induced hypertension. It is defined as hypertension arising for the first time in the second half of pregnancy and in the absence of proteinuria. It is not associated with adverse pregnancy outcome and as such should be clearly distinguished from pre-eclampsia.
Signs and symptoms
Gestational hypertension (HTN) is a condition in which the blood pressure rises during pregnancy. The most common symptom is a high blood pressure reading during your pregnancy check-up. Other signs and symptoms may include:
• headache
• nausea
• vomiting
• lightheadedness
• fatigue
• irregular heartbeat
• swelling in your feet or hands
If you are noticing any of these signs, it is crucial to seek medical attention. Gestational high blood pressure can cause severe issues for both you and your baby.
Diagnosis
• No symptoms of pre-eclampsia are seen
• physical findings are unremarkable for pregnancy
•The laboratory results are normal and there is no presence of protein in the urine.
•The main observation is that the person has consistently high blood pressure levels.
Management
• Conservative outpatient management is appropriate.
• To confirm or rule out pre-eclampsia, it is important to conduct appropriate laboratory tests. Delivery should be planned for around the anticipated due date.
Causes
There is no single cause for gestational hypertension, as the disorder can be the result of a variety of underlying medical conditions. However, certain factors are often associated with the development of the condition, including:
1. High blood pressure during pregnancy
2. Obesity
3. A history of hypertension
4. Certain medications, such as ACE inhibitors or beta blockers
5. Inherited factors, such as a family history of hypertension
6. Certain environmental pollutants
7. Certain conditions, such as polycystic ovarian syndrome (PCOS), that can affect the menstrual cycle
8. Illicit drug use
9. Diabetes
10.Gestational diabetes
11. Prediabetes
prevention
Hypertension, or high blood pressure, can occur during pregnancy and can have serious consequences for both the mother and baby. Here are some ways to prevent hypertension during pregnancy:
•Eat a healthy diet: Eating a balanced diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats can help prevent hypertension.
•Stay active: Regular physical activity can help prevent hypertension during pregnancy. Talk to your healthcare provider about what types and amounts of exercise are safe for you.
•Manage stress: Stress can contribute to hypertension, so it's important to find ways to manage stress during pregnancy. This may include practicing relaxation techniques, such as meditation or yoga.
•Monitor your blood pressure: Your healthcare provider will monitor your blood pressure regularly during pregnancy to detect any signs of hypertension. If your blood pressure is consistently high, your healthcare provider may recommend medication or other treatments.
•Attend regular prenatal check-ups: Regular prenatal care is essential for preventing and managing hypertension during pregnancy. Attend all scheduled appointments and follow your healthcare provider's recommendations for managing your blood pressure.
•Avoid smoking and alcohol: Smoking and alcohol can increase the risk of hypertension during pregnancy, so it's important to avoid them.
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