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Hypertensive Disorders in Pregnancy

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What causes hypertensive disorders in pregnancy?

High blood pressure is a fairly common condition observed in most adults these days. Also called hypertension, it is observed among pregnant women between the ages of 20 to 44. However, when there is good control of blood pressure throughout the pregnancy, both the mother and her baby are likely to stay stable and healthy. This is why it is essential to get your medication sorted before, during and after pregnancy.

What are the complications due to high blood pressure?

Monitoring high blood pressure is essential to avoid unwanted complications during pregnancy. This can impact both the mother and her baby.

Complications for the mother:

  • Preeclampsia
  • Eclampsia
  • Stroke
  • Artificially induced labour, and
  • Placental abruption from the uterine wall

Complications for the baby:

  • Preterm delivery (in less than 37 weeks of pregnancy).
  • Low birth weight (less than 5 pounds/ 8 ounces).
  • Malnourishment due to lack of enough oxygen and nutrients to grow, leading to premature delivery.

So given the extremity of the complications, if you are expecting or planning, you must discuss the problems with your healthcare partner before, during, and after pregnancy.

What are the symptoms of hypertensive disorders in pregnancy?

To understand the symptoms we need to understand the types of hypertensive disorders that might happen to a woman during her pregnancy.

  • Chronic Hypertension: This signifies high blood pressure before pregnancy or up to 19 weeks of your pregnancy. Those who get this in the first trimester have a strong likelihood of developing preeclampsia in the 2nd or 3rd trimesters.
  • Gestational Hypertension: This is typical for almost all pregnancies. Women develop high blood pressure during pregnancy but don’t have any other associated problems like excessive protein in the urine or any other renal ailments and cardiac problems. This usually surfaces around the 21st or later weeks of pregnancy which are closer to the actual delivery. The good part is that this variant disappears after the birth of your child. The only downside to this is that subsequently women in this category tend to develop chronic hypertension in future.
  • Preeclampsia/Eclampsia: This is a tricky variant. Preeclampsia happens to women who suddenly develop high blood pressure and other associated issues like protein in their urine, etc, right around 20 weeks of pregnancy. Women with chronic hypertension are at a higher risk of getting preeclampsia. Sometimes the condition can worsen and lead to seizures. This is when it becomes a medical emergency. This severe condition is what is medically called eclampsia.
  • Postpartum preeclampsia: In some rare cases, preeclampsia happens post-delivery. And it can happen to anyone, even those women who had no blood pressure problems throughout their pregnancy. Women are typically diagnosed within 48 hours of their delivery, but it can show up even 6 weeks later.How to understand that you might be developing preeclampsia? Watch out for the following symptoms:
    • Persisting headache that will not go away easily
    • Changes in vision like blurring, seeing spots, etc.
    • Pain in the upper abdominal area
    • Nausea, vomiting and breathing trouble
    • Sudden weight gain
    • Swollen hands or face

    The following profile of people are more likely to get preeclampsia:

    • Women who have their first delivery.
    • Preeclampsia happened during a previous pregnancy.
    • Women with chronic kidney disease, high blood pressure, or both.
    • Multiple pregnancies (twins, triplets, etc.).
    • Family history of thrombophilia
    • Obesity or type I or type II diabetes
    • Delayed pregnancy where the mother is aged 40 or above.

What are the treatments for hypertensive disorders in pregnancy?

Depending on the stage of the pregnancy, the treatment approach will differ before, during and after pregnancy.

  • Before Pregnancy: When planning for pregnancy, set up a discussion with your healthcare partner or gynaecologist. Make sure you discuss the following:
    • Pre-existing health problems and ongoing medications
    • Weight management with help of diet and regular physical activity.
  • During Pregnancy: Once the pregnancy is confirmed, the following need to be done:
    • Regular and timely prenatal care.
    • Regulate the medicines and dosages if any to make them safe for the baby.
    • Track your blood pressure at home and report to your doctor for any irregularities
    • Watch out for symptoms of Preeclampsia
    • Monitor your weight gain and be careful with your diet.
  • After Pregnancy: Once the baby is delivered watch out for these things:
    • Keep monitoring your pressure if you had high BP during your pregnancy because if unnoticed, the risk of stroke is significantly higher post-delivery.
    • Watch out for symptoms of preeclampsia and immediately seek medical help if the symptoms are prominent.

In conclusion, there can be multiple problems that can occur during a pregnancy, hypertension or high blood pressure is one of them. But this can be managed with proper planning and consultation with an experienced obstetrician. In case you are planning your pregnancy, it is always advisable to discuss your concerns with an expert who will give you the real picture based on your health. At the CK Birla Hospital, our expert OB GYNs provide holistic counselling and support to all our patients to prepare them physically and mentally towards a smooth pregnancy despite all concerns. Reach out to us to book an appointment with Dr. Aruna Kalra.

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