High Blood Pressure in Pregnancy

Apr 7, 2012 , Translated by Kristina Knazko

vysoky-krevni-tlak-v-tehotenstvi.jpg - kopie
vysoky-krevni-tlak-v-tehotenstvi.jpg - kopie
High blood pressure in pregnancy affects about 10% of women. It is a condition that should never be underestimated. High blood pressure in pregnancy can be lead to a number of serious illnesses such as preeclampsia, eclampsia or even HELLP syndrome. High blood pressure in pregnancy can be a symptom of a life-threatening illness for the mother and her fetus.

High Blood Pressure in Pregnancy

Blood pressure is the pressure that circulating blood exerts on arterial walls.  Without blood pressure, blood would not be able to travel throughout the circulatory system.  Normal blood pressure should be between 110/65 mmHg and 140/90 mmHg.  High blood pressure is blood pressure above 140/90 mmHg.  High blood pressure can occur during pregnancy, typically in the second half.  It is important to determine whether the woman suffered from high blood pressure before, or whether the condition emerged during her pregnancy.  In either case it is essential that the pregnant woman visits her doctor for testing.

The Emergence of High Blood Pressure in Pregnancy

High blood pressure in pregnancy appears in the second half of pregnancy, so-called late gestosis.  The cause of high blood pressure in pregnancy is still not certain.  During pregnancy, the body undergoes numerous changes, mainly hormonal changes, changes in the immune system or changes in the physical properties of blood and blood vessels.  These changes return to normal after giving birth.  It is thought that these changes are what cause high blood pressure in pregnancy.  What is certain is that it is caused by a combination of factors.

High Blood Pressure in Pregnancy and its Pathology

High blood pressure is sometimes part of what is called late-gestosis, i.e. an illness affecting women in the second half of pregnancy.  There are several illnesses that can appear in late-gestosis whose symptoms include high blood pressure.  These are preeclampsia, eclampsia, chronic hypertension, superimposed hypertension and HELLP syndrome.

Preeclampsia

Preeclampsia is a condition characterized by high blood pressure, protein in urine and swelling.  It typically appears after the 20th week of pregnancy, most often in women who are pregnant for the first time.  The cause is not known, but there are a number of theories.  Blood coagulation disorders and arterial contractions in the pregnant woman are monitored.  All these changes propagate to the placenta, and thus the fetus as well.  The mother is subjected to special care which includes bed rest, oxygen therapy, and blood pressure lowering medications.  With suspicion of swelling of the brain, antiedematous medications are administered in order to decrease swelling.

Eclampsia

Eclampsia is a condition characterized by the presence of muscle cramps in pregnant women, following preeclampsia.  Initial symptoms include headaches, nausea, vomiting and difficulty breathing, which can lead to respiratory arrest.  These symptoms can later be followed by altered consciousness in the form of a coma.  This condition occurs as a result of spasms or contractions of blood vessels in the brain, decreasing its supply of oxygen.  This can also cause swelling of the brain and changes in its structure.  If this condition occurs, emergency cesarean section is required. 

Chronic Hypertension

Chronic hypertension is high blood pressure appearing before the 20th week of pregnancy.  This suggests the presence of high blood pressure before pregnancy and can be confirmed by examining any changes to the retina, heart or kidneys.  This condition should be monitored, as it can lead to preeclampsia.

Superimposed Hypertension

Superimposed hypertension is a condition that follows chronic high blood pressure in pregnancy.  It leads to a rapid increase in blood pressure, swelling and protein in urine, indicating a kidney disorder.  This is a life-threatening condition that can reoccur in subsequent pregnancies.

HELLP Syndromes

HELLP syndrome is a very serious pregnancy complication that ends in death in 40% of cases.  It often affects women in the last phase of pregnancy, usually around the 37th week.  It can occur following preeclampsia or as a separate illness.  This syndrome results in the breakdown of red blood cells, an increase of liver enzymes and a decrease in platelets.  The cause of this illness is still not known.  Initially symptoms include nausea, vomiting, fatigue and pain in the abdomen and under the ribs.  These are later followed by hemorrhagic manifestations, such as blood in urine or bleeding into the gastrointestinal tract.  Symptoms of high blood pressure, swelling and protein in urine can also be symptoms.  In the event of this condition, immediate birth and rapid treatment of all of the above symptoms are essential.

Complications of High Blood Pressure in Pregnancy

High blood pressure in pregnancy is dangerous for the mother as well as her fetus.  High blood pressure affects the supply of oxygen and nutrients to the fetus, slowing its development and growth.  It can also lead to placental abruption, which leads to death of the fetus.  Women with high blood pressure in pregnancy are at risk for stroke, organ failure, and blood clotting disorders.

Diagnosing High Blood Pressure in Pregnancy

High blood pressure in pregnancy is diagnosed by measuring blood pressure when visiting a doctor.  This is the most basic and an essential part of every gynecological visit.  Clinical manifestations also contribute to a diagnosis.  It is also essential to perform laboratory testing focused on blood coagulation, blood count, and biochemical analysis of liver enzymes.  A urine sample is also necessary.

Treating High Blood Pressure in Pregnancy

High blood pressure in pregnancy must be determined due to the possibility of further complications that can become life threatening for the mother and fetus.  Treating high blood pressure in pregnancy can be no pharmacological, or pharmacological.

  • Non-pharmacological treatment of high blood pressure in pregnancy is suitable for those with a blood pressure between 140/90 mmHg and 150/100 mmHg.  Non-pharmacological treatment is possible depending on blood pressure values, stage of pregnancy and presence of risk factors for the mother as well as the fetus.  This type of treatment includes bed rest and constant monitoring.  Small doses of calcium are recommended.
  • Pharmacological treatment for high blood pressure in pregnancy rests in the administration of hypertensives, which lower blood pressure.  Calcium channel blockers are also given as they also help lower blood pressure.

 

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