Hypertension in Pregnancy

Apr 7, 2012 , Translated by Kristina Knazko

hypertenze-v-tehotenstvi.jpg - kopie
hypertenze-v-tehotenstvi.jpg - kopie
Hypertension, or high blood pressure, is a very common illness affecting men and women alike. Hypertension can occur during pregnancy, where it is a very serious complication. Hypertension in pregnancy can be a manifestation of other illnesses such as preeclampsia and ecplampsia, which can put the mother and fetus at great risk. It is therefore important to closely monitor hypertension in pregnancy.

Hypertension in Pregnancy

Hypertension, or high blood pressure, is now regarded as a disease of civilizations, affecting 20% of the world's population. Blood pressure is the pressure exerted by blood on the walls of vessels when flowing through the circulatory system. Without blood pressure, blood would not be able to circulate. The normal range for blood pressure is between 110/60mmHg and 140/90mmHg. Hypertension is when blood pressure is higher than the normal range, i.e. 140/90mmHg or higher. Hypertension can appear during pregnancy, usually in the second half. It is important to distinguish whether the woman suffered from high blood pressure before the pregnancy, or whether it is a case of gestational hypertension. Either way is it essential that the expectant mother visits her doctor to be examined.

The Emergence of Hypertension in Pregnancy

Hypertension in pregnancy appears in the second half of pregnancy, during so-called late gestosis. The cause of hypertension in pregnancy is not known. During pregnancy, the woman undergoes numerous changes which return to normal after birth. These include mainly hormonal changes, changes of the immune system, and changes in the physical properties of her blood and blood vessels. It is thought these changes have a role in the emergence on hypertension in pregnancy. However, the emergence of hypertension in pregnancy is definitely caused by a combination of many factors.

Hypertension in Pregnancy and Pathological Conditions

Hypertension in pregnancy can be a part of co-called late gestosis, an illness affecting women in the second half of pregnancy. Late gestosis includes a number of illnesses that exhibit high blood pressure as a major symptom. These include preeclampsia, eclampsia, chronic hypertension, superimposed hypertension and HELLP syndrome.

Preeclampsia

Preeclampsia is a condition characterized by hypertension, protein in urine and swelling. It usually appears after the 20th week of pregnancy, mostly in women who have not been pregnant before. Its cause is not known, but there are a number of theories. Coagulation disorders and arterial contractions in the body of women suffering from preeclampsia need to be monitored. All these changes are propagated to the placenta, and thus to the fetus. The pregnant woman is subjected to special care, which includes bed rest, oxygen therapy, the administration of medications to lower blood pressure and eliminate arterial contractions. Antiedimatous treatment, i.e. medication to reduce swelling, is applied in the case of incipient cerebral swelling.

Ecplampsia

Ecplampsia is a condition characterized by muscle cramping in pregnant women, linked to preeclampsia. Initial symptoms include severe headaches, nausea, vomiting and breathing difficulties, even respiratory arrest. Coma can follow. This state occurs as a result of spasms or contractions of the vessels in the brain, lowering its blood supply. This leads to swelling of the brain and changes in its structure. If this condition occurs, the fetus needs to be delivered by cesarean section without delay.

Chronic Hypertension

Chronic hypertension is the emergence of high blood pressure before the 20th week of pregnancy. This suggests the presence of hypertension before pregnancy, which can be confirmed by changes on the retina, heart or kidneys. This condition needs to be monitored as it can develop into preeclampsia.

Superimposed Hypertension

Superimposed hypertension is a condition linked to chronic hypertension in pregnant women. It causes a rapid increase in blood pressure, swelling and the presence of protein in urine, indicating kidney dysfunction. This is a life-threatening condition that can reappear in subsequent pregnancies.

HELLP Syndrome

HELLP syndrome is a very serious pregnancy complication that ends in death in up to 40% of cases. It frequently affects women in the final stage of pregnancy, usually around the 37th week. It can be preceded by preeclampsia, or can occur as an independent illness. This syndrome causes the breakdown of red blood cells, elevated liver enzymes and lowered platelet count. The cause of this illness is still unknown. Initially it begins with nausea, vomiting, fatigue and pain in the abdomen and under the ribs. These symptoms are later followed by hemorrhaging manifestations such as blood in urine or bleeding into the digestive tract. High blood pressure, swelling and protein in urine are also symptoms of the illness. With the development of this condition, immediate delivery of the fetus and treatment of all of the above symptoms are necessary.

Complications of Hypertension in Pregnancy

Hypertension in pregnancy is dangerous for both the mother and the fetus. Elevated blood pressure causes a decreased supply of oxygen and nutrients to the fetus' blood, leading to slowed development and growth. It can also cause placental abruption, which results in fetal death. For women, hypertension in pregnancy is risky due to the possibility of a stroke, organ failure or blood clotting disorders.

Diagnosis of Hypertension in Pregnancy

Diagnosing hypertension in pregnancy is based on blood pressure taken by a doctor. This is the fundamental and essential part of every visit to the gynecologist. Clinical manifestations also take part in the diagnosis, as well as laboratory tests focused on blood coagulation, complete blood count and biochemical analysis of liver enzymes. Laboratory tests also require a urine sample.

Treatment of Hypertension in Pregnancy

Hypertension in pregnancy must be treated to prevent life-threatening complications for the mother, as well as the fetus. Treatment for hypertension in pregnancy can be non-pharmaceutical or pharmaceutical.

  • Non-pharmaceutical treatment for hypertension in pregnancy should be considered for women with blood pressure between 140/90mmHg and 150/100mmHg. Non-pharmaceutical treatment is possible depending on blood pressure measurements, the phase of pregnancy and the presence of risk factors for the mother as well as the fetus. This type of treatment focuses on bed rest and constant monitoring. Small doses of calcium are also recommended.
  • Pharmaceutical treatment for hypertension in pregnancy is based on the administration of antihypertensive medications, which lower blood pressure. These include diuretics, which lower blood pressure by increasing fluid output. Calcium channel blockers are also prescribed, as the help reduce blood pressure but using a different mechanism.

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