High Blood Pressure during Pregnancy 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.    Experts    believe    that    placental pathology   may   be   contributing   to   it   in   some   way. 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 Being pregnant after 40. IVF treatment Family history of kidney disease, hypertension or preeclampsia Increased   Blood   Pressure   during   Pregnancy   can   lead   to   Preeclampsia,   a   condition   that   can   occur   during the   second   half   of   pregnancy   when   thare   is   protein   in   the   urine   in   addition   to   the   increased   blood   pressure. It   occurs   in   2   to   6%   of   all   pregnancies.   If   untreated   it   will   lead   to   Eclampsia   causing   fits,   kidney   damage, stroke   and   maternal   death.   It   can   also   cause   premature   separation   of   placenta   from   uterus   leading   to   foetal distress. Monitoring and 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.   Occasionally protein   may      appear   in   the      urine   with   normal   blood   pressure   as   a   sign   that   trouble   is   brewing.   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   fits   (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 (fluid in the lungs). 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   are   Headaches,   Visual disturbance,   Abdominal   pain   with   Vomitting,   Swelling   of   face   and   limbs.   Blood   pressure   will   increase   with kidney involvement leading to reduced urine formation and presence of protein in the urine.  Complications of Postpartum preeclampsia: Eclampsia with all its complications Difficulty breathing due to fluid build up in the lungs Stroke and thromboembolism, Low platelet count and haemolysis (destruction of red blood cells) Abnormal liver function. Treatment: Women   developing   symptoms   after   discharge   should   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   day   for   two   weeks   and   then   at   weekly   intervals   for   6   weeks.   Liver function   test   and   platelet   count   must   also   be   done.   Medication   is   adjusted   according   to   the   level   of   BP   and it can gradually be discontinued once the BP is stable (normal) and no protein in the urine is detected.