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. K. Badrinath, FRCS., MSc (Orth) (Lond) ALL RIGHTS RESERVED | © 2019 MADRAS RED FORT DOCTORS FOUNDATION