High blood pressure early pregnancy symptoms
Hi guyz, how are you doing? Today we would be taking a Look at blood pressure and pregnant women. It is important to note that hypertension may appear before or during the pregnancy. In some cases it becomes permanent while in other cases it might only be for a short while (i.e only for the period of pregnancy).
There are different types of high blood pressure during pregnancy namely:
Gestational Hypertension: “Gestation” simply means hypertension during pregnancy. It is usually develops after 20 completed weeks of pregnancy.
Chronic Hypertension: This type of hypertension usually presents even before pregnancy or is present before 20 completed weeks of pregnancy.
Pre Eclampsia: This is sometimes a sequel of gestational hypertension and chronic hypertension. It usually occurs after 20 weeks of pregnancy with signs of organic system damage. It is a very serious condition during pregnancy and if left untreated can be very fatal for both the baby and mother.
Chronic Hypertension with superimposed pre eclampsia
This category or pregnant women have chronic high blood pressure even before pregnancy and then develop worsening high blood pressure with complications during pregnancy. From the above listed types of high blood pressure during pregnancy it is important to differentiate between hypertension that starts during pregnancy as they both have completely different consequences.
Before we go further I would like to discuss a little about pre eclampsia which is one of the types of high blood pressure during pregnancy. Like I mentioned earlier it is usually a sequel to gestational hypertension and chronic hypertension. It is very peculiar because it is associated with symptoms such as weight gain, headache, oedema, swelling, abdominal pain and blurred vision.
Just as the name indicates, Pre eclampsia if not checked and properly managed could lead to eclampsia (the more serious form). Eclampsia goes a step further in the symptoms to include seizures and this could have devastating consequences for both mother and the foetus. It is sad to know that the causative factors for preeclampsia are unknown but it is said to be more common in elderly primigravidas (first pregnancy in a woman older than 40 years) and also extremely young primigravidas( less than 19 years of age). Also it has been found in many women carrying twins. A previous history of pre preeclampsia in pregnancy can also increase the chances of reoccurrence, likewise a maternal history of preeclampsia.
So just how do we make a diagnosis of pre eclampsia? The pregnant woman most times present with two or more of the following symptoms, abdominal pain, weight gain, blurred vision, headache & bleeding preeclampsia. A diagnosis of following this above symptoms is then made when:
- The blood pressure increases above 140 / 90 mmHg after 20 completed weeks of pregnancy
- Excess protein in the urine.
NB: Gestational high blood pressure is also known as transient high blood pressure as it is usually resolved 12 weeks after delivery.
Why is High Blood pressure worrisome during Pregnancy?
Hypertension is seen as a problem during pregnancy for the following reasons.
- It decreases the flow of blood through the placenta to the baby. This means that the baby is deprived of enough blood and subsequently receives less oxygen and decreased nutrients. It is logical to say any one not receiving proper nutrient would not grow appropriately likewise due to the decreased flow of nutrients the baby would grow very slowly and may have a low birth weight.
- Hypertension in some cases is extremely life threatening during pregnancy and as such the baby might have to be brought out prematurely in order to save the life of both baby and mother.
- Preeclampsia can lead to a condition known as abruptioplacenta (where the placenta separates from the all of the uterus before delivery and can cause severe bleeding and damage to the placenta. This could be potentially life threatening to both mother and baby.
- Finally preeclampsia in pregnancy can lead to an increased risk of future heart and blood disease.
Now that we have seen that hypertension in pregnancy can lead to a lot of problems, we would proceed to discuss management of hypertension in pregnancy including preeclampsia. First things first, it is important to determine the type of high blood pressure in pregnancy. Is it gestational hypertension chronic hypertension, preeclampsia or chronic hypertension with super imposed preeclampsia.
Doing that successfully would require being able to determine if the woman was previously hypertensive before pregnancy, before 20 weeks of gestation or hypertensive after 20 weeks of pregnancy. Therefore women should check their blood pressure occasionally even before pregnancy. The first step in managing worsening hypertension during pregnancy is placing the woman on bed rest and limiting strenuous activity. They should be admitted to the hospital for close observation and investigation especially in cases of preeclampsia.
Women with chronic high blood pressure may need to take antihypertensives during pregnancy especially if the diastolic blood pressure is above 100 mmHg. The various antihypertensives would be discussed in chapter 7. However the best medication for high blood pressure during pregnancy is “methyl dopa” as it is both safe and very effective in both mother and baby.
Dealing with preeclampsia
In my opinion preeclampsia is the most dangerous hypertensive condition in pregnancy as it can lead to Eclampsia. The best form of treatment for preeclampsia is termination of pregnancy (i.e bringing out the baby) although this is the most preferred form of treatment, it might not always be feasible.
It is only favourable when the pregnancy is 36 weeks and above but in situations when the pregnancy is not up to 28 completed weeks of gestation(in Nigeria) the fetus may not be mature enough to survive.
So here is the deal, if preeclampsia does not get worse progressively and the mother’s life is not in danger, it is best to try prolonging the pregnancy for as long as possible as every extra day is very important for the wellbeing of the baby to avoid early delivery, the pregnant woman should be constantly monitored ie the blood pressure should be monitored as well as the fetal movement and urine protein, the diastolic value of blood pressure should not exceed 110 mmHg, intravenous medications should be given for immediate effect in lowering the blood pressure and the pregnant woman should be on a good and healthy diet.
Finally if the mother has chronic high blood pressure, the suitable drugs for the mother available during breast feeding include Nifedipine, Timolol and menthyl dopa as these drugs do not affect the baby during breast feeding.
I would like to end this chapter by advising pregnant women to be more vigilant and aware of “hypertension in pregnancy.”