Dealing With Hypertension In Pregnancy
Pre-Existing Hypertension
Some women already have Hypertension (High Blood Pressure) before they become pregnant and they may be on treatment for this. Your medication may need to be changed, so it is important to see a healthcare professional before, or as soon as you know you are pregnant.
Some women are found to have Hypertension before they are 20 weeks pregnant. (If Hypertension is first discovered before you are 20 weeks pregnant, this usually means that you had previously undetected high blood pressure before you were pregnant.)
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So, Hypertension before 20 weeks of pregnancy is not caused by pregnancy but is pre-existing, or chronic, high blood pressure.
If you have pre-existing Hypertension, you have an increased risk of developing pre-eclampsia during your pregnancy.
Note: If you are taking medicines to treat high blood pressure then, ideally, you should have this reviewed before you become pregnant by your doctor.
Gestational high blood pressure
Some women can develop new high blood pressure during their pregnancy. This is called gestational high blood pressure (or hypertension) or pregnancy-induced high blood pressure (or hypertension).
Gestational high blood pressure is high blood pressure that develops for the first time after the 20th week of pregnancy. Doctors can confirm this type of high blood pressure if you do not go on to develop pre-eclampsia during your pregnancy and if your blood pressure has returned to normal within six weeks of giving birth. If you have gestational high blood pressure, you do not have protein in your urine when it is tested by your midwife or doctor during your pregnancy.
Note: Some women may be found to have new Hypertension after 20 weeks of pregnancy. At first, they may not have any protein in their urine on testing. However, they may later develop protein in their urine and so be diagnosed with preeclampsia. You are only said to have gestational hypertension if you do not go on to develop pre-eclampsia during your pregnancy.
Pre-eclampsia and eclampsia
Pre-eclampsia is a condition that can affect some women who develop new high blood pressure after the 20th week of their pregnancy. Pre-eclampsia can also sometimes develop in women who have Hypertension before they are pregnant (pre-existing Hypertension ) or in women who have protein in their urine before they are pregnant (for example, due to kidney problems).
Pre-eclampsia not only causes high blood pressure; it also affects other parts of your body such as your kidneys, liver, brain and blood clotting system. Pre-eclampsia causes protein to leak from your kidneys into your urine. If you have pre-eclampsia, you will have high blood pressure and protein will be found in your urine when it is tested. Pre-eclampsia gets better within six weeks of you giving birth.
Eclampsia can be a complication of pre-eclampsia. In eclampsia, a woman with pre-eclampsia has one or more fits (seizures or convulsions). This is a serious condition. The aim is to detect and treat preeclampsia successfully to try to prevent eclampsia from developing.
How common is Hypertension during pregnancy?
Hypertension during pregnancy is quite a common problem.
About one in 10 pregnant women have problems with Hypertension .
Up to three in 100 pregnant women have pre-existing Hypertension .
About four to eight in 100 pregnant women have gestational Hypertension and do not go on to develop pre-eclampsia.
Between two and eight in 100 pregnant women develop pre-eclampsia.
For every 100 women who have already developed pre-eclampsia in one pregnancy, 16 will develop it again in a future pregnancy. Up to half of these women will develop gestational hypertension in a future pregnancy.
Problems with new high blood pressure are more common during your first pregnancy.
What are the possible problems with high blood pressure during pregnancy?
As a rule, the higher your blood pressure, the greater the risk for you and your baby.
Mild-to-Moderate Hypertension
If your blood pressure remains mildly to moderately raised and you do not develop pre-eclampsia then the risk is low. Most women with Hypertension during pregnancy just have mildly or moderately raised blood pressure.
However, it is important that your blood pressure and urine should be checked regularly throughout your pregnancy and that you look out for any signs of possible pre-eclampsia.
Severe Hypertension or Pre-Eclampsia
Severe Hypertension , especially with pre-eclampsia, is serious.
· The risks to you as the mother include:
· An increased chance of having a stroke.
· Damage to your kidneys and liver.
· An increased risk of blood clotting problems.
· An increased risk of severe bleeding from your placenta.
· Having fits (seizures) if you go on to develop eclampsia.
· The risks to your baby include:
· An increased chance of poor growth.
· An increased chance of premature birth.
· An increased chance of stillbirth.
What Are Symptoms Of Hypertension During pregnancy?
Many women with high blood pressure (hypertension) during their pregnancy do not have any symptoms. This is why your blood pressure is checked regularly by your doctor or midwife during your pregnancy. Your urine is also tested regularly for protein, to look for possible pre-eclampsia.
However, there are some symptoms that you should look out for that could be signs of pre-eclampsia. If you develop any of these, you should see your doctor or midwife urgently so that they can check your blood pressure and test your urine for protein. They include:
· Severe headaches that do not go away.
· Problems with your vision, such as blurred vision, flashing lights or spots in front of your eyes.
· Tummy (abdominal) pain. The pain that occurs with pre-eclampsia tends to be mainly in the upper part of the abdomen, just below your ribs, especially on your right side.
· Vomiting later in your pregnancy (not the morning sickness of early pregnancy).
· Sudden swelling or puffiness of your hands, face or feet.
· Feeling out of breath.
· Not being able to feel your baby move as much.
· Just not feeling right.
Note: swelling or puffiness of your feet, face, or hands (oedema) is common in normal pregnancy. Most women with this symptom do not have pre-eclampsia but it can become worse in pre-eclampsia. Therefore, report any sudden worsening of swelling of the hands, face or feet promptly to your doctor or midwife.
What is the treatment for high blood pressure in pregnancy?
If your doctor or midwife finds that your blood pressure is high during your pregnancy, they will usually check to see if you have any protein in your urine and ask you if you have any symptoms of pre-eclampsia. If your blood pressure remains high, or if you have any signs of pre-eclampsia, you will usually be seen by a specialist (an obstetrician). In order to advise on treatment, there are various questions that need to be considered by the specialist, such as:
· How severe is your high blood pressure (hypertension)?
· Is there pre-eclampsia and, if so, how severe is it?
· How far is your pregnancy?
· What are the risks to you, the mother, and your baby? This will depend on the severity of your high blood pressure and whether or not pre-eclampsia is present.
If Hypertension remains mild and pre-eclampsia does not develop
There is usually little risk. You will be advised to take 75-150 mg aspirin daily from 12 weeks of pregnancy. Regular checks of your blood pressure and your urine for protein, as well as checks to see how your pregnancy is progressing, may be all that is needed until the natural time of birth. Checks may include blood tests and an ultrasound scan to look at how your baby is growing and to check the blood flow from the afterbirth (placenta) to the baby. You may be followed up by an obstetrician. You may need medicines to control your blood pressure during your pregnancy. You may be offered a placental growth factor blood test to help rule out pre-eclampsia between 20 weeks and up to 35 weeks of pregnancy, if you are suspected of developing pre-eclampsia.
If Hypertension becomes severe, or if pre-eclampsia develops
There are risks to both you, as the mother, and to your baby if Hypertension becomes more severe, especially if you develop pre-eclampsia. You will usually be seen urgently by a specialist and you may be admitted to hospital. Blood tests may be suggested to check to see how much your blood pressure or pre-eclampsia is affecting you. The well-being of your baby may also be checked using ultrasound scanning. A recording of your baby’s heart rate may be carried out.
For severe Hypertension , especially if pre-eclampsia develops, there is often a dilemma. If the high blood pressure is caused by the pregnancy, the only cure is to deliver your baby. This may be fine if your pregnancy is near to the end. The birth can be induced, or your baby can be born by
Caesarean section if necessary. However, a difficult decision may have to be made if high blood pressure or preeclampsia becomes severe earlier in your pregnancy.
Medicine to lower the blood pressure may be prescribed for a while. This may allow your pregnancy to progress further before delivering your baby. The best time to induce the birth (or deliver by caesarean section) varies depending on the factors mentioned above.
If you have severe pre-eclampsia, the medicine magnesium sulfate may be given via a drip around the time that your baby is delivered. This may reduce your chance of developing eclampsia and prevent you having fits (seizures).