Hypertension in Pregnancy
Hypertension in pregnancy, which can be defined as the increase in blood pressure of the expectant mother during pregnancy, can occur in different ways. So what are the symptoms of hypertension in pregnancy? What risks are the babies of mothers with blood pressure problems at? How is it treated? Here are the answers to all your questions in this article…
What is hypertension in pregnancy?
Hypertension is defined as a blood pressure above 140/90 mmHg during pregnancy.
What are the types of hypertension in pregnancy?
Various classification systems are used for this definition all over the world. The classification system prepared by the National Institutes of Health Working Group is widely used. According to this classification, there are 4 basic groups; gestational hypertension, preeclampsia and eclampsia, chronic hypertension and superimposed preeclampsia developing on the basis of chronic hypertension.
- Gestational hypertension: It is defined as the high blood pressure detected for the first time after the 20th week of pregnancy. In these patients, there is no protein leakage in the urine and blood pressure returns to normal values within 12 weeks following delivery.
- Preeclampsia and eclampsia: It is defined as the presence of new-onset hypertension and protein leakage in the urine in a woman with normal blood pressure after the 20th week of pregnancy. Eclampsia, on the other hand, is the picture that occurs when preeclampsia is complicated by convulsions (neurological seizures) and coma.
- Chronic hypertension: It is defined as hypertension known to be present before pregnancy or diagnosed before 20 weeks of gestation. In these patients, hypertensive values continue after the 12th week following delivery.
- Superimposed preeclampsia: In a woman with chronic hypertension, worsening of blood pressure values or new onset of protein leakage in the urine, elevated liver enzyme values and thrombocytopenia, etc. observing the findings.
What are the risk factors?
There are various risk factors that play a role in the development of preeclampsia. While preeclampsia generally affects young women who are experiencing their first pregnancy, superimposed preeclampsia is often observed in hypertensive older mothers.
The presence of preeclampsia in a previous pregnancy also significantly increases the risk. Although there are various opinions on genetic susceptibility, its foundations have not been clearly revealed. It has been determined that diseases such as multiple pregnancy, chronic kidney diseases, some rheumatological diseases (antiphospholipid antibody syndrome, etc.), obesity, diabetes mellitus increase the risk.
How to follow up expectant mothers with high blood pressure during pregnancy?
If the blood pressure values can be controlled with antihypertensive drugs used during pregnancy, expectant mothers diagnosed with gestational hypertension and chronic hypertension can wait with strict blood pressure monitoring until the time of delivery. In the presence of severe hypertension or superimposed preeclampsia, delivery is required.
In preeclampsia, the approach is different. The approach in mild or severe preeclampsia near term is to terminate the pregnancy with delivery as soon as possible. However, follow-up is planned if the mother and baby are stable during early pregnancy periods away from term. Outpatient blood pressure, blood tests and the well-being of the baby in the womb are followed by ultrasound in the hospital or outpatient clinic every 3 days. Outpatient follow-up should be performed only in conscious patients in selected mild preeclampsia cases and in the group that can cooperate for daily evaluation when necessary. When symptoms or signs of disease progression are observed in this patient group, hospitalization, close observation and delivery when necessary should be planned.
What symptoms should expectant mothers who do not know that they have a blood pressure problem pay attention to during their pregnancy?
Blood pressure should be measured at check-ups from the beginning of pregnancy. Other than that, 20. especially the week after persistent headache, vision changes, right upper abdominal pain, stomach pain, nausea, vomiting, shortness of breath, decreased urination if you have symptoms such as significant weight gain and simultaneously within 1-2 days of birth must apply to the doctor.
Is it just high blood pressure dangerous? Does low blood pressure also cause problems?
Systemic blood pressure in pregnant women starts to decrease in the first trimester (first 3 months), reaches its lowest level in the middle of pregnancy (2nd trimester), and rises back to the pre-pregnancy level before delivery. While hypotension and a significant decrease in heart rate may occur with this condition of pregnancy, which is defined as the “supine hypotensive syndrome” as a result of the compression of the enlarged uterus, this situation may also manifest itself as weakness, lightheadedness, dizziness, nausea and even fainting. These hemodynamic effects disappear when the pregnant woman is turned on her side and the symptoms suddenly disappear.
Low blood pressure during pregnancy usually does not cause serious health problems and can be easily treated. However, blood pressure that is too low can sometimes cause problems and cause uncomfortable complaints. While low blood pressure is very common, certain conditions can cause blood pressure to drop further in pregnant women. These may be allergic reactions, infection, prolonged bed rest, decreased fluid intake, malnutrition, anemia, some hormonal disorders, heart diseases and bleeding. Therefore, blood pressure should be measured in every doctor control of pregnant women.
What risks are the babies of mothers with blood pressure problems at?
The rise in blood pressure is in parallel with maternal-fetal risks and poor pregnancy outcomes. The incidence of intrauterine growth retardation (developmental retardation in the womb), small for gestational age, placental abruption (separation of the placenta from the uterus before birth), preterm birth, perinatal mortality (death in the womb) in the babies of mothers with this condition increased compared to the pregnants with normal blood pressure.
How is hypertension treated during pregnancy?
In cases of chronic hypertension, gestational hypertension and mild preeclampsia, the blood pressure and the well-being of the mother and the baby are controlled and it is tried to be kept constant at 140/90 mmHg with medical treatment. The definitive treatment in severe preeclampsia cases is to terminate the pregnancy with delivery.
After birth, especially in the first 48 hours, the risk of pulmonary edema, heart failure, kidney failure and cerebral hemorrhage due to high blood pressure in the mother is highest. In the future, the risk of cardiovascular disease, renal disease, and cerebrovascular disease is minimally increased.
As a result, our advice to pregnant women; It is recommended that they monitor their blood pressure regularly, pay attention to their weight gain, eat protein-rich diets, do daily activities and short exercises, not interrupt their doctor’s check-ups, and maintain their pregnancy in cooperation with their doctor.