Pregnancy Induced Hypertension (PIH)
Some women who had normal blood pressure prior to pregnancy may develop hypertension in the latter half of pregnancy.
All pregnant women need to understand the warning signs of hypertensive disorders of pregnancy which are common and remain a significant threat to the health of mother and baby.
Gestational Hypertension
At the mild end of the spectrum is gestational hypertension, also known as pregnancy-induced hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant.
Gestational hypertension usually subsides after the baby is born.
This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus.
Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth.
Some women who have gestational hypertension later on develop preeclampsia.
Preeclampsia
Preeclampsia is like gestational hypertension because it also involves high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy.
But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine.
Preeclampsia during pregnancy is mild in the majority of cases and affect roughly 5-8% of pregnancies.
However, a woman can progress from mild to severe preeclampsia or to full eclampsia very quickly―even in a matter of days. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant. The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy).
Because preeclampsia can affect any pregnancy, the single most important thing you can do to protect your baby and you is to keep your prenatal appointments
Symptoms of Preeclampsia
Preeclampsia usually manifests after the first 20 weeks of pregnancy. A spike in blood pressure can be the first sign of preeclampsia, which is why monitoring your blood pressure during pregnancy is so important. Other symptoms include:
- Severe headaches
- Sensitivity to light, blurred vision, or temporary loss of vision
- Nausea
- Vomiting
- Proteinuria (each prenatal visit your urine will be checked for protein)
- Decrease in urination
- Pain in the upper abdomen, especially on the right side
- Difficulty breathing, due to fluid in the lungs
- Sudden weight gain or edema (swelling) in the hands and face – these signs are considered less reliable since both are also normal symptoms of pregnancy
If you have any of these symptoms, especially if they develop in the second half of pregnancy, call your ob-gyn right away.
What causes Pregnancy Induced Hypertension (PIH)
Researchers are still studying the exact causes for preeclampsia, but it appears that the problem begins in the placenta.
When you become pregnant, the placenta is the organ that develops to feed and send oxygen to the fetus to help it grow. New blood vessels must form in order to send nutrient-rich blood into the placenta.
But in women with preeclampsia, the new blood vessels are more narrow than usual and don’t seem to react as well to the mother’s hormones. They’re unable to carry enough blood, which slows the baby’s development, causes hypertension, and damages other organ systems in the mother — especially the kidneys.
RISK FACTORS
Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy.
Moderate Risk Factors
- First Pregnancy
- Past pregnancy complicated by lower birth weight
- Last pregnancy was over 10 years ago
- New father – each pregnancy from a new partner increases the risk of preeclampsia
- Chronic high blood pressure or kidney disease before pregnancy
- BMI over 30
- Women older than 35 are at higher risk.
- African American ethnicity
- Family history of preeclampsia
High Risk Factors
- High blood pressure or preeclampsia in an earlier pregnancy
- Multiple gestation (being pregnant with more than one fetus)
- Medical history of
- Chronic Hypertension
- Diabetes
- Kidney Disease
- Rheumatoid arthritis
- Lupus
- Scleroderma
- Multiple sclerosis
- PCOS
Treatment of pregnancy induced hypertension
Delivery is the only way to cure preeclampsia and management depends on the risk to allowing your pregnancy to progress balanced with the risk of delivering your baby too early.
Delivering the fetus can help resolve preeclampsia and eclampsia, but symptoms can continue even after delivery, and some of them can be serious.
Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications.
If the pregnancy is at less than 37 weeks, however, the woman and her healthcare provider may consider treatment options that give the fetus more time to develop, depending on how severe the condition is. A healthcare provider may consider the following options:
- If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the healthcare provider may ask the woman to go on bed rest to try to lower blood pressure and increase blood flow to the placenta.
- Close monitoring of the woman and her fetus will be needed.
- Ultrasound every 2-3 weeks
- Fetal growth
- Fluid around the baby
- Tone and movement
- Fetal heart rate monitoring (NST) done twice weekly
- Home monitoring with Kick Counts.
- We will monitor the mother
- More frequent visits
- BP checks
- Urine protein
- Home blood pressure monitoring
- Blood work
- Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.
- In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously.
- Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications.
- Steroid injections to help speed up the development of the fetus’s lungs in anticipation of early or preterm delivery.
When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. If the pregnancy is at less than 34 weeks, healthcare providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery.
Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications.