Hypertensive Disorders in Pregnancy with the Focus on Pre-Eclampsia

Pre-eclampsia is a complication of pregnancy that usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal, but it may develop after delivery of a baby, a condition known as post-partum pre-eclampsia.

Q. What is considered a normal and abnormal blood pressure?

A. According to the American Heart Association a normal blood pressure reading is 120\80mmHg and below. Readings below 90\60mmHg indicate low blood pressure. Readings above 140\90 mmHg indicate high blood pressure.

Beware that increases in blood pressure of more than 30mmHg systolic pressure or a rise in diastolic pressure of more than 15mmHg over blood pressure values taken at a first visit may indicate the development of hypertension, even if the blood pressure is not yet in the hypertensive range.

Q. Does every pregnant woman suffer from pre-eclampsia?

A. Not all pregnant women suffer from pre-eclampsia, but there are higher risk profiles:

• Women with a previous history of pre-eclampsia
• Women with multiple pregnancies (pregnant with more than 1 baby) due to large placental site
• Women with a history of chronic high blood pressure
• Women with obesity
• Women with gestational diabetes
• First pregnancy
• Age (over 35 years and under 20 years)

Q. What causes pre-eclampsia?

A. The cause of pre-eclampsia is unknown; however, the placenta plays a key role in pre-eclampsia. Early in a pregnancy new blood vessels develop and evolve to supply oxygen and nutrients to the placenta. In women with pre-eclampsia these blood vessels do not seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.

Q. How do you feel when you have high blood pressure?

• Headache that won’t go away
• A woman may feel dizzy
• You can have blurred vision
• Chest pains
• Shortness of breath
• Nose bleeding

Q. How can I prevent hypertension during pregnancy?

A. The following may help to reduce the chance of getting pre-eclampsia:

• Low dose aspirin (75mg) taken daily from the 12th week of gestation until 34 weeks gestational age. Normally prescribed for those at risk of developing pre-eclampsia
• Keep active, eat a balanced diet, and reduce salt intake

Q. Is pre-eclampsia curable?

A. The only cure for pre-eclampsia is the delivery of the baby and placenta. In some cases, the baby must be delivered immediately, regardless of the gestational age to save the mothers or baby’s life.

It is imperative that mothers continue to monitor their health for at least 6 weeks after delivery as they are still at risk of experiencing post-partum pre-eclampsia.

Q. How is pre-eclampsia treated?

A. Many factors influence the health care provider’s decision about how to manage pre-eclampsia including the gestational age and health of the baby, overall health, and age of the mother and careful assessments of how the disease is progressing.

Antihypertensive drugs (methyl dopa 250mg-500mg) orally 3 times a day is prescribed.

The healthcare provider will watch for signs of instability in the mother including very high blood pressure that is not responding to antihypertensives.

If less than 38 weeks and the blood pressure is controlled, delivery is delayed to up to 38 weeks. If the blood pressure is not controlled with medications and treatment, and the baby or mother’s life is at risk, the mother may be given steroids to aid the maturation of the infant’s lungs prior to delivering the baby.

Q. Can a woman with pre-eclampsia deliver her baby normally?

A. If your blood pressure remains within target levels, you should be able to have a natural vaginal birth. At 38 weeks gestation, you will be admitted in the hospital where labour will be induced. The blood pressure is monitored every hour during labour.

Q. What does pre-eclampsia do?

A. Pre-eclampsia causes your blood pressure to rise and put you at risk of brain injury. It can impair your kidney and liver function and can cause blood clotting problems, pulmonary edema (fluid in the lungs), seizures and in severe forms or left untreated, maternal, and infant death.

Pre-eclampsia affects the blood flow to the placenta often leading to smaller or premature born babies. The effects of being born early can vary, some babies may spend only a day or two under close observation while others may spend months in a neonatal intensive care unit. Some babies may also have lifelong problems such as learning disorders, cerebral palsy, blindness, and deafness.

Having a premature baby can also mean a great deal of emotional and financial stress for the family.

Intrauterine growth restriction: because of reduced flow to the placenta, this restricts the supply of food to her unborn baby thus the baby becomes malnourished and is small for gestational age.

Death: Infant death is one of the most devastating consequences of pre-eclampsia.

In conclusion: pre-eclampsia is a hypertensive disorder to pregnancy responsible for significant maternal mortality. Most deaths related to pre-eclampsia could be avoided with timely and effective care.