Hypertension During Pregnancy
The Threat of High Blood Pressure
Definition
It is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It is most common in nulliparous (have not been pregnant) women. There are two categories of gestational hypertension. These are:
Preeclampsia
Non-convulsive form of the disorder. It develops in about 7% of pregnancies and may be mild or severe. Marked by the onset of hypertension after 20 weeks of gestation.
The incidence is significantly higher in low socioeconomic groups.
Eclampsia
Convulsive form of the disorder. Occurs between 24 weeks of gestation and the end of the first postpartum (after delivery) week. Incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease
Currently gestational hypertension and its complications are the most common cause of maternal death in the developed countries.
The Story Behind Gestational Hypertension
There is no exact cause for this condition. The systemic peripheral spasm of the vessels can occur. It affects every organ system. There are researches that support with geographic, ethnic, racial, nutritional, immunologic, and familiar factors may contribute to preexisting vascular disease, which in turn may contribute to its occurrence. The age is considered as a factor. Adolescents younger than age 19 and primiparas (first time being pregnant) older than age 35 are at higher risk.
What to look for?
The following are the common clinical manifestations of a woman who have gestational hypertension:
Blood pressure over 140/90 mmHg or an increase of 300mmHg systolic and 15mmHg diastolic over baseline obtained in two occasions at least 4 to 6 hours apart;
Increase in generalized edema associated with a sudden weight gain of more than 5 lb (2.3kg) per week;
Usually appears between the 20th week and 24th weeks of gestation and disappears within 42 days after the delivery;
A final diagnosis usually deferred until blood pressure returns to normal after delivery; if blood pressure remains elevated, chronic hypertension, either alone or superimposed on gestational hypertension, may be the cause;
Additional signs and symptoms with severe preeclampsia include increased blood urea nitrogen (BUN), creatinine, and uric acid levels; frontal headaches (forehead), blurred vision, nausea, vomiting, irritability, and epigastric pain.
What test is being done?
Laboratory tests is use to determine the protein level in the urine. Proteinuria (protein in the urine) is of gestational hypertension. In preeclampsia, there is protein level in the urine that exceeds 300mg/24 hours (1+) and in eclampsia, 5g/24 hours (5+) or more.
How is it managed medically?
High protein diet with adequate fluid intake with restriction of excessively salty foods;
Bed rest in side-lying position;
Close observance of blood pressure, fetal heart rate, edema, proteinuria, and signs of pending eclampsia;
Administration of antihypertensive drugs
How it is managed at home?
When you know someone who happens to have this condition, it is best for you to advise then to monitor their vital signs especially the blood pressure regularly. The fetal heart rate must be closely monitored as well. Monitor the extent and location of the edema. Make sure to provide a quiet, darkened room until the pregnant mother’s condition stabilizes and enforce absolute bed rest. Provide emotional support to the pregnant mother and her family by:
Encourage them to verbalize their feelings
If the mother’s condition necessitates premature deliver, point out that infants of the mother with gestational hypertension are usually small for gestational age but sometimes far better than other preterm infants of the same weight, possibly because they have developed adaptive response to stress in utero; and
Help the mother and her family to develop effective coping strategies.