Hypertensive disorders in pregnant women
HYPERTENSIVE disorders in pregnancy, also referred to as maternal hypertensive disorders, are believed to complicate up to 10 per cent of all pregnancies. The group of conditions, which obstetrician-gynaecologist Dr Robyn Khemlani says includes pre-eclampsia, gestational hypertension and chronic hypertension, not only affects the mother, but may significantly threaten the health of the foetus.
“Complications of hypertension in pregnancy still contribute significantly to maternal morbidity and mortality and other challenges such as preterm births, stillbirths and neonatal deaths,” Dr Khemlani said.
This is why, she says, blood pressure monitoring is the most important and frequent screening test in the antenatal period and is undertaken by health care assistants, midwives, and obstetricians daily.
“It is the most common medical disorder in pregnancy, therefore blood pressure measurement must be done accurately and consistently throughout a woman’s pregnancy. The diagnosis of hypertension in pregnancy requires a systolic blood pressure (SBP) greater than or equal to 140 mmHg and/or a diastolic blood pressure greater than or equal to 90 mmHg over several readings,” Dr Khemlani advised.
She said that a woman who consistently struggles with an elevated blood pressure is at risk of developing preeclampsia, eclampsia, stroke, the need for labour induction (giving medicine to start labour to give birth), and placental abruption (the placenta separating from the wall of the uterus), as well as abnormalities in her body’s clotting function, kidney and liver functions.
“In the case of the foetus, chances are that he/she would be delivered preterm — this is birth before 37 weeks of pregnancy. There is a greater possibility of a low birth weight, since with high blood pressure this could cause a decreased blood supply to the placenta. In a case like this, what also happens is that the foetus would also be deprived of sufficient amounts of oxygen and nutrients,” Dr Khemlani explained.
She also pointed out that when the child is born prematurely this may lead to the child developing breathing problems, especially when the lungs aren’t fully developed. There is also an increased risk of infections and other complications.
To alleviate the possibility of these and other complications, Dr Khemlani said the key to ensuring blood pressure and pregnancy do not become dangerous or life-threatening in combination is to closely and properly manage the condition.
“An accurate measurement of blood pressure is crucial to the diagnosis and management of hypertensive disorders in pregnancy. If you do have high blood pressure in pregnancy, keep track of your blood pressure at home with a home blood pressure monitor. If your blood pressure is higher than usual or if you have symptoms of preeclampsia, then you must contact your doctor or get it checked out at the hospital,” Dr Khemlani instructed.
Symptoms of preeclampsia include
•A headache that will not go away
•Changes in vision, including blurry vision, seeing spots, or having changes in eyesight
•Pain in the upper stomach area
•Nausea or vomiting
•Swelling of the face or hands
•Sudden weight gain
•Trouble breathing or shortness of breath.
If the doctors realise that a woman is hypertensive then they may provide medications that will help with controlling the condition if they believe that she needs it. In addition to this, if she is overweight the doctor will recommend that she stays active by doing light, safe exercises such as walking; that she limits her salt intake and or avoid it altogether; and that she sticks to a healthy, balanced diet.
If her blood pressure is constantly high, even with extensive efforts to control it, then sometimes a Caesarean section is recommended as it increases the chances of a safe delivery for both mother and baby. Otherwise, if her blood pressure is being properly managed the doctor might recommend that the woman has labour induced a few days before her due date, as this may reduce the risk of complications.
