Ways to deal with hypertension in pregnancy

Currently, hypertensive disorders are one of the most important causes of maternal and neonatal morbidity and mortality.

It is becoming a growing public health problem of great importance as two patients are involved - Mother & the Fetus. Increasing maternal age has contributed to increasing magnitude of this problem. Management of hypertensive disorders in pregnancy is quite different from the garden variety of hypertension.

Pregnancy being limited to short duration of time mild/uncomplicated hypertension in pregnancy generally requires no treatment apart from close monitoring for both mother and unborn baby.

Life-style modifications like fluid and salt restriction are not recommended during pregnancy and the choice of drug is extremely important as some drugs are not safe during pregnancy.
Sustained BP elevation of 140/90 or greater is taken as hypertension during pregnancy.

There can be two situations; Hypertensive women who is pregnant or a pregnant woman who becomes hypertensive during pregnancy.

A woman who knows that she is hypertensive should plan pregnancy after optimum control of high blood pressure. It is important to record blood pressure for every pregnant woman during her first check up as well as during every subsequent check up as initially there may not be any associated symptoms. However, there are risks to both the mother and baby.

Hypertensive Diseases associated with Pregnancy are accordingly classified into different categories and can give rise to life threatening complications for the mother like Eclampsia or HELLP Syndrome.

Eclampsia is presence of convulsions and HELLP Syndrome is a distinct clinical entity with: Hemolysis, Elevated Liver enzymes, Low Platelets.

High blood pressure during pregnancy affects the growth of baby, can result in a birth of a small or premature baby who may not survive. In mother, there is a risk of kidney and liver failure, higher proportion of caesarean births, convulsions and stroke and even death.

Whenever hypertension is recorded during pregnancy, the aim of management is to monitor fetal and maternal well being and decide the optimum time of delivery with least possible trauma to the mother and fetus, with birth of an infant who subsequently thrives and a complete restoration of health to the mother.

Complete resolution of the signs and symptoms does not occur till after delivery. The ultimate cure is delivery, however, if it occurs early in pregnancy and maternal disease is mild, expectant management with close observation is possible. Periodic monitoring for fetal wellbeing is required till fetal maturity is attained. Women are also taught about the danger signs like occurrence of headache, visual disturbances, and photophobia or epigastric pain when they must report immediately. Sometimes a premature delivery is required to save mother and baby.

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