Hypertension in pregnancy
Around 6% of pregnant women develop hypertension during pregnancy. Hypertension in pregnancy (gestational hypertension) is defined as a condition wherein a pregnant woman with normal blood pressure, develops high blood pressure of over 140/90 mmHg after 20 weeks of gestation and has no proteinuria (excess protein in urine). Women of age younger than 20 or older than 40, women having kidney diseases or diabetes are more prone to acquire hypertension in pregnancy.
Gestational hypertension which is accompanied with protein in urine (protein) is referred to as preeclampsia. Eclampsia is a severe form of preeclampsia in which the woman has seizures. Eclampsia it usually occurs near the end of pregnancy. If left untreated, eclampsia would have detrimental health effects on the mother and the fetus. Nearly 5.4% of pregnant women in India have known to have preeclampsia and 0.6% have been diagnosed with eclampsia
HELLP (Hemolysis, elevated liver enzymes, low platelet count) syndrome is a variant of eclampsia and is a life- threatening pregnancy complication. Women who develop HELLP syndrome may get critically ill or die because of liver rupture or stroke.
Signs and symptoms:
Symptoms of gestational hypertension are different for every woman. Some women with gestational hypertension could be completely asymptomatic. However, if you have the following symptoms consult your doctor right away:
Severe headaches
Dizziness
Excessive swelling of the extremities
Blurred vision
Excessive nausea or vomiting
Decreased or no urination
Sudden weight gain
Right upper abdominal pain
Risks to the mother and baby due to gestational hypertension
High blood pressure decreases the blood flow to the placenta. This causes decreased oxygen and food supply to the fetus. This would eventually result in low birth weight and other fetal abnormalities. Preeclampsia can cause placental abruption in which the placenta separates from the walls of the uterus before delivery. This may cause severe bleeding and have serious health consequences on the mother and the baby. High blood pressure also increases the risk of stroke and cardiovascular diseases in the mother.
Diagnosis of gestational hypertension and preeclampsia
1. Blood pressure: Normal blood pressure is 120/80 mmHg where 120mmHg indicates the systolic pressure and 80mmHg indicates the diastolic pressure.
Refer the following table to interpret the ranges of blood pressure during pregnancy:
Category
Systolic blood pressure
Diastolic blood pressure
Normal
120 mmHg
80 mmHg
Hypertension in pregnancy
Greater than and equal to 140 mmHg
Greater than and equal to 90mmHg
Preeclampsia
160 mmHg
110 mmHg
Eclampsia
Greater than 160 mmHg
Greater than 110mmHg
2. Urine test to assess protein levels:
A 12-hour or 24-hour urine sample needs be collected to determine the amount of protein being excreted. Presence of increased levels of protein in the urine is indicative of preeclampsia. Refer the following table to interpret the results of your urine test:
Category
Protein in urine
Normal
Less than 80 mg per 24 hours collection
Preeclampsia
80-300 mg per 24 hours collection
Eclampsia
Greater than and equal to 300 mg per 24 hours collection
3. Kidney function tests: Preeclampsia is associated with decreased kidney function. Kidney function can be assessed by using the following the tests:
Uric acid test: Kidneys filter out the uric acid from the body. Decreased kidney function would cause accumulation of uric acid in the blood.
Serum creatinine: Creatinine is waste product excreted via urine. Decreased kidney function would cause increase in creatinine levels in blood.
Blood urea nitrogen (BUN) test: Urea is a waste product produced by the liver that is excreted by the kidneys. Increase in blood urea nitrogen concentration indicate kidney dysfunction.
Parameter
Normal values
Interpretation
Uric acid
2.4-6.0 mg/dL
Increased level in blood is an indication of decreased kidney function.
Creatinine
0.8 mg/dL
Increased level in blood is an indication of reduced kidney function.
Blood urea nitrogen
7-20 mg/dL
Increased level in blood is an indication of decreased kidney function.
Other blood tests: Your blood sample may be collected to assess the following:
Hematocrit value: It refers to the percentage of red blood cells in the body. The Hematocrit value gradually decreases during pregnancy. Any increase in the hematocrit value during pregnancy is suggestive of preeclampsia.
Platelet count: Reduced platelet count is indicative of HELLP syndrome
Partial thromboplastin time (PTT): This test is the measures the time taken by the blood to clot. In preeclampsia, there is an increase in the Partial thromboplastin time.
Parameter
Normal levels
Interpretation
Hemoglobin count (Hematocrit value)
12-16gm/dL
Increase in the hematocrit value indicates preeclampsia.
Platelet count
150-400 million per ml of blood
Decrease in platelet count indicates HELLP syndrome.
Partial thromboplastin time (Blood clotting time)
25 to 35 seconds
Increased blood clotting time indicates preeclampsia.
Monitoring of fetus:
Gestational hypertension may have serious health effects on the fetus. Fetal monitoring methods would enable you to assess the health of the fetus. Various methods employed in fetal monitoring include:
Fetal movement counting: In this process, the fetal movements and kicks are tracked. Any change in the number or frequency of the fetal movements indicates that the fetus is under stress.
Doppler flow studies: Hypertension may cause decreased blood flow through uterine blood vessels and placenta. This test uses sound waves to measure blood flow through a blood vessel.
Management of hypertension in pregnancy
Early diagnosis may prevent complications of gestational hypertension such as preeclampsia, eclampsia and HELLP syndrome.
Medications: Medications may help to lower your blood pressure. However, need of medications such as hydralazine may be necessary only if the patient has developed severe blood pressure. Magnesium sulphate is administered to relieve seizures associated with eclampsia.
Bed rest: Your doctor may ask you to get hospitalised or take rest at home. Lying on the left side is beneficial for patients with preeclampsia.
Salt intake: Your diet plan should include foods with less salt as salt increases blood pressure.
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References
Gestational hypertension. http://www.stanfordchildrens.org/en/topic/default?id=gestational-hypertension-90-P02484. Accessed on 4/10/2017.
Blood tests for preeclampsia. https://www.webmd.com/baby/tc/blood-tests-for-preeclampsia-topic-overview. Accessed on 4/10/2017.
Preeclampsia. https://labtestsonline.org/understanding/conditions/pre-eclampsia/start/2. Accessed on 5/10/2017.
