1. Hypertension and Preeclampsia
High blood
pressure, or hypertension, occurs when there is a consistently
higher-than-normal pressure or force of blood against the walls of your
arteries. It is normal for a pregnant woman’s blood pressure to drop
during her first and second trimesters. By the third trimester, however,
blood pressure usually returns to normal levels. However, in about 8 to
10 percent of pregnant women, instead of returning to normal, blood
pressure begins to increase to abnormally high levels in the second or
third trimester. This condition is known as pregnancy-induced
hypertension. Women who enter pregnancy with high blood pressure are
said to have chronic high blood pressure.
Mild hypertension during pregnancy
is not necessarily dangerous by itself, but it can be a sign of a more
serious condition called preeclampsia. High blood pressure puts a woman
at higher risk for preeclampsia.
Preeclampsia, which is also
sometimes called toxemia, is a disorder that only occurs during
pregnancy and can also occur during the period right after delivery. It
can greatly affect both the mother and unborn baby. Preeclampsia occurs
in about 5 to 8 percent of all pregnancies, and very severe cases of
preeclampsia can be life threatening. Typically, this condition develops
after the twentieth week of pregnancy, in the late second trimester and
into the third trimester, although for some it can develop earlier.
High blood pressure that develops before the twentieth week is usually a
sign of chronic high blood pressure or pregnancy-induced hypertension,
but it can also be an early sign of preeclampsia.
Untreated, preeclampsia can cause
high blood pressure, problems with blood supply to the placenta and
fetus, problems to the liver, kidney, and brain function of the mother
as well as the risk of stroke, seizures, and fluid on the lungs. Because
the condition affects the blood flow to the placenta and fetus, the
baby has a harder time getting the oxygen and nourishment it needs.
These babies are often smaller in size and tend to be born prematurely.
Women who develop severe preeclampsia can develop life-threatening
seizures called eclampsia.
Both chronic high blood pressure
and preeclampsia can develop gradually or suddenly and can be mild or
severe. If you develop high blood pressure during your pregnancy, you
will be monitored closely for signs of preeclampsia throughout your
pregnancy.
Diagnosing
There is no single test that can
diagnose preeclampsia. Your blood pressure is checked at each and every
doctor’s visit, which makes regular prenatal care even more essential
for all pregnant women. A sudden rise in your blood pressure can be an
early sign of preeclampsia. A urine test is also used to check for
protein in the urine, which can be another warning sign.
High blood pressure does not
necessarily mean you have preeclampsia. In addition to high blood
pressure, women with preeclampsia tend to have excessive swelling or
edema in the hands and face as well as protein in the urine. Many women
who experience high blood pressure during pregnancy without these other
symptoms don’t have preeclampsia.
Causes
The causes of high blood pressure
and/or preeclampsia are not actually known. Preeclampsia seems to have a
possible genetic link because women with a family history of the
condition have a higher risk than those who do not. Preeclampsia is more
common in first pregnancies as well. The risk of preeclampsia is much
higher in women with any of the following conditions or characteristics:
• Carrying more than one baby
• Teenage mother
• History of preeclampsia
• Obesity
• Polycystic ovarian syndrome
• Over age forty
Other factors that put women at a
higher risk include high blood pressure, diabetes, an autoimmune disease
such as lupus, or a kidney disorder before pregnancy.
Signs and Symptoms
The signs and symptoms of
pregnancy-induced hypertension and pre-eclampsia can be classified into
three categories: mild, moderate, and severe. The signs and symptoms of
high blood pressure and preeclampsia are often silent if the condition
is mild. Suspicions usually surface unexpectedly during routine blood
pressure checks and urine tests. Moderate preeclampsia can bring with it
signs of high blood pressure, protein in the urine, rapid weight gain
(more than 1 pound a day), problems with blood clotting, and excessive
swelling of the hands and face. Severe preeclampsia can show signs of
brain or certain body organ trouble, such as severe headaches,
dizziness, vision problems, breathing problems, abdominal pain, and
decreased urination. Very rarely, preeclampsia can progress to a
condition called eclampsia that can be life-threatening, especially if
the preeclampsia is not treated properly and early enough.
Signs of edema or swelling alone do
not necessarily mean that you have preeclampsia. Edema can be a very
normal symptom of pregnancy. It is considered more serious when it does
not go away after putting your feet up, if it is very obvious in your
face and hands, and if it causes a rapid weight gain of more than 5
pounds per week or more than 1 pound per day.
Treatment
If you are diagnosed with
preeclampsia, treatment depends on the severity of your condition, the
health of your baby, and the stage of your pregnancy. It is recommend
that you lie on your left side as much as possible to help take
unnecessary pressure off the blood vessels. This allows for greater
blood flow.
If you develop mild preeclampsia
close to your due date, and your cervix is showing signs of thinning and
dilation, your doctor may want to induce labor. This will help prevent
any complications that could develop if the pre-eclampsia were to worsen
before your delivery.
If your cervix is not showing signs
that it is ready for induction, your doctor will probably monitor you
and your baby very closely until the time is right to induce or until
labor begins on its own. If you develop preeclampsia before the
thirty-seventh week of pregnancy, your doctor will most likely recommend
bed rest, either at home or in the hospital, depending on your
situation. For some, depending on the severity of the blood pressure,
blood pressure medication will be prescribed until the pressure
stabilizes or until delivery. With severe preeclampsia, a medication to
prevent eclampsia (a very serious condition involving seizures) may also
be prescribed.
Even though cutting salt from your
diet is usually a good way to help control high blood pressure, it is
not a good idea to cut the salt in your diet if you have high blood
pressure during pregnancy. It is essential that your body gets a normal
intake of salt during pregnancy. If you have questions about salt intake
with regard to your blood pressure, ask your doctor and a registered
dietitian for advice and information.
In general, if you develop
preeclampsia, delivery of your baby is the best way to protect you both
from complications. If this isn’t possible because it is too early in
the pregnancy, steps will be taken to manage the preeclampsia until your
baby can be safely delivered and survive outside of the womb.
At this
point, early diagnosis through simple blood pressure checks and other
routine tests at regular prenatal visits is the best way to detect
pregnancy-induced hypertension or preeclampsia. The earlier the
condition is detected, the earlier treatment and monitoring can begin
and the better chance you and your baby have for a healthy pregnancy and
healthy delivery.
2. HELLP Syndrome
About 4 to 12 percent of women who
develop severe preeclampsia develop a condition called HELLP syndrome,
usually in the last trimester. HELLP stands for the following:
• Hemolysis (the breaking down of red blood cells)
• Elevated Liver enzymes
• Low platelet count
Symptoms
of HELLP include vomiting, nausea, headache, and pain in the right upper
abdominal area due to problems with liver bloating. It is possible to
experience this syndrome before the classic symptoms of pre-eclampsia
even begin to manifest. Many symptoms of the HELLP syndrome are easily
mistaken for the flu or for possible gallbladder problems. Some women
develop HELLP syndrome without ever having preeclampsia, within two to
seven days after delivery. Treatment for HELLP includes medication to
help control blood pressure and medications to help prevent seizures
and, occasionally, platelet transfusions. Basically, the only real cure
for HELLP is delivery of the baby. Most women who develop HELLP end up
delivering their babies early to prevent any serious complications. It
is important to listen to your body, and if you have any of these
symptoms, contact your doctor immediately.
