HYPERTENSION   IN   PREGNANCY

Hypertension is the most common medical problem seen in pregnancy, complicating many pregnancies. Hypertensive disorders are divided into 4 categories:

1.      Chronic Hypertension

2.      Preeclampsia – Eclampsia

3.      Preeclampsia Superimposed on Chronic Hypertension

4.      Transient Hypertension of Pregnancy

Chronic Hypertension – is defined as blood pressure over 140/90 mm Hg before persons become pregnant. When hypertension is seen early in pregnancy, less than 20 weeks, this usually represents chronic hypertension. Chronic hypertension is seen in 22% of women of childbearing age.

Preeclampsia is normally seen after 20 weeks of pregnancy. It occurs in 5% of all pregnancies, 10% of first pregnancies and 20% of pregnancies with a history of chronic hypertension.

Mortality / Morbidity

Hypertensive disorders are among the leading causes of death of pregnant women. Severe complications of hypertension in pregnancy include seizures, intracerebral hemorrhage, and swelling of the lungs and liver.  Complications of the babies of women with hypertension include placental abruption ( placenta separating from womb) , lack of proper growth of the fetus, premature labor, and intrauterine fetal death. Avoiding these severe complications is one of the main goals in treating hypertension in pregnancy.

RACE

Black women have higher rates of preeclampsia because there is a greater prevalence of chronic hypertension in black people in the United States. Chronic hypertension is present in 22.3% of black people, 4.6% of white people and 6.2% of Hispanic Americans.

AGE     

Preeclampsia is more common under 18 years old and over 35 years old.

Risk Factors of Chronic hypertension and Preeclampsia

·         Gestational age

o   Hypertension prior to 20 weeks of pregnancy is almost always due to chronic hypertension. Preeclampsia is rare prior to the 24 weeks.

o   New onset or worsening hypertension after 20 weeks  of pregnancy is more commonly seen in preeclampsia

o   The diagnosis of severe hypertension or preeclampsia in the first or early second trimester may be seen in molar pregnancies.

·         Personal risk factors

o   First pregnancy

o   Age younger than 18 years or older than 35 years

o   History of preeclampsia

o   African-American

o   Obesity ( BMI >35 )

o   Interpregnancy interval less than 2 years or more than 10 years

·         Maternal medical risk factors

o   Chronic hypertension

o   Preexisting diabetes ( Type 1 or Type 2 ), especially with microvacular disease

o   Kidney disease

o   Systemic lupus erythematosus

o   Obesity

o   Thrombophilia

·         Placental  / Fetal risk factors

o   Multiple gestations – twins, triplets, etc.

o   Hydrops fetalis

o   Molar pregnancies

Symptoms of Preeclampsia

·         Blurred vision and Visual spots – occurs  because of spasm of blood vessels in the brain

·         Headaches – often is a new onset described as throbbing, frontal aching similar to migraine headaches

·         Stomach pain – is due to swelling and inflammation of the liver. Pain may be of sudden onset, may be constant, and may be moderate to severe in intensity.

·         Lower leg swelling and edema is common

·         Rapid weight gain is a result of edema and swelling

Symptoms of Chronic Hypertension

·         Most women have no symptoms from chronic hypertension. Headaches, blurred visions, and other symptoms occur sometimes.

Causes of Chronic Hypertension

·         Chronic hypertension may be from Essential Hypertension

·         Secondary Hypertension – as a result of the following:

o   Kidney disease – Polycystic kidney disease

o   Kidney vascular disease – Renal artery stenosis

o   Endocrine disorders – Hyperthyroidism, hypothyroidism

o   Aortic vascular disease

o   Oral contraceptive use

Causes of Preeclampsia

            The exact cause is unknown.

Monitoring the Fetus during Preeclampsia and Chronic Hypertension

Fetal Monitoring

Close fetal monitoring is very important in women with preeclampsia and chronic hypertension. Poor blood flow through the placenta can cause problems with the growth and development of the baby. Fetal monitoring may be ordered twice weekly and sometimes daily.

Serial ultrasounds

Multiple ultrasounds may be ordered to follow the growth and development of the baby. Chronic hypertension and preeclampsia may be associated with fetal growth restriction.

Treatment of Chronic Hypertension and Preeclampsia

1.      Mild chronic hypertension – observation, antihypertensive medications

2.      Women with chronic hypertension in pregnancy should be monitored for the development of worsening hypertension and the development of superimposed preeclampsia.( 25% risk of developing this condition)

3.      Women with suspected or diagnosed preeclampsia should be hospitalized for close observation and a plan developed for delivery of the baby.

Fetal lungs are mature – delivery of the infant can proceed routinely.

Immature fetal lungs – if under 34 – 36 weeks the testing for fetal lung maturity should be performed along with fetal biophysical profiles and nonstress testing.  Delivery should occur if either the mother’s or the baby’s condition shows deterioration.

Plans are always to maximize the health and well being of the mother and the baby.   

   

                                             WEB  SITE   MENU

                                                           
             PREGNANCY TOPICS            PREMATURE       HYPERTENSION  IN         MEDICATIONS IN                   ECTOPIC   
                AND  RESOURCES                 LABOR              PREGNANCY                  PREGNANCY                      PREGNANCY

                                                             
                       LABOR                  NORMAL VAGINAL     CESAREAN DELIVERY            NEWBORN                 STERILIZATION
                  INSTRUCTIONS                 DELIVERY                                                  RESOURCES

                                              
                 GYNECOLOGICAL               SURGICAL            UTERINE FIBROIDS       ABDOMINAL PAIN          VAGINAL BLEEDING
                      SERVICES                  PROCEDURES                 

                                                      
                   GYNECOLOGICAL            ONE DAY                      OVARIAN  CYSTS        LEAKING BLADDER        MENOPAUSE
                        SURGERY                 HYSTERECTOMY

                                                                    
                SEXUALLY TRANSMITTED         VAGINAL                    PREGNANCY            ABNORMAL PAP             HPV INFECTION
                           DISEASES                DISCHARGES             PRECAUTIONS                 SMEARS            
                        
                                               
                    BOTOX THERAPY           BEAUTIFUL LIPS               LASER HAIR          SMARTLIPO LASER      CELLULITE REDUCTION
                                                                                            REMOVAL              BODY SCULPTING

    _______________________________________________________________________________________________________________________                     

                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
              and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal
              Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
                                                                                 Aesthetic Services