What to know about hypertension in pregnancy

By Josephine Idiovwan

Hypertension in pregnancy is a leading cause of maternal and fetal morbidity and mortality. Hypertension in pregnancy is the onset of elevated blood pressure equal to 140mm of mercury and diastolic blood pressure equal to or greater than 90 mm of mercury recorded on two occasions after 20 weeks of pregnancy, i.e., when a pregnant woman has elevated blood pressure for the first time in pregnancy equal to more than 140/90 mm of mercury after 20 weeks of pregnancy.

It becomes a case of chronic hypertension If it occurs before 20th weeks of pregnancy. On the occasion that it happens after, it is called gestational hypertension, otherwise know as pregnancy induced hypertension.

Chronic hypertension develops before 20th week of pregnancy or exists before gestation. It can only be classified supposing that the blood pressure remains high after 12th week of delivery while pure gestational hypertension ends by 12 week of post delivery. It is expected that the Blood pressure returns to normal after delivery.

The National institute of health claimed that it is estimated that 5-10% of pregnancies are complicated by hypertensive disorders in Nigeria. Nevertheless, the actual incidence and prevalence of hypertension related disease in pregnancy might be grossly underestimated, especially in rural areas due to underreporting by healthcare workers and poor utilization/ unavailability of healthcare facilities.

A Senior Registrar in the department Gynecology, Federal Medical Center, Asaba, Dr Ossai Chukwuma, disclosed exclusively to Nigeria Wave that hypertension in pregnancy is not a preventable condition, but early diagnosis and proper intervention can mitigate severity and prevent complications.
Categories of

Hypertension in pregnancy are;
1.Gestational Hypertension: High blood pressure without protein in urine.
2. Preeclampsia: Not just having high blood pressure in pregnancy but also having proteinuria.
3. Eclampsia: It occurs when woman who already has preeclampsia develops seizures or convulsion. It carries the worst prognosis.

Factors that can put a woman at risk of developing pregnancy induced hypertension are;

• Age- women above 35 years
• A woman who is pregnant for the first time ( Primigravida) .
• High Basal Metabolic Index of more 30kg per meter square (Obesity)
• Women with pre existing Hypertension (Chronic hypertension)
• A woman whose last delivery is more than 10 years, i.e., long inter pregnancy interval.
• Family history of hypertension.
• A woman who has a new consort ( new partner)
• A woman who has a history of Gestational Hypertension in previous pregnancy has a very high risk of reoccurrence.

Symptoms
A pregnant woman should seek immediate care if she notices any of the following symptoms;
• Severe Headache.
• Progressive leg swelling.
• Visual disturbance.
• Pains in the upper abdomen.
• Puffiness of the face.
• Convulsion.
• Difficulty in breathing
• When or during a blood pressure check , above 140/90 mm mercury.
Complications of High blood pressure in an expectant Mother can result in Miscarriage, Acute kidney injury, Fluid in the lungs and surgical intervention. The fetus may be faced with growth restriction, Placenta separating before onset of labor or death.

Administration of drugs to control the blood pressure together with maternal and fetal surveillance is key in the management of hypertension in pregnancy.

In Fetal surveillance, scan and biophysical profile are carried out to monitor the wellbeing of the fetus. This is to forestall incidence of fetal growth restriction while ensuring its healthiness.

Maternal surveillance involves measurement of the blood pressure to ensure that it is within normal as well as regular checking of urine to detect protein. Because the presence of protein changes the treatment.

In a nutshell, once hypertension occurs in pregnancy, the goal is to control the blood pressure, ensure maternal and fetal surveillance till fetus is mature and then deliver the baby, as delivery of the fetus and placenta is the definitive treatment. However, factors such as disease severity may warrant early delivery before fetal maturity in order to save the live of the affected woman.