English
Ελληνικα
Hypertension during pregnancy occurs when a woman’s blood pressure rises above 140/90 mmHg or more, while, before the pregnancy it was normal. (100-120/65-80mmHg)
An increase in blood pressure suggests a higher risk of increased maternal and fetal morbidity. If blood pressure was high before the event of pregnancy it is possible that there is a chronic hypertensive condition, suggesting that the values will remain high for several weeks after birth. (1% of cases)
Pre-eclampsia is characterised by hypertension and albuminuria (over 300mg/24hr of albumin –plasma protein– present in the urine) and usually occurs after the 20th and mostly after the 30th week of pregnancy.
Clinical symptoms
- Lower limb oedema that does not subside after lying down. On the contrary, it might extend to the upper limbs and the face.
- Excessive weight gain due to fluid retention.
Even if the symptoms are not assessed by the pregnant woman herself, they must be considered when carrying out the regular monthly examinations.
Factors associated with a higher risk for presenting with pre-eclampsia:
- First pregnancy
- Age under 18 or over 35 years old
- Obesity
- Multiple pregnancy
- Personal or family history of preeclampsia
- Chronic pre-existing hypertension
- Gestational diabetes
- Chronic renal disease
- Over 10 years since last pregnancy
- Smoking
Therapy
Treatment of gestational hypertension and pre-eclampsia is for parturition to take place. Clearly, this is a problem if pre-eclampsia occurs early on during pregnancy.
In cases where hypertension and albuminuria is mild (i.e. one cross in the urine), the woman is advised to rest and monitor the condition regularly.
In cases of increasing values, we need to administer anti-hypertensive medication and the pregnant woman must remain in bed. Presumably, it is crucial that the woman’s condition is monitored very often by regular checks of her blood pressure, as well as blood and urine tests. If her systolic pressure is equal to or over 160mmHg, or her diastolic pressure is equal to or over 110mmHg, the condition requires hospitalisation and, depending on the severity, it might be required that the woman gives birth immediately.
Complications
a. From the mother
In severe hypertensive disorder:
- Placental abruption
- Haemolysis (rupture of erythrocyte contents into the plasma)
- Cerebral haemorrhage
- Liver and renal lesions
b. the embryo
Decrease in blood flow is associated with:
- Higher risk for premature birth
- Recessive fetal development
- Intrauterine death
Fortunately, nowadays, when there is appropriate monitoring during the entire duration of the pregnancy, it is extremely rare that pre-eclampsia will lead to eclampsia, a condition that is life-threatening to both the mother and the child. Additionally, except for the symptoms mentioned above, eclampsia includes convulsions.
