Some weeks ago, we had an informative session on hypertension in pregnancy with our community on Instagram, the guest speaker was Adedoyin Ade-onojobi, an obstetrician and gynecologist practicing in Abeokuta, Nigeria. This article is an extract from the discussion.
Hypertension in pregnancy is one of the diseases that cause maternal mortality. Pre-eclampsia is common, affecting between two and eight in 100 women during pregnancy. It is usually mild and normally has very little effect on pregnancy. However, it is important to know if you have the condition because, in a small number of cases, it can develop into a more serious illness. Severe pre-eclampsia can be life-threatening for both mother and baby.
What is Hypertension?
Hypertension is when the blood pressure is too high, meaning when the blood pressure is measured, the reading is or above 140/90mmHg. This reading has to be taken twice giving about 6 hours apart in between the readings.
What is Pre-eclampsia?
Pre-eclampsia is a condition that typically occurs after 20 weeks of pregnancy. It is a combination of:
• raised blood pressure (hypertension)
• protein in your urine (proteinuria).
Pre-eclampsia may or may not give one any symptom at home except it was diagnosed in one of the routine check up during antenatal clinic, that is why, it is essential for pregnancy women to attend their antenatal clinic frequently.
What are the symptoms of Pre-eclampsia?
The symptoms of severe pre-eclampsia include:
• severe headache that doesn’t go away with simple painkillers
• problems with vision, such as blurring or flashing before the eyes
• severe pain just below the ribs
• heartburn that doesn’t go away with antacids
• rapidly increasing swelling of the face, hands or feet
• feeling very unwell
Why do I need to know if I have pre-eclampsia?
Around one in 200 women (0.5%) develop severe pre-eclampsia during pregnancy. The symptoms tend to
occur later on in pregnancy but can also occur for the first time only after birth..The symptoms mentioned above are serious and you should seek medical help immediately. If in doubt, contact the maternity unit at your local hospital.
In severe pre-eclampsia, other organs, such as the liver or kidneys, can sometimes become affected and
there can be problems with blood clotting. Severe pre-eclampsia may progress to convulsions or seizures before or just after the baby’s birth. These seizures are called eclamptic fits and are rare, occurring in only one in 4000 pregnancies.
How may pre-eclampsia affect my baby?
Pre-eclampsia affects the development of the placenta. Placenta is responsible for the nutrition, respiration, excretion and general well being of the baby in the womb, suffice it to say that anything that affects the placenta can affect the baby and can prevent the baby from growing up as it should. There may also be less amniotic fluid around your baby in the womb.
If the placenta is severely affected, your baby may become very unwell. In some cases, the baby may even die in the womb. However, early detection, attendance of antenatal clinic and management of the condition can help save the life of the baby and mother.
Who is at risk of pre-eclampsia and can it be prevented?
The exact cause of pre-eclampsia is still unknown. However, there are certain risk factors that predisposes women to this condition.
Pre-eclampsia can occur in any pregnancy but you are at higher risk if:
• your blood pressure was high before you became pregnant
• your blood pressure was high in a previous pregnancy
• you have a medical problem such as kidney problems or diabetes, obesity or a condition that affects the
immune system, such as lupus.
If any of these apply to you, you should be advised to take low-dose aspirin (75 mg) once a day from
12 weeks of pregnancy, to reduce your risk.
The importance of other factors is less clear-cut, but you are more likely to develop pre-eclampsia if more
than one of the following applies:
• this is your first pregnancy
• you are aged 40 or over
• your last pregnancy was more than 10 years ago
• you are very overweight – a BMI (body mass index) of 35 or more
• your mother or sister had pre-eclampsia during pregnancy
• you are carrying more than one baby.
If you have more than one of these risk factors, you may also be advised to take low-dose aspirin once a
day from 12 weeks of pregnancy.
other risk factors are for
• transgender males who decided to have children and eventually got pregnant.
How is pre-eclampsia monitored?
If you are diagnosed with pre-eclampsia, you should attend hospital for assessment.
While you are at the hospital, your blood pressure will be measured regularly and you may be offered
medication to help lower it. Your urine will be tested to measure the amount of protein it contains and
you will also have blood tests done. Probably, an eye check with the ophthalmologist. Your baby’s heart rate will be monitored and you may have ultrasound scans to measure your baby’s growth and well being.
What are the birth options for those diagnosed of Pre-eclampsia?
There is a myth that all women who have pre-elampsia must have a caesarean section birth,this is not true. You will continue to be monitored closely to check that you can safely carry on with your pregnancy. You are likely to be advised to have your baby at about 37 weeks of pregnancy, or earlier if there are concerns about you or your baby. This may mean you will need to have labour induced or, if you are having a caesarean section, to have it earlier than planned.
However, women who present themselves late to the antenatal clinic or when they are having severe symptoms may likely have an emergency caesarean section to save the life of the mother and child.
I hope you enjoyed reading this article, please check for the concluding section of this article in the next article.