Hypertension in pregnancy is a very common medical disorder with a lot of maternal, fetal and neonatal mortality and morbidity. It complicates around 7-15% of all pregnancies.

What do you understand by hypertension in pregnancy?

Defined as blood pressure of140/90 mm Hg or higher after 20 weeks of gestation. It also causes excretion of significant protein in urine.

The risk factors of hypertension in pregnancy:

• Obesity
• Sedentary lifestyle
• Smoking
• Previous pregnancy with high BP
• First pregnancy
• Family history of high BP
• Multiple pregnancy
• Age>40 years
• ART( IVF )

Types of hypertension in pregnancy:

1. Gestational hypertension- New onset hypertension after 20 weeks of pregnancy without protein excretion
2. Pre-eclampsia- Hypertension associated with proteinuria after20 weeks of gestation.
3. Eclampsia- Very serious complication of pregnancy. When patient develops convulsions
4. Chronic hypertension- Preexisting high BP or rise of BP before 20 weeks of pregnancy

BP measurement – BP should be measured in sitting position with arm at the level of heart with a proper cuff size

Symptoms of hypertension in pregnancy:

• Headache
• Visual disturbances
• Severe pain in abdomen, especially epigastric area
• Vomiting
• Swelling of face, hands and feet

Antenatal education about awareness of symptoms is necessary so that adequate medical attention is taken when any alarming symptom develops.

Prevention of hypertension in pregnancy:

Low dose aspirin is recommended in high risk cases from 12 weeks gestation. Hypertension in past pregnancy, chronic renal disease, autoimmune disease, diabetes, chronic hypertension, BMI>35, age>40, are a few high risk factors.

Calcium supplementation also reduces the risk of high BP in pregnancy

Management of hypertension in pregnancy:

• If the patient is already hypertensive, then certain medicines such as ACE inhibitors and angiotensin receptor blockers should be stopped and safe drugs started as they cause risk of congenital anomalies in baby.
• Management depends on the severity of BP, gestational age of fetus. It consists of limitation of activities, close monitoring, bed rest and delivery when indicated. Intensive monitoring of both mother and baby is done. Anti hypertensive medicines are given. Visits to hospital are more frequent. Blood tests for liver, kidney function and urinary protein are done. USG with Doppler studies is more frequent.
• Steroids to help lung maturation of baby are given to mother in injection form.
• Magnesium sulphate is a very useful drug given with careful monitoring to reduce the risk of convulsions. It is anticonvulsant given in eclampsia via drip at tertiary care centre.
• Delivery of baby is the only way to treat pre eclampsia, so once the baby is mature enough, delivery is conducted.
• Post delivery usually the mother recovers slowly ( by 6weeks) but monitoring of BP is important. Baby might need care in NICU

Complications due to hypertension in pregnancy:

• Mother- Eclampsia, liver, kidney, lung or multiple organ failure. Blood clotting defect, stroke, abruptio placenta, HEELP syndrome
• Baby- Hypoxia, prematurity, IUGR, still birth

Prognosis of hypertension in pregnancy :

Major cause of maternal deaths all over the world. Risk is very high in severe hypertension. There is also a risk of cardiovascular disease later in life, so lifestyle modification, BP control, exercise, dietary modification, weight management, no smoking is necessary to prevent complications in future.