By Idesha S. Reese

Hypertensive disorders affecting pregnant women

Hypertension or high blood pressure is defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg – a systolic pressure over 140 or a diastolic pressure above 90. It affects six percent to 8 percent of all pregnancies. Hypertensive disorders during pregnancy are divided into four categories:  1) chronic hypertension, 2) preeclampsia/eclampsia, 3) preeclampsia superimposed on chronic hypertension and 4) gestational hypertension.

Chronic Hypertension – a long-term condition where your blood pressure is higher than normal

Preeclampsia – a condition involving blood pressure elevation after 20 weeks of gestation with proteinuria (excretion of protein in urine) or thrombocytopenia (platelet count <100,000), impaired liver function, development of renal deficiency, pulmonary edema (fluid accumulation in lungs) or new onset cerebral or visual disturbances

Superimposed preeclampsia on chronic hypertensionchronic hypertension in conjunction with preeclampsia

Gestational Hypertension – blood pressure elevation after 20 weeks gestation without proteinuria or any of the other symptoms of preeclampsia

Anyone with chronic hypertension should take steps to get their condition under control before becoming pregnant and discus with their doctor if their condition has had an adverse effect on their overall health. Being overweight can also contribute to hypertension, so being at a healthy weight before pregnancy is a good idea. Management of any existing medical condition is recommended prior to pregnancy to help ensure the best possible outcome for mother and baby.

How a hypertensive disorder can affect labor and delivery outcomes

With any hypertensive disorder, blood pressure of the expectant mother will be monitored and if deemed necessary ultrasound exams will be performed throughout the pregnancy to track the growth of the baby. Pregnancy and delivery complications from hypertension are directly related to the severity and duration of elevated blood pressure. That is why it is important to get the elevation in blood pressure, along with any other symptoms, under control.

Possible labor and delivery outcome complications from hypertensive disorders include but are not limited to:

Preeclampsia – also known as toxemia, is a condition usually beginning after the 20th week of pregnancy for which hypertension is a key factor

Eclampsia – symptoms of preeclampsia with new occurrence of seizures

Small for gestational age – also referred to as low birth weight, is fetal weight that is below the 10th percentile for gestational age of the infant

Preterm birth – birth before 37 week’s gestation

Placental abruption – when the placental separates from the walls of the uterus prior to delivery. This condition can deprive the baby of necessary oxygen and nutrients and cause heavy bleeding in the mother

Cesarean section – sometimes when a hypertensive disorder develops during pregnancy it may not be safe for the mother, the baby or both to undergo the stress of laboring and contractions; a cesarean section will then be performed to safely deliver the infant

Maternal death – increased likelihood of maternal death is associated with the symptoms and effects of preeclampsia

Stillbirth and Neonatal demise – preeclampsia and its complications cause greater risk for stillbirth and intrapartum complications from prolonged hypertension increase risk for neonatal demise

In most cases, many of the symptoms of preeclampsia start to go away after delivery. Elevated blood pressure caused by preeclampsia or gestational hypertension should start to return to normal levels once the baby and placenta have been delivered. Patients will continued to be monitored and treated postpartum for all related symptoms and should follow the doctor’s plan of care.

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