Hypertension is the most common health problem in pregnant women, and is present in about 10 to 15% of pregnant women. A pregnant woman may have hypertension in pregnancy is because it was already hypertensive before becoming pregnant or because developed hypertension during your pregnancy.
When the frame of hypertension arises only after the 20th week of pregnancy in a woman who was previously not hypertensive, we we classify it as gestational hypertension. Once it emerges, the gestational hypertension tend to remain for the rest of the pregnancy, but tends to disappear within the first 12 weeks after delivery.
In this article we will discuss hypertension in pregnancy, explaining the differences between chronic hypertension in pregnant, gestational hypertension and preeclampsia. Let’s talk also about the treatment of hypertension in pregnant women and the risks to the baby.
Types Of Hypertension In Pregnancy
The pregnant woman may be affected by 4 different forms of hypertension during pregnancy, namely:
1- preexisting chronic Hypertension – individuals with blood pressure values above 140/90 often mmHg are considered hypertensive. In pregnancy, is considered a preexisting hypertension hypertension whole that already existed before the woman getting pregnant. As expected, women who are high blood pressure before pregnancy, will continue to be on high blood pressure throughout pregnancy.
Hypertension is also considered preexisting if she is identified before the 20th week of pregnancy. When his wife discovers she is hypertensive before the 20th week is because she was already hypertensive before pregnancy and simply didn’t know about maternity jeans of Internetsailors.
2- Pre-eclampsia -is the emergence of hypertension after the 20th week of pregnancy associated with protein loss in the urine, which is called proteinuria (read: PROTEINURIA and FOAMY URINE). A high blood pressure that occurs after the 20th week of pregnancy and is associated with kidney problem, the liver, central nervous system or drop in the number of platelets can also be pre-eclampsia.
In this article we will address preeclampsia. To learn more about this complication of pregnancy, browse to the following article: ECLAMPSIA | PREECLAMPSIA | Symptoms and treatment.
3- Pre-eclampsia overlaid to chronic hypertension – is preeclampsia occurring in previously hypertensive women.
4- gestational Hypertension – gestational hypertension that is considered high blood pressure that arises only after the 20th week of gestation and which shows no loss of protein in the urine, or any other suggestive manifestation of preeclampsia.
In this article let’s stick to gestational hypertension, which is a form of hypertension induced by pregnancy.
What Is Gestational Hypertension
As we just explain, gestational hypertension is a form of hypertension that occurs after the 20th week of pregnancy in women previously healthy and which does not present any sign of preeclampsia.
Despite this form of hypertension could appear from the 20th week of gestation, the vast majority of cases only shows up right at the very end of pregnancy, already in the third quarter.
Gestational hypertension is a unique pregnancy hypertension, disappearing in most cases spontaneously within 1 or 2 weeks after delivery. Up to 12 weeks postpartum hypertension does not disappear, the patient becomes regarded as the bearer of chronic hypertension. Not spontaneous resolution of hypertension occurs in about 15% of cases.
Gestational hypertension is a risk factor for the future development of hypertension. Even women who have blood pressure normalization after delivery, in the long run, having 4 times greater risk of developing chronic hypertension (read: HIGH BLOOD PRESSURE).
As mentioned in the introduction to the article, about 10 to 15% of pregnant women end up developing gestational hypertension. Some clinical characteristics increase the risk of developing high blood pressure during pregnancy. They are:
Pregnant women with overweight (read: WEIGHT GAIN in PREGNANCY).
Pregnant women of black ethnicity.
Pregnant women with more than 35 years.
Family or personal history of preeclampsia.
Pregnancy during adolescence.
Gestational hypertension is a less severe problem that preeclampsia, but she still can bring harm to the pregnant woman and the baby. Pregnant women who have a higher risk of changes in the flow of blood in the placenta, fetal growth restriction, Placental Abruption and preterm labor. Complications are more common in women with gestational hypertension severe, characterized by persistently blood pressure levels above 160/110 mmHg.
Risk Of Preeclampsia
Among pregnant women who initially presented with criteria for gestational hypertension, about 1/3 will eventually evolve to have criteria of preeclampsia, which is a form of hypertension much more serious.Therefore, all pregnant women with gestational hypertension must be carefully observed during pregnancy, with frequent searches through the urine proteinuria (read: URINALYSIS).
We don’t know yet if the gestational hypertension and preeclampsia are two distinct disease or just different clinical spectra of the same disease.
Some clinical characteristics at the time of the submission of gestational hypertension predict an increased risk of progression to pre-eclampsia. They are:
Onset of hypertension before the 34th week of pregnancy.
Changes in Uterine artery flow detectable via ultrasound with doppler.
High levels of uric acid.
Treatment Of Hypertension In Pregnancy
Many of the drugs usually used to treat hypertension are contraindicados in pregnancy, which makes the control of blood pressure in pregnancy a task more complicated. In addition, the safety margin is smaller, since a reduction beyond the desired blood pressure can cause severe reduction of blood flow to the placenta, bringing harm to the fetus. Therefore, except in serious cases, the obstetricians usually choose not to treat with drugs high blood pressure during pregnancy.
The treatment of pregnant hypertensive depends on the degree of hypertension.
the) blood pressure less than 160/110 mmHg – non-severe pregnancy hypertension.
Most women with gestational hypertension that presents blood pressure levels below 160 mmHg/110 mmHg can be accompanied with weekly or bi-weekly queries to measure blood pressure and urine protein excretion.Pregnant women should also be targeted to assess your daily blood pressure at home.
The goal of the consultations so frequent is to identify early any sign of progression to pre-eclampsia. Patients should be informed about the signs and symptoms of gravity, such as headache, Visual changes, abdominal pain, decreased fetal movements or vaginal bleeding.
On non-severe gestational hypertension, the pregnant woman does not need to be on bed rest, but indicated a reduction in day-to-day activities. Physical exercise should be avoided and if the professional work is very stressful or strenuous, the ideal is to get away.
Scientific studies show us that the treatment of blood pressure in gestational hypertension non-serious does not bring benefits to the mother or the fetus, and may also cause undesirable side effects. Therefore, if the woman does not have blood pressure values above 160/110 mmHg, there’s no need to start any antihypertensive drug.
Delivery in gestational hypertension is usually performed between 37th and 39th week of pregnancy, according to the clinical situation of the pregnant woman and the fetus.
b)blood pressure greater than 160/110 mmHg – severe pregnancy hypertension.
Women who develop severe gestational hypertension have rates of complications of pre-eclampsia, and therefore should be treated similarly.
Severe gestational hypertension need to be treated with antihypertensive medications and delivery is usually performed between 34 and 36 weeks of pregnancy.
If the pregnant woman has less than 34 weeks, hospitalization for control and monitoring of the fetus and blood pressure is usually indicated. The goal in these cases is to try to take the pregnancy safely until at least 34 weeks.
The most commonly used drugs for blood pressure control are methyldopa, Hydralazine, nifedipine and Labetalol.
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