High Blood Pressure In Pregnancy

  • Kidney failure
  • Liver damage
  • Bleeding in the brain
  • Fluid on the lungs (called pulmonary edema)
  • Delay of the fetus' growth

Eclampsia

Eclampsia is another type of hypertension in pregnancy. It includes all the components of preeclampsia -- high blood pressure, abnormal swelling, and protein in the urine -- with the additional symptom of seizures. The seizures associated with eclampsia may be caused by tiny spots of bleeding in the head called petechial hemorrhages. These hemorrhages occur because the high blood pressure ruptures tiny blood vessels in the brain. Two percent of preeclamptic patients will progress to eclampsia.

An eclamptic patient is very ill, and needs medications for high blood pressure as well as for seizures. Patients with this disease are admitted to the hospital, usually to the intensive care unit. The mortality (death) rate of eclampsia is 8% to 36% for the patient and 13% to 30% for the fetus. The major cause of death for the patient is due to what are called intracranial hemorrhages -- large areas of bleeding in the head, not small, petechial, ones.

In both eclampsia and preeclampsia, there are a number of blood tests that the doctor will order to monitor the kidney, liver and other organs.

HELLP Syndrome

HELLP Syndrome is yet another type of hypertensive disorder that occurs in pregnancy. HELLP stands for:

Hemolysis (blood breakdown)
Elevated Liver enzymes (indicating liver problems)
Low Platelets (cells that help the blood clot normally)

HELLP patients are very sick and are managed right away in the hospital. The complications are similar to those of preeclampsia and eclampsia, including pulmonary edema, bleeding in the brain, liver and kidney disease, and fetal abnormalities and death.

Treatment

The goal of treatment for hypertensive disorders of pregnancy includes the prevention of maternal complications, the birth and development of a healthy baby, and the mother's future good health.

Ultimately, the high blood pressure of severe preeclampisa or eclampsia usually resolves upon delivery of the baby, and therefore delivery is considered definitive treatment for severe hypertension in late pregnancy.

Women with preexisting high blood pressure can be put on blood pressure-lowering medicines during pregnancy in an effort to prevent adverse consequences. As long as women with chronic hypertension are followed closely and demonstrate no complications they can maintain normal lifestyles. However, a woman whose blood pressures are consistently high or one who shows any of the signs described earlier -- kidney, liver, lung, or blood clotting problems -- needs to be managed more urgently in the hospital.

These patients and others with severe hypertensive disorders in pregnancy will need blood pressure-lowering drugs that are administered directly into the blood through a catheter (tube) in the vein (intravenous). Medications called hydralazine or labetalol are usually used in these circumstances. If there is evidence of seizures or even the potential of seizures, the patient will be put on magnesium . a drug that prevents eclamptic seizures. Depending on the severity of the disease and the maturity of the pregnancy, a pregnant woman may have to be induced into labor early or may need to have an urgent cesarean section to prevent permanent damage to her or the fetus. Patients respond much better if they get aggressive anti-seizure therapy and delivery, if appropriate.

Prevention

There are many risk factors for the development of hypertension in pregnancy. Some of these include: