hypertension in pregnancy
Fatima Ali Abubakar
federal university of health sciences azare, bauchi state.(FUHSAMSA)
08146657360
[email protected]
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contents
● introduction
● epidemiology of hypertensive disorders in pregnancy (HDP)
● classification of hypertension in pregnancy
● clinical features
● complications of hypertension in pregnancy
● investigations
● treatments
● conclusions
● references
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introduction
What is hypertension ?
According to WHO, hypertension, also known as high or raised blood pressure is a
condition in which the blood vessels have persistently raised pressure. blood pressure is
created by force of blood pushing against the walls of blood vessels as it is pumped by
the heart .the higher the pressure the harder the heart has to pump.
hypertension is a serious medical condition and can increase the risk of heart, brain,
kidney, and other diseases. it's a major causes of premature death worldwide, with
upwards of 1 in 4 men and 1 in 5 women, over a billion of people having the
condition.
hypertension in pregnancy
hypertension in pregnancy also known as gestational hypertension is confirmed when a
pregnant woman has a systolic blood pressure greater than or equal to 140mmHg and/or
diastolic blood pressure greater than or equal to 90mmHg on two or more occasion at
least four hours apart.
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epidemiology of hypertensive disorders (HDP)
epidemiology is the study of distribution and determinants of health related states among
specific populations and the application of that study in the control of health problems.
epidemiology in pregnancy hypertension is the prevalence of hypertensive disorders and
its associated risk factors among women.
A study was conducted among women attending antenatal care at the clinic of usmanu
danfodiyo university teaching hospital (UDUTH), sokoto. out of 216 women 36 develop
hypertensive disorders giving a prevalence rate of 17% while 180 which is 83% of the
women were normotensive (normal blood pressure).
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classification of hypertension in pregnancy
hypertensive disorders during pregnancy can be classified into 5 categories :
1. chronic hypertension
2. gestational hypertension
3. chronic hypertension with superimposed preeclampsia
4. preeclampsia
5. eclampsia
1.chronic hypertension
A woman is said to have chronic hypertension when she developed high blood
pressure (greater than 140/90 mmHg) before pregnancy or during the early weeks
of pregnancy (first 20 weeks).
2.gestational hypertension
It occurs when a woman develops blood pressure after 20 weeks of pregnancy or
close to delivery. There is no excess protein in the urine and there are no other
signs of organ damage. In some cases, it eventually leads to preeclampsia.
3.chronic hypertension with superimposed preeclampsia
when chronic hypertension leads to worsening of high blood pressure during
pregnancy, which result in protein in the urine (a condition called proteinuria ) it
leads to chronic hypertension with superimposed preeclampsia.
4. preeclampsia
is a Condition when a woman with gestational hypertension also has increased
protein (proteinuria ) in her urine.
5. eclampsia
When preeclampsia leads to women having seizures and eventually entering a
coma, during pregnancy or after giving birth, it is called an eclampsia. It is fatal.
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clinical features
Clinical features of hypertensive disorders in pregnancy are the way the disease manifests
its signs and symptoms. generally, a pregnant woman that's hypertensive shows sign of ;
● acute increase in blood pressure greater than 140/90mmHg.
● development of consistent symptoms with severe preeclampsia.
● symptoms of end organ damage.
other symptoms manifests in different forms as the case may be;
chronic hypertension
1. pulmonary oedema
2. retinopathy
3. renal dysfunction or failure
4. hypertensive encephalopathy; and
5. cerebral hemorrhage
gestational hypertension
1. increased blood pressure
2. absence/presence of protein in urine
3. oedema
4. weight gain
5. blurred vision
6. nausea
7. vomiting
8. right-side upper abdominal pain
preeclampsia
1. high blood pressure
2. protein in urine
3. blurred vision
4. headache
5. nausea
6. oedema
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eclampsia
1. upper right abdominal pain
2. severe headache
3. blurred vision
4. mental state change
5. seizure
6. nausea
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complications of hypertension in pregnancy
complications of hypertensive disorders in pregnancy is the physical and mental condition that
affect the health of pregnant or postpartum women and her baby or both. The physical
and mental complications can manifest before, during or after pregnancy. complications from
high blood pressure can affect both the mother and the infant in many ways :
for the mother;
● induced labor : the act of giving medicine in order to give birth
● placental abruption : the act of placenta separating from wall of uterus
● stroke
● preeclampsia and eclampsia respectively.
for the baby ;
● low birth weight : the placenta doesn't receive enough blood from the mother, hence
the fetus have less nutrient which prevents it from growing
● premature delivery : due to the induced labor, the baby is born before it due time which
result in early delivery
● stillbirth : in some worst cases, a baby might be born dead due to high blood pressure
complications.
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investigations of hypertension in pregnancy
a clinical investigation is a clinical intervention, it is a clinical test or investigation
offered to or carried out on a person, it may include blood test for specific
antibodies, scans or physical examination for specific diseases.
many factors can result in hypertension in pregnancy there will be a second
measurement of blood pressure if a pregnant woman has high blood pressure for
the first reading. If blood pressure is confirmed in pregnant women, other
additional tests may be provided in order to check for other symptoms of
preeclampsia. the test can be :
1. blood test
2. urine analysis
3. fetal ultrasound
4. nonstress test or biophysical profile
blood test
A blood test is a lab analysis of things that may be found in the blood. A blood
sample analyzed in the lab can show how well the liver and kidneys are working. A
blood test can also measure the amount of blood platelets.
urine analysis
is a medical test that includes physical examination of the urine, chemical evaluation
using urine test strips and microscopic examination. urine samples can also determine
how well the kidneys are working.
fetal ultrasound
Fetal ultrasound is a test used during pregnancy. it creates an image of the baby inside
the mother. It is a safe way to check the health of an unborn baby. The image of the
baby created during the ultrasound test can be used to estimate the baby's weight and
the amount of fluid in the uterus (amniotic fluid).
nonstress test or biophysical profile
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A non-stress test is a screening test used in pregnancy to assess fetal status by means of
the fetal heart rate and its responsiveness.
Biophysical profile (BPP) measures the health of the baby during pregnancy. The BPP
checks the baby's heart rate, muscle tone, movements and breathing. It also measures the
amount of amniotic fluid around the baby.
Both tests can be used to measure how well a baby is doing. If any problem arises,
appropriate measures are taken to prevent any shortcomings.
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treatments of hypertension in pregnancy
treatment is any action or way of treating a patient or a condition medically or
surgically, it involves the management and care to prevent, cure, ameliorate, or slow
progression of a medical condition. treatment for hypertensive disorders in pregnancy
can be administered before, during, or after pregnancy. it can be offered at different
stages of pregnancy ; which are:
● preconception
● antenatal
● intrapartum
● postnatal
preconception (before pregnancy )
treatment before conception aims at preventing hypertensive disorders during pregnancy.
women can either be hypertensive or normotensive before pregnancy
a hypertensive woman have blood pressure greater than 140/90mmHg and have a higher
risk of hypertension during pregnancy, which may lead to preeclampsia or eclampsia
symptoms.to prevent it from happening, a hypertensive woman is advised not to conceive
in her state or instead should take the medicine provided by her doctor in order to
reduce the blood pressure. She is also advised to have a healthy food intake and to
have regular exercise.
A normotensive woman has a normal blood pressure.a normotensive woman is advised
to keep a healthy weight through healthy eating and regular physical activity.
antenatal (during pregnancy )
Many factors trigger hypertension during pregnancy for both hypertensive and
normotensive women. preventive measures are taken in order to prevent it from
developing into preeclampsia or eclampsia. a pregnant woman is advised to:
● get early and regular prenatal care
● keeping track of her blood pressure, and contacting a doctor if the pressure is
higher than usual or if there are any persistent symptoms.
● having good quality nutritional foods and a steady health weight.
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intrapartum (onset of labor to delivery )
intrapartum refers to the time of pregnancy from onset of labor to delivery of the
newborn. During labor, management of preeclampsia involves taking medication that
helps to stabilize blood pressure and prevent seizures. magnesium sulfate may be injected
to prevent seizures.
postnatal (after pregnancy )
In some cases after pregnancy a woman might experience an increase in blood pressure
which results in high risk of stroke and other health problems after delivery. symptoms
of preeclampsia can also be developed after delivery which is an urgent matter that
needs emergency medical care.
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conclusions
hypertension is the most common medical problem encountered in pregnancy and remains
an important cause of maternal and fetal morbidity and mortality. It complicates about
15% of pregnancies and accounts for approximately a quarter of all antenatal admissions.
the hypertension disorders in pregnancy cover wide range of conditions, of which
preeclampsia posses the greatest potential risk and remain one of the most common
causes of maternal death.
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references
department of obstetrics and gynecology,usmanu danfodiyo university teaching hospital sokoto
nigeria, 2014,national library of medicine, Nigerian medical journal, available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178334/#:~:text=In%20Nigeria%2C%20it%20
is%20 estimated,period%20than%20any%20 other%20
disorder.&text=Hypertensive%20disorder%20in%20pregnancy%20is,maternal%20
mortality%20in%20this%20 center.
world health organization, available at
https://www.who.int/health-topics/hypertension#tab=tab_1
Jennifer Kelly bedded,2023,gestational hypertension, March
24,https://www.whattoexpect.com/pregnancy/high-blood-pressure/
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