Mothers-to-be
must be alert to PIH
By Melanie Amarasooriya
High blood pressure or hypertension is known to complicate one in
every five to ten pregnancies. In fact pregnancy-induced hypertension
(PIH) is recognized as the second leading cause of maternal deaths
in Sri Lanka and the leading cause in developed countries. 'MediScene'
spoke to Dr. J.M. Kumarasiri, Consultant Obstetrician and Gynaecologist
at Castle Street Hospital for Women to find out more about this
condition.
Are you at risk?
You are considered more at a risk if:
>This is your first pregnancy or
the first pregnancy with a new partner.
> You have had pregnancy-induced
hypertension(PIH) before.
> You have diabetes or other vascular
diseases like systemic lupus erythematosis (SLE), or chronic (persistent)
kidney disease.
> If your mother or sisters had
pregnancy-induced hypertension(PIH).
> If you are less than 25 or more
than 35 years.
> If you are obese.
> If you have had high blood pressure
even before the pregnancy.
> Multiple pregnancies i.e. pregnant
with twins, triplets etc.
How do you know that you have pregnancy-induced
hypertension (PIH)?
Once you know that you are pregnant, you need to register yourself
in an obstetric clinic or visit your Obstetrician. Doctors will
keep a record of your blood pressure at each visit. Usually the
blood pressure drops in the initial part of the pregnancy and rises
during the latter part from about 20 weeks of gestation. The upper
limit of the normal range of blood pressure during pregnancy is
considered as 140/90 mm Hg. The first number is the systolic pressure.
This is the pressure in the arteries when the heart contracts. The
second number is the diastolic pressure. This is the pressure in
the arteries when the heart rests between each heart beat.
If either number is high it is considered abnormal. But a single
reading of high blood pressure will not confirm that you are hypertensive.
The doctor may need to recheck your blood pressure after 20 to 30
minutes from the first reading and during this period you need to
rest. Avoid being excited and walking up and down or exerting yourself
since all this raises blood pressure. A second reading of blood
pressure should be taken only after 20 minutes rest.
If you are found to have high blood pressure:
> You need not panic. Most pregnant
mothers with PIH deliver healthy babies with no complications at
all.
> But you need to be a little careful.
Do not exhaust yourself. Rest well.
> Sometimes the doctor may ask you
to be admitted to hospital to observe whether your blood pressure
comes to normal levels with bed rest. If so you may not need medication
at that stage.
> If you do not respond to rest,
you will be prescribed medication as necessary to lower your blood
pressure.
> You can take these drugs while
you are at home provided that your blood pressure is not too high.
> You may need repeated hospital
admissions for monitoring of blood pressure, treatment etc.
During this time you need to:
> Rest. However, not strict bed
rest. You can walk around. Your body needs exercise to avoid other
problems. Nevertheless, do not exhaust yourself.
> Check your blood pressure frequently,
as advised by your doctor.
> Check urine for proteins as advised
by your doctor.
> Take your medication properly.
Do not throw them away thinking that drugs are harmful for the baby.
It is uncontrolled pressure that is more harmful.
See your doctor/ Go to the hospital immediately if you get
> Headaches.
> Swelling or puffiness of your
feet, face, or hands (oedema). Note: this is common in normal pregnancy
but can become worse in PIH.
> Blurring of vision, or other visual
problems.
> Pain in the right upper abdomen.
>Vomiting.
>Just not feeling right.
But you may feel well and have no symptoms at all with hypertension.
This is one reason why it is important to have regular blood pressure
and urine checks when you are pregnant.
What are the complications?
Pregnant mothers with PIH can have seizures and this is a very serious
complication. This stage is called eclampsia and mothers who have
this complication can end up having a stroke or with kidney, lung
or liver problems. This is a life-threatening stage and all measures
should be taken to prevent this through routine blood pressure and
urine checks.
What are the treatment options available?
Blood pressure can be controlled with oral medication initially.
But if it is not responding or becomes very severe with impending
life-threatening complications the only option is immediate delivery
of the baby and the placenta, the cause of the disease. Therefore,
this can cause preterm deliveries.
Do you need to check blood pressure even
after delivery?
Yes. You need to keep a tab on your blood pressure recordings. If
it does not get controlled spontaneously after six weeks of delivery
the chances are that you have chronic high blood pressure or 'essential
hypertension' and not the pregnancy- induced one.
That is the type of blood pressure that our fathers and mothers
have when they get older. You might have had it at an early age
and had it diagnosed only at pregnancy. Otherwise the blood pressure
comes to normal after pregnancy but could recur with a subsequent
pregnancy.
Can it be prevented?
No proven method is available to prevent PIH. The only solution
is to monitor the condition closely and prevent complications.
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