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BLOOD PRESSURE PROBLEMS IN PREGNANCY

What are Blood Pressure Problems in Pregnancy ?

Blood pressure is measured in two numbers: the higher figure is called the systolic pressure; the lower one is called diastolic. The reason that there are two numbers is because the blood pressure bounces from the lower to the higher with every heartbeat. A normal blood pressure in most young women is about 120/80. Exercise or worry can make it go up: this probably does no harm because it usually lasts for quite a short time. When blood pressure stays high for much of the time, it can cause problems and is called hypertension.

Women who have high blood pressure in pregnancy are not all the same. Some have high blood pressure even before they are pregnant and will continue to have it; some were normal before pregnancy but the pressure then goes up during pregnancy. A third group also have this rise, but as well as this, a chemical called a protein appears in their urine which was not there before pregnancy.

If protein is present in the urine, your blood pressure condition is then called pregnancy toxaemia or pre-eclampsia. It is pre-eclampsia that we are particularly concerned about. It may lead to complications which affect both you and your baby. High blood pressure does not usually alter the way you feel. This is why it is vital that your blood pressure is actually measured before and during pregnancy. It is very unusual for complications to result from high blood pressure in pregnancy alone. However, if protein in the urine is also present (pre-eclampsia), complications affecting both mother and baby can occur. Although these complications are not common, they can be serious, and any pregnant women with pre-eclampsia will be monitored very carefully. In the mother, some of the complications of pre-eclampsia result from blood pressure rising to unsafe levels. The condition affects almost every organ in the body, and may cause problems affecting the kidneys, liver, heart, nervous system and blood. In the baby, the most common problem affecting the baby is prematurity. In severe cases of pre-eclampsia, it is sometimes necessary to deliver the baby early for the mother’s sake, even if the baby is premature. Another complication is a reduction in the blood supply to the womb. This may affect the growth of the baby, and how well the baby copes with the stress of labour.

How do Blood Pressure Problems in Pregnancy occur ?

Although many steps in the process leading to high blood pressure in pregnancy are understood, the cause is not yet known.

Why do Blood Pressure Problems in Pregnancy occur ?

Around 5 to 10% of women who are pregnant with their first baby will be found to have high blood pressure. One out of every three of these will also have protein in their urine, and therefore have pre-eclampsia. Unless someone has high blood pressure in a first pregnancy, it is not likely to happen with later pregnancies. Any pregnant woman who is due to have her first baby may develop high blood pressure in pregnancy, but some women are at increased risk. These include women with twin pregnancies or those with a mother or sister who had high blood pressure in their pregnancies. In addition, those with a history of high blood pressure in a previous pregnancy or even before they were not pregnant are also at risk.

Treatment Involved for Blood Pressure Problems in Pregnancy

If you do not have protein in your urine, your doctor may well be happy for you to remain at home, just having regular blood pressure and urine checks. These can be done by your community midwife. If you were on blood pressure tablets before pregnancy, they may have to be changed: some drugs suit the baby better. If protein is found in your urine, you will often be admitted to a hospital antenatal ward. You may be annoyed about being in hospital despite feeling quite well, but it is for the good of both you and your baby. Nor will it be possible for your doctor to tell you just how long you will need to stay. High blood pressure in pregnancy (especially pre-eclampsia) is very unpredictable.

The wellbeing of both you and your baby can change very quickly, calling for a change of treatment or the need to deliver your baby early. Whilst in hospital, your condition will be watched carefully. Blood and urine tests will check that your kidneys and liver are working well. One type of blood cell, called platelets, are reduced in severe pre-eclampsia. This could cause bleeding and bruising. Your baby will also be observed using ultrasound (a type of radar scanning) to measure its growth. Its wellbeing will also be checked using a heartbeat recording. There are drugs which will lower your blood pressure without harming your baby. However, these drugs will not prevent the effects of pre-eclampsia on your liver or kidneys. Nor will they improve the blood supply to your womb.

In view of this, many doctors would only use drugs to lower blood pressure in women whose blood pressure had risen to unsafe levels; once blood pressure control has been achieved, they would recommend delivery of the baby if they felt there was a risk either to you or your baby. If you have high blood pressure in pregnancy without protein in your urine, you will probably be allowed to go into labour naturally. If you have pre-eclampsia, it will not be possible for your doctor to plan ahead. The possible delivery of your baby will be discussed on a day-to-day basis whilst you are in hospital. Whether you have a Caesarean section or a vaginal delivery will depend on how many weeks pregnant you are, and how severe the condition is. If you are unfortunate enough to be one of the small number of women who has severe pre-eclampsia, then you will be watched very carefully on the labour ward. An anaesthetist will be involved with your care as well as the obstetrician. The main aim of your doctors will be to prevent your blood pressure rising to unsafe levels, and to prevent eclampsia , where a fit occurs. Having a fit is a very rare complication. You may be given a drug to prevent this happening.

Eclampsia used to be more common, before it was realized just how important it was to identify and treat pre-eclampsia. A few hours after delivery, high blood pressure tends to subside and you can expect to make a steady recovery. If tablet treatment was needed to control blood pressure during pregnancy, then it may be necessary to continue this, but usually only for a matter of days or weeks. Attempts at preventing high blood pressure in pregnancy, such as bed rest or altering diet, will have little effect. In selected patients, there is some evidence that a low dose of aspirin may be of benefit. Low dose aspirin is not a useful treatment of high blood pressure in pregnancy once it has developed.

During Treatment for Blood Pressure Problems in Pregnancy

You cannot tell whether your blood pressure is high or whether you have protein in your urine. This can only be done by testing. However, any symptoms you experience should be reported to the doctor or midwife.

After Treatment for Blood Pressure Problems in Pregnancy

If your blood pressure was normal before pregnancy, and returns to normal after pregnancy, you are no more likely than anyone else to suffer high blood pressure in later life. However, if you have another pregnancy, you will have a 1 in 4 chance of developing high blood pressure again during that next pregnancy. If so, it is often less severe, and usually occurs later in the pregnancy. If you had high blood pressure before pregnancy, it is not likely to be more severe or harder to control afterwards.

If Blood Pressure Problems in Pregnancy are Left Untreated

It is extremely important for high blood pressure to be controlled in pregnancy. If it is not controlled, there are serious risks to you and your baby.

Effects on Family of Blood Pressure Problems in Pregnancy

The finding of high blood pressure during pregnancy can be very worrying for the mother. It can be difficult to understand the concern of the doctors or midwives if you feel well. Understanding shown by family and friends can be important in this period.