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Pregnancy induced hypertension (PIH)

What is pregnancy-induced hypertension (PIH)?

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Pregnancy-induced hypertension (PIH) is a form of high blood pressure during pregnancy. It occurs in about 5 percent to 8 percent all pregnancies. Another type of high blood pressure is chronic hypertension - high blood pressure that occurs before the onset of pregnancy.

Hypertension induced pregnancy also called toxemia or preeclampsia. It occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, in women with chronic hypertension, pregestational diabetes, and women who had PIH in a previous pregnancy.

Usually there are three characteristics top of this disorder, including:

• High blood pressure (blood pressure above 140/90 mm Hg or a significant increase one or both pressures)
• protein in the urine
• edema (swelling)

Eclampsia is a severe form of the induced pregnancy hypertension. Women with eclampsia have seizures as a result of the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops into the end of pregnancy, in most cases.

HELLP syndrome is a complication of severe preeclampsia or eclampsia. This syndrome is a set of changes including physical breakdown of red blood cells, changes in the liver, and low platelets (cells found in blood that are needed to help the blood clotting to control bleeding).

What causes pregnancy-induced hypertension (PIH)?

The cause of preeclampsia is unknown. Some factors may increase the risk of developing PIH, including the following:

• pre-existing hypertension (pressure high blood pressure)
• kidney disease
• diabetes
• PIH with a previous pregnancy
• maternal age under 20 years over 40
• multiple pregnancies (twins, triplets)

Why is pregnancy-induced hypertension is a problem?

With high blood pressure, there is an increase in the resistance of blood vessels. This can impair blood flow in many organs the expectant mother including the liver, kidneys, brain, uterus and placenta.

There are other problems that may develop as a result of PIH. Placental abruption (premature detachment of the placenta from the uterus) may occur in some pregnancies. PIH can also lead to fetal problems including intrauterine growth restriction (poor fetal growth) and stillbirth.

If untreated, severe PIH may cause dangerous seizures and even death of the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered preterm before 37 weeks gestation.

What are the symptoms of pregnancy-induced hypertension?

The following are the most common symptoms of hypertension in pregnancy. However, each individual may experience symptoms differently. Symptoms may include:

• increased blood pressure
• protein in the urine
• edema (swelling)
• sudden weight gain
• visual changes such as blurred or double vision
• nausea, vomiting
• right-sided abdominal pain or pain in the stomach
• urinating small amounts
• changes in liver or kidney function tests

How is pregnancy-induced hypertension diagnosed?

The diagnosis is often based on increasing levels of blood pressure, but other symptoms can help establish the diagnosis of HIE. Tests for pregnancy-induced hypertension may include the following:

• Measuring blood pressure
• Urine tests
• assessment of edema
• Frequent weight
• Eye exam to check for changes in the retina
• liver and kidney function tests
• blood coagulation tests

Treatment of hypertension induced by pregnancy:

Specific treatment for pregnancy-induced hypertension will be determined by your physician based on:

• your pregnancy, overall health and medical history
• extent of disease
• Your tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Your opinion or preference

The goal of treatment is to avoid worsening of the disease and to avoid causing any complications. Treatment of pregnancy-induced hypertension (PIH) may include:

• bedrest (either at home or in hospital may be recommended)
• hospitalization (as specialized personnel and equipment may be required)
• magnesium sulfate (or other antihypertensive medications for PIH)
• Fetal monitoring (to monitor the health of the fetus when the mother has PIH) may include:
  • Fetal movement counting - Monitoring of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.
  • Nonstress testing - a test that measures the fetal heart rate in response to movements of the fetus.
  • Biophysical profile - a test that combines nonstress test ultrasound to examine the fetus.
  • Doppler flow studies - type of ultrasound that uses sound waves to measure blood flow through a blood vessel.
• Lab tests of urine and blood (for changes that may signal worsening of PIH)
• medicines called corticosteroids that can help mature the lungs of the fetus (lung immaturity is a major problem in premature babies)
• delivery of the baby (if treatments fail to control PIH or if the fetus or the mother is in danger). Cesarean delivery may be recommended in some cases.

Prevention of pregnancy-induced hypertension:

Early identification of women at risk of pregnancy-induced hypertension can help prevent some complications of the disease. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease.

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About the Author

The Author is an Infertility Expert from Nottingham. Visit his blog at infertilityhospital.blogspot.com

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