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Gestational Hypertension

Gestational hypertension, which is also known as pregnancy-induced hypertension (PIH), is the developing of high blood pressure after 20 weeks of pregnancy in pregnant women who do not have it before pregnancy. High blood pressure may affect blood flow to organs such as brain, liver, kidneys and placenta and subsequently cause damages in these organs. This condition is more common during the third trimester of pregnancy. This is a short-live condition and your blood pressure will return to normal within a week after delivery.

The blood pressure reading is represented by 2 numbers which are based on systolic pressure (top number) and diastolic number (bottom number). Systolic pressure is the pressure in blood vessels when the heart is contracting while diastolic pressure is measured when the heart is relaxing.  A blood pressure of 140/90mmHg is considered to be high. However, pregnant women tend to have lower blood pressure at around 90's/50's to 110's/70'smmHg.  Gestational hypertension is suspected if there is a rise in the blood pressure by 30/15mmHg (for example, a rise from 90/50mmHg to 120/70mmHg) over the course of pregnancy. Even though the final pressure may seem normal compared to the general population.

The exact cause of leading to gestational hypertension is not known. It seems to be an immunologic rejection of the pregnancy whereby the mother's body sees the baby as an 'outsider' and try to get rid of it.

Gestational hypertension affects 5% of all pregnancies and 1 in 4 pregnant women who have gestational hypertension will progress to pre-eclampsia during pregnancy, delivery or soon after giving birth.

Pre-eclampsia

Pre-eclampsia is a condition of high blood pressure plus hyperproteinurea (protein in the urine). It always occurs after 30 weeks of pregnancy. Uncontrolled pre-eclampsia will lead to eclampsia (seizure) which is due to cerebral oedema (excess fluid in the brain), kidney failure and liver damage.  Pre-eclampsia usually goes away spontaneously within 6 weeks after delivery.

Signs and symtoms

1.
Visual disturbances such as blurriness and flashing lights which are due to vasospasm (cramping of blood vessels) and retina haemorrhage.
2.
Severe headache and dizziness due to high blood pressure and cerebral oedema.
3.
Upper abdominal pain and vomiting which are due to liver swelling and inflammation.
4.
Oedema (swelling) of the face, hands and legs due to oedema.
5.
Rapid weight gain due to water retention.
6.
Hyperproteinurea (leaking of protein in the urine).

Effects on Baby

1.
Placental abruptio due to separation of the placenta from the uterine wall before delivery which will cause vaginal bleeding or internal bleeding and lead to death or disability of the baby.
2.
Intrauterine growth retardation (IUGR) which is due to the constrictions of blood vessels that supply baby with oxygen and nutrients. The retardation of the baby's growth will result in low birth weight. The baby will need ventilator and incubator support after birth.
3.
Intrauterine death (IUD) which is due to placental abruptio, placental insufficiency and cord compression.
4.
Preterm delivery due to spontaneous preterm delivery. Elective preterm delivery is sometimes indicated to prevent further complications to the mother and the baby.
5.
Meconium aspiration; the baby passes motion (meconium) before birth and aspiration of the meconium will damage the baby's lungs.

Effects on Mother

1.
Eclampsia (seizure)  which is due to the swelling of brain (cerebral oedema). Sometimes may lead to coma and death.
2.
Stroke which is due to bleeding in the brain.
3.

Heart failure.

4.
Swelling of liver with or without liver dysfunction.
5.
Kidneys failure.

Management and Treatment

The best way of treating pre-eclampsia is to terminate the pregnancy and deliver the baby. Pre-eclampsia will subscribes completely within 6 weeks after delivery. In severe pre-eclampsia, delivery is induced at 36 weeks of pregnancy to prevent long-term complication to the mother and the baby. Before delivery is induced, the mother is given corticosteroid to speed up the development of the baby's lungs and improve the baby's lungs function after birth. Respiratory distress syndrome in this preterm baby will be reduced by the corticosteroid.

Other treatments for pre-eclampsia are:

1.

Medication to control high blood pressure.

2.
Bed rest.
3.
Regular monitoring of your blood pressure and alter the medication to maintain good control.
4.
Monitoring of the baby's growth by ultrasound scan and cardiotopogram. When the risk of the baby in the uterus is high, delivery will be induced and the baby delivered preterm.
5.

Practice low-salt diet.

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