Hypertension is the most common medical problem encountered during pregnancy. It is a very dangerous condition and is defined as elevated blood pressure greater than or equal to 140/90mmHg taken at least on two occasions with patient at rest, or with a single reading of 160/110mmHg or greater.
Medical experts consider it as one of the most common causes of maternal morbidity and mortality worldwide.
About 10 to 15 per cent of women will develop hypertension in pregnancy around the world, according to the world Health Organisation.
Dr Oke Oluwaseyi Felix, a consultant obstetrician and gynaecologist at Oshen-King Faisal Hospital, Kigali, supports this, saying that it is also responsible for 20 to 25 per cent of hospital admissions during the antenatal period.
Hypertension in pregnancy can be grouped into four categories.
One is pre-existing hypertension where a woman already had hypertensive conditions before getting pregnant.
"Women with this condition most of the time get pregnant before they go to the hospital for guidance. But women who have this condition should see a doctor first before getting pregnant,” he says.
"When a woman comes with hypertension before 20 weeks of pregnancy, it is likely that this woman had hypertension before she was pregnant, because most of the time, if it pregnancy-induced hypertension, it usually starts after 20 weeks of pregnancy,” Oluwaseyi explains.
The second is pregnancy-induced hypertension where a woman who was not hypertensive before develops the condition during pregnancy, which is usually 20 weeks into the pregnancy.
Oluwaseyi also notes pre-eclampsia as the third category. With this, a pregnant woman has elevated blood pressure and proteinuria that is the presence of protein in urine. These signs indicate that there is a possibility that the woman is developing pre-eclampsia in pregnancy.
"She can also complain of headaches, blurred vision, and epigastric pain in the right upper part of the abdomen, and may notice reduction in passing urine. Pre-eclampsia is a multi-systematic problem, it affects all the organs of the body, the kidneys, liver, the eyes, the central nervous system, in fact, most of the time, a woman has to be admitted for close monitoring,” Oluwaseyi says.
Pre-eclampsia is very risky, to the extent that at times, medics have to deliver the baby regardless of whether it has matured or not, if the woman’s condition is getting worse. If they don’t deliver at that time, the woman can get a stroke or the placenta can detach on its own, and when this happens, it can result in the death of mother and baby.
"The woman can have cortical blindness as a complication and can even bleed into the brain; as I said earlier, it affects the entire system. So at that point in time, you are not thinking that the foetus is not yet mature, it’s about the mother’s wellbeing depending on the situation,” Oluwaseyi says.
"Eclampsia is the fourth category, with this, a woman has generalised convulsions during pregnancy and no matter what, it means the foetus must come out, irrespective of the stage of pregnancy, because delivery is a very important action if convulsions occur. Convulsions should not be allowed to continue because for every episode, there is injury to the brain,” he says.
It is also necessary to note that the above conditions can develop during pregnancy, in labour and after delivery.
CAUSES
Unfortunately, there is no particular cause of this condition, rather, there are risk factors which may increase the chances of a woman developing hypertension in pregnancy.
One of them is genetic factors. If your mother had it, or your sister, there is a possibility you will have it too. This is why the healthcare providers always ask for family history during antenatal booking, Oluwaseyi explains.
He points out that women pregnant for the first time, those carrying more than one baby, those who’ve had the condition in a previous pregnancy, obese women or those getting pregnant after 40 years of age, and diabetic patients, are all at risk of hypertension in pregnancy.
MANAGEMENT
Treatment depends on the kind of classification the woman belongs to when she gets to the hospital, and, how old the pregnancy is. However, once this condition starts, it progresses, hence, close evaluation and monitoring is necessary to get to a safer point for the mother and the delivery of the baby. The aim of management is not to cure the condition.
Medics warn that when managing hypertension, one doesn’t have to bring down the blood pressure too rapidly, there is need to strike a balance because the high blood pressure is not good for the mother, but at the same time, if you bring it down too low it could be bad for the baby and sabotage growth.
Oluwaseyi explains that once hypertension in pregnancy sets in, it is hard to predict how it is going to turn out, but the patient needs to have close follow up, preferably at the hospital.
The gynaecologist also warns that this condition during pregnancy should be managed in places where there are facilities for neonatal back up, in case the baby has to be delivered prematurely.
"And when a woman delivers, they should be encouraged to use an effective family planning method, so that they don’t get pregnant in a short period of time,” Oluwaseyi says.
He says that if there are any signs of hypertension, a woman needs to see an obstetrician immediately, because the health of a woman cannot be overemphasised.
"Once a pregnant woman has hypertension, she should go to the hospital, it could be mild or severe, but this should be distinguished by the doctor who will then prescribe the appropriate anti-hypertensive drug and other necessary modalities of treatment,” Oluwaseyi says.
He adds, "Women should not be allowed to die or suffer illnesses in the process of carrying out normal physiological responsibilities, and everyone has a role to play to prevent this killer in women called hypertension in pregnancy.”