Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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The doc said I need admission for high BP???? But I am fine and don’t medicines work ??
An often encountered issue in the prenatal or antenatal consultations is high blood pressure. Mums are suddenly noticed to have a raised blood pressure ( BP ) at an apparently regular follow up visits and are taken aback when the doc asks for admission and observation.
These ones are at least the fortunate lot whose blood pressure rise could be detected but sometimes not so lucky situations occur. A mum could present with either seizures ( fits ), bleeding, respiratory difficulties, dead baby or may be brought in a critical situation. Raised blood pressure in pregnancy is not as simple or indolent as it would be in a non-pregnant older woman. For that matter, raised blood pressure is a sign of something going wrong and needs to be investigated for its probable cause and effect to the mother and her baby.
One of the most unpredictable and frustrating complications of pregnancy is raised blood pressure. Raised blood pressure is called as hypertension and when it is associated with urinary protein excretion, it is called as preeclampsia. In the recent years it is identified as the commonest abnormality encountered during pregnancy and is responsible for adverse outcomes, both in the mum and the baby. Its occurrence is much on rise and causes many short term and long term effects. Life style changes, certain precautions can go a long way in reducing the severity of this disease and therefore have written this article.
The article is divided in three parts :
1. Understanding the issue of hypertension in pregnancy (HTNP) and its presence
2. How can I prevent the severity of hypertension and what are the situations that are at risk
3. The long-term consequences of hypertension In pregnancy
So, let us deal with understanding the issue of HTNP today.
What actually is blood pressure ?
The most important circulating fluid in our body is the blood. It courses through the blood vessels and consists of fluid ( plasma ) and cells ( red , white and platelets ). Each component has a specific function ranging from delivery of oxygen, nutrients, immunity and controlling blood loss. The blood has to reach to every organ and cell of the body and this is done by the network of blood vessels which too are of different types, cadre and have specific functions. The heart pumps this blood through the vessels which help in being propelled to reach out and also at the same time the blood has to be purified and this is a complex continuously ongoing process in our body. The blood pressure measures the pressure of the blood when it is being pumped ( Systolic Blood Pressure or the SBP ) and also the one which is present in the resting state in the vessel ( Diastolic Blood Pressure DBP ).
How is the blood pressure measured ?
The ideal way of measuring the blood pressure is with the mercury manometer but due to the paucity of mercury and its actual ban in many places electronic devices are used to measure the blood pressure. For this the pressure cuff is tied on the forearm and the pressure is measured. The readings are measured in two digits the upper measure and the lower measure.
The upper measure is the SBP which ranges between 130 to 110 mm of Hg in a normal state
while the lower measure is DBP which ranges from 70 to 80 mm of Hg.
Every time that I visit the doctor, my blood pressure is being checked. In fact this is the first thing that they do ?
This ensures that you are in the right hands. Every visit during pregnancy ideally the blood pressure should be measured. Raised BP is a sign that something somewhere is not quite right. In addition the mums may not be able to point at a specific symptom to say that they are not well enough. Today BP measuring done in an appropriate manner can help detect HTNP much early in its occurrence and this can help save many complications and lives.
What is normal blood pressure ?
BP record of 120 / 80 mm of Hg measurement is taken as normal. Most mothers record a BP of 110 / 70 mm of Hg in the second half of pregnancy and this is considered to be a normal change which occurs as the mother’s blood and circulation system is getting adjusted to the changing pregnancy related demand on it. A low resistance blood flow with lowered pressure can help perfuse the baby and the placenta better. It should not be lower than 110 / 70 mm of Hg to be able to maintain the optimum perfusion to both the maternal as well as the fetal systems.
What is considered as abnormal blood pressure during pregnancy or what is HTNP ?
BP measurement of 140 / 90 mm of Hg or more is considered as abnormal BP and can be a sign of an underlying, sometimes serious pathology. Many a times this needs to be compared with the BP reading before conception but many women haven’t checked their BP before conception and therefore the doctor has to judge based on the clinical presentation and laboratory investigations, the severity of this finding. Many a times single reading mayn’t be sufficient and a repeat reading at a later time may be performed to confirm the abnormality. Other clinical parameters too need to be taken into consideration. Women commonly say that they are scared when they come to the hospital and their BP otherwise is normal. This is typically called as a white collar HTN. Sometimes there can be just a single abnormal reading and this is called as transient HTN. Both these conditions are a suggestion of a hyper-responsive circulatory system and need to be noted and closely monitored.
The doctor suggested that I get admitted because my BP was raised ! I wasn’t ready for that and I felt it was over treatment !!
Hospitalization is suggested when the BP record is very high and the doctor has clinically identified some other parameters which can be signs suggestive of a severe disease. Also monitoring every 2- 4 hourly for 48-72 hours is recommended to identify any other abnormalities. Raised BP is a sign of underlying systemic abnormality which can be diagnosed many a times only by laboratory testing.
Is there anyway to identify if I have HTN and need to see the doctor ?
Sudden headache, burning in the chest, sudden swelling on the feet, excessive weight gain in a short span, feeling unwell or sick, vomiting after the first 3 months, sudden blackouts, giddiness, acute sudden sharp pain in abdomen associated with bleeding or tightness, unconsciousness, reduced urine and fits are all conditions, which are associated with HTN.
Why is there HTN in pregnancy and can it be prevented ?
The foundation of this disease is laid down early, when the pregnancy is just beginning to form. When the early placentation occurs at the time when the early embryo gets attached to the lining of the mother’s womb, the disease is believed to start. If this placentation is not optimum due to various issues such as obesity, thyroid disorders, diabetes, anemia, folic acid deficiency, it rises an environment of low oxygen gradient which can cause release of certain ROS ( Reduced Oxygen Species). ROS are elements which over a period of time get accumulated and are not contained due to the body’s fighting mechanisms ( immunological system ) and result in presentation of HTNP in later part of the pregnancy. The disorder is similar to a slowly occurring and gradually compounding allergic reaction and this reaction is against the pregnancy.
It can be prevented by proper pregnancy planning, regular checkups, appropriate nutrients and reducing the obvious at risk situations which we will discuss in the second part. Optimum and planned weight gain and regular antenatal checkups on time have been identified to help reduce the adverse outcome due to disease severity.
The doctor ordered check of proteins in my urine ( proteinuria ) why ?
Proteins in urine helps the doc differentiate whether HTN is due to pregnancy ( Gestational ) which is not ominous and can be dealt with just medications and observation or disorder associated with increased proteinuria. HTN with proteinuria is called as preeclampsia and is a serious disorder for which the pregnancy is to be terminated or the mum delivered. Such a preeclampsia occurring before 34 weeks, is more dangerous than the later occurring disease. Many a times doctors offer a hospital based expectant treatment in order to stabilised the mother’s HTN with medications and to allow the baby to mature to the age it can survive, if not on its own, atleast in a NICU ( Neonatal Intensive Care Unit )
Some more in the next blog !! Feel free to ask any doubts or questions here. This will help me to guide you better. Happy reading and remember I care for you.
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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