HIGH BLOOD PRESSURE DURING PREGNANCY
High blood pressure (the pressure that the blood exerts against the blood vessel wall with each heartbeat) is called hypertension. High blood pressure is also called hypertension. Severe or uncontrolled high blood pressure during pregnancy can have negative consequences for the mother and baby.
Normal blood pressure means that the measured blood pressure is 120/80 or lower.
The first value mentioned when referring to blood pressure, e.g. 120 systolic, is the pressure on the vessel wall at the moment when the heart is pumping. The second unit, e.g. 80 diastolic pressure, refers to the pressure on the blood vessel during the resting phase of the heart as the blood returns to the heart.
Slightly elevated (elevated) blood pressure is a systolic pressure of 120-129 and a diastolic pressure of 80 or below.
Stage 1 hypertension: Systolic pressure is blood pressure between 130-139 and diastolic pressure between 80-89 mmHg.
Stage 2 hypertension: Systolic pressure should be at least 140 and diastolic pressure at least 90.
Chronic hypertension is high blood pressure that exists before pregnancy or occurs before the 20th week of pregnancy.
In gestational hypertension, high blood pressure occurs after the 20th week of pregnancy and usually disappears after delivery. However, these women may be more likely to have high blood pressure in the future than other women.
High blood pressure during pregnancy can cause many complications for the pregnant woman and the fetus:
– Fetal growth restriction: High blood pressure can cause resistance in the placental bed, which can lead to a restriction in the transfer of nutrients through the placenta to the baby, which in turn can lead to a slowing of the baby’s growth. The baby may be measured smaller than the required week size.
– Pre-eclampsia: Preeclampsia, commonly known as pregnancy poisoning, is more common in pregnant women with high blood pressure than in normal women.
– Preterm delivery: If the placenta is not able to nourish the baby sufficiently and it is thought that the baby will develop more healthily outside the womb during the examinations, a decision for preterm delivery may be taken.
– Placental abruption: Early separation of the placenta is an obstetric emergency and high blood pressure poses a risk for placental abruption.
If there is high blood pressure before pregnancy, that is, if the pregnant woman has chronic hypertension, sometimes this condition can return to normal during pregnancy and the medication used may not be necessary. However, if the severity increases during pregnancy and medication was not used before, it may be necessary to start medical treatment during pregnancy or to continue the existing treatment. In this case, the expectant mother may have to monitor her own blood pressure every day at home. Ultrasonographic examinations can determine whether fetal growth restriction has occurred and, if necessary, Doppler ultrasonography can be used to determine whether there is resistance to umbilical cord nourishment.
PREECLAMPSIA
Preeclampsia, popularly known as pregnancy intoxication, is a condition that occurs after the 20th week of pregnancy and is characterized by high blood pressure and signs of deterioration in many organs. Protein may be observed in the urine (proteinuria), liver function tests may increase, the number of blood clotting cells may decrease and pulmonary edema may occur. Preeclampsia and severe preeclampsia are divided into 2 categories. In the current situation, classification and treatment can be arranged, or an urgent decision can be made to deliver.
Pre-eclampsia occurs after 20 weeks, usually in the 3rd trimester. When it occurs before 32 weeks, it is called early-onset pre-eclampsia. It can also occur after childbirth.
Although it is not clear who will develop pre-eclampsia, some women are at higher risk.
It is more likely to be seen in pregnant women who are experiencing pregnancy for the first time, in women who have had preeclampsia in their previous pregnancy or who have a family history of preeclampsia, in pregnancies aged 40 and over, in multiple pregnancies, in pregnant women with diabetes, in patients with thrombophilia, in patients with lupus, in pregnant women who are obese and in pregnant women who conceive with in vitro fertilization method.
Pre-eclampsia also has risks for the baby. In case of pre-eclampsia, a decision may be made to deliver the baby prematurely, and emergency delivery may be planned because the baby is at risk inside. In this case, the premature baby may face complications of prematurity.
A mother with pre-eclampsia also has an increased risk of heart disease, stroke, kidney disease and high blood pressure after pregnancy. There is also a risk of severe pre-eclampsia, characterized by seizures called eclampsia during pregnancy and after delivery.
Pre-eclampsia can also cause HELLP syndrome, which is characterized by hypertension, increased liver function tests and low blood clotting cells during pregnancy. HELLP syndrome is an urgent and dangerous form of obsteria.
Symptoms of pre-eclampsia include:
These include headaches that do not go away, sweating of the hands and face, changes in vision and floaters, pain in the upper abdomen and shoulders, nausea and vomiting in the second half of pregnancy, sudden weight gain and difficulty breathing.
In the case of mild hypertension and preeclapmia, the pregnancy can be followed up at home or in the hospital until 37 weeks according to the doctor’s recommendation. Unless otherwise indicated by the baby’s movements, well-being on NST and regular measurements of the pregnant woman’s blood pressure, follow-up until 37 weeks and then delivery can be recommended. However, in this case, there is also the possibility of an earlier delivery during follow-up.
In case of severe pre-eclampsia, hospitalization is essential and delivery is planned after 34 weeks. Before 34 weeks, if the condition of the baby and mother is stable, 34 weeks can be waited. In the meantime, corticosteroids can be administered to the mother for the baby’s lung development, and medical treatment can be applied to lower the mother’s blood pressure and prevent seizures. However, if the condition of the baby and the mother is considered risky, it is sometimes not possible to wait until the 34th week.
In order to prevent pre-eclampsia, it is important to lose excess weight if present before pregnancy and controlled weight gain during pregnancy, and if diabetes is present, it is important to get pregnant after blood sugar regulation and to organize follow-up during pregnancy. If there is high blood pressure before pregnancy, it should be regulated and pregnancy risks should be calculated and pregnancy should be planned under the control of a doctor.