Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy are a group of conditions that affect the blood pressure of pregnant women. They can cause serious complications for both the mother and the baby, such as preterm birth, low birth weight, placental abruption, foetal growth restriction, and maternal organ damage.

Hypertensive disorders of pregnancy are a group of conditions that affect the blood pressure of pregnant women. They can cause serious complications for both the mother and the baby, such as preterm birth, low birth weight, placental abruption, foetal growth restriction, and maternal organ damage. According to the National Institutes of Health, the burden of HDP in Africa is high, with about one in 10 pregnancies affected.

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Major Types of Hypertensive Disorders in Pregnancy

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There are four major types of hypertensive disorders of pregnancy:

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  • Chronic hypertension: This is high blood pressure that occurs before 20 weeks of gestation or persists longer than 12 weeks after delivery. It may be preexisting or newly diagnosed during pregnancy. It increases the risk of preeclampsia, foetal growth restriction, and placental abruption.
  • Gestational hypertension: This is high blood pressure that occurs after 20 weeks of gestation and resolves by 12 weeks postpartum. It does not involve any signs of organ damage or proteinuria (protein in the urine). It may progress to preeclampsia or chronic hypertension.
  • Preeclampsia: This is a syndrome of high blood pressure and either proteinuria or signs of organ damage (such as low platelet count, impaired liver function, kidney dysfunction, pulmonary edema, or neurological symptoms) that occurs after 20 weeks of gestation. It can be mild or severe, depending on the presence and severity of these features. It can also occur superimposed on chronic hypertension. It is a leading cause of maternal and foetal morbidity and mortality.
  • Eclampsia: This is a life-threatening complication of preeclampsia that involves seizures or coma in the absence of other causes. It can occur before, during, or after delivery. It requires immediate treatment with magnesium sulphate to prevent further seizures and delivery of the baby as soon as possible.

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Causes of Hypertensive Disorders of Pregnancy

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The exact causes of hypertensive disorders of pregnancy are not fully understood, but they are thought to involve abnormal placental development, immune system dysfunction, genetic factors, and environmental factors. Some risk factors for developing these conditions include:

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  • First pregnancy
  • Multiple pregnancy (twins, triplets, etc.)
  • Maternal age over 35 years or under 20 years
  • Preexisting chronic hypertension, diabetes, kidney disease, or autoimmune disease
  • Family history of preeclampsia
  • Obesity

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The Diagnosis of Hypertensive Disorders of Pregnancy

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The diagnosis of hypertensive disorders of pregnancy is based on blood pressure measurements and laboratory tests. Blood pressure is considered elevated if it is 140/90 mm Hg or higher on two occasions at least four hours apart. Proteinuria is detected by a urine dipstick test or a 24-hour urine collection. Other tests may include blood counts, liver enzymes, kidney function tests, and ultrasound to assess foetal growth and well-being.

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Management of Hypertensive Disorders of Pregnancy

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The management of hypertensive disorders of pregnancy depends on the type, severity, gestational age, and maternal and foetal condition. The main goals are to prevent maternal and foetal complications, control blood pressure, and deliver a healthy baby at an optimal time. Some general principles are:

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  • Women with chronic hypertension should receive antihypertensive medication before and during pregnancy to keep their blood pressure below 160/105 mm Hg. They should also be monitored closely for signs of preeclampsia and foetal growth restriction.Women with gestational hypertension or preeclampsia without severe features should have regular blood pressure checks, antenatal testing for foetal well-being and disease progression, and delivery by 37 weeks of gestation.
  • Women with preeclampsia with severe features should be hospitalised and treated with magnesium sulphate to prevent seizures, antihypertensive drugs to lower blood pressure below 160/110 mm Hg, corticosteroids to enhance foetal lung maturity if less than 34 weeks of gestation, and delivery plans. Delivery is indicated as soon as the maternal and foetal condition is stable, usually within 24 to 48 hours.
  • Women with eclampsia should receive immediate magnesium sulphate and antihypertensive drugs, followed by delivery as soon as possible.

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Hypertensive disorders of pregnancy can worsen or present for the first time after delivery. Therefore, women who had these conditions should be monitored closely for 72 hours postpartum and advised to seek medical attention if they experience symptoms such as headache, visual changes, chest pain, shortness of breath, or abdominal pain.

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Hypertensive disorders of pregnancy are serious but preventable and treatable conditions that require early detection and appropriate management. If you are pregnant or planning to become pregnant, you should talk to your health care provider about their risk factors and how to reduce them. You should also follow a healthy lifestyle, such as eating a balanced diet, exercising moderately, avoiding smoking and alcohol, and taking prenatal vitamins. Low-dose aspirin (81 mg per day) may be recommended for women at high risk of preeclampsia after 12 weeks of gestation. Regular prenatal visits and blood pressure checks are essential to monitor the mother and the baby's health and to intervene promptly if any problems arise.

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