HYPERTENSION IN PREGNANCY

PRESENTED BY:

CHUKU JOY CHIOMA

Reg:2017/246408

DEPARTMENT OF PHYSIOLOGY

COURSE CODE: PYS 484

SUPERVISOR: PROF. BOND ANYAEHIE

JANUARY
 Hypertension in Pregnancy

Outline
• Definition
Blood pressure
Hypertension
• Hypertension in Pregnancy.
• Types of hypertension in pregnancy
• Signs and Symptoms.
• Risk factors of maternal hypertension
• Complication of hypertension in pregnancy.
• Treatment.
• Prevention.
 Definition of Blood pressure

• Blood pressure is the force of circulating blood on the walls of the

arteries.
• Blood pressure is measured in millimeters of mecury (mmHg) and it
is given as 2 figures.
• Systolic pressure: The pressure when the heart pushes blood out.
• Diastolic pressure: The pressure when the heart rest between beats.
• It is written like this 120/80. It is read as "120 over 80". The top
number is called the systolic and the bottom number is called the
diastolic.
•
 Definition of Hypertension

• A persistent elevation of blood pressure is known as

hypertension.
• Blood pressure greater than or equal to 140/90mmHg
(Brown et Al 1994).
 Hypertension in Pregnancy

• It is a persistent increase in the blood during pregnancy. It

is the most common medical problem encounter during
pregnancy, complicating up to 10% of pregnancies.
• The definition of hypertension in pregnancy has not
always been standardized, but following the “National
High Blood Pressure Education Program Working Group
on High Blood Pressure in Pregnancy” recommendation
is currently a systolic blood pressure (SBP) ⩾ 140 mmHg
and/or a diastolic blood pressure (DBP) ⩾ 90 mmHg.
•
The severity of hypertension is as follows:

• Hypertension categories in pregnancy.

• Non-severe hypertension. Any values between SBP 140–159 mmHg
and DBP 90–109 mmHg. Sometimes this category as a whole is
termed “mild,” or it is further broken down into mild (140–149/90–99
mmHg) and moderate (150–159/100–109 mmHg).
• Severe hypertension. SBP ⩾ 160 mmHg and/or DBP ⩾ 110 mmHg.14
Severe hypertension in pregnancy has lower thresholds than in non-
pregnant adults because pregnant women are known to develop
hypertensive encephalopathy at lower blood pressures.15
Types of Hypertension in Pregnancy
• According to the CDC, blood pressure measurements that are greater than or
equal to 140/90 millimeters of mercury indicate high blood pressure.
• (NHBPEP, 2000), There are four(4) categories of hypertension disorder in
pregnancy as recommended of the National High Blood Pressure Education
Group on High Blood Pressure in Pregnancy.
• Chronic hypertension.
• Gestational hypertension.
• Preeclampsia superimposed on chronic hypertension
• Preeclampsia-Eclampsia
• A person
may have chronic hypertension before pregnancy, whereas gestational
hypertension only occurs during pregnancy.
• However, gestational hypertension may sometimes persist after the pregnancy
to become chronic hypertension.
 Chronic hypertension
• This means having high blood pressure before you get pregnant or 2weeks before
gestation
• Women who have chronic hypertension either had high blood pressure before becoming
pregnant or developed it within the first half, or 20 weeks, of their pregnancy.
• It is possible for a woman to develop a subtype called chronic hypertension with
superimposed preeclampsia.
• Women with this condition have high blood pressure and can possibly develop an
abnormal amount of protein in their urine, or proteinuria. The presence of protein in the
urine can indicate problems with the kidneys. Women may also have changes in liver
function.
 Gestational hypertension.
• Gestational hypertension only occurs during pregnancy and without the presence of
protein in the urine or changes in liver function. Women usually develop this condition
in the second half, or after the first 20 weeks, of their pregnancy.However some women
with gestational hypertension have a higher risk of developing chronic hypertension

• This form of high blood pressure is typically temporary and tends to go away after
childbirth. However, it can increase a woman’s risk of developing high blood pressure
later in life.
• In some cases, the blood pressure will remain elevated after the pregnancy, resulting in
chronic hypertension
 Preeclampsia superimposed on chronic hypertension
• Preeclampsia is a high blood pressure condition that women can develop during pregnancy or after
giving birth. It is a serious condition that can have severe consequences. It usually occurs in the third
trimester. It rarely occurs after delivery, but it is possible.
• About 20-25 of women with chronic hypertension develop preeclampsia in pregnancy. It is a pregnancy
complication charactized by high blood pressure and signs of damage to another organ/system, most
often liver and kidney. It occurs after 20weeks gestation. It is clinically defined as hypertension and
proteinuria.(Singh and Loscalzo, 2014).

• Women who develop a mild form of preeclampsia may not experience any symptoms.
• If symptoms of preeclampsia do develop, they can include.
• Blurred vision
• Nausea and vomiting
• Proteinuria
• Abdominal pain.
• Dizziness and headache
• Shortness of breath.
• Excessive swelling of the face and hand
• High blood pressure.
• Irritability
• Weight gain dur to fluid retention.
 Preeclampsia-Eclampsia.
• Preeclampsia-Eclampsia: Women with preeclampsia can
develop seizure. It can be as a result of uncontrolled
preeclampsia. It is a medical emergency
 Signs and Symptoms

According to Kasper et al, (2015), the signs and symptoms includes:

• Edema.
• Weight loss.
• Headache
• Dizziness.
• Proteinuria.
• Pains in upper part of the stomach.
• Blurred vision
 Risk factors of Maternal
Hypertension

• Maternal personal risk factor

• Maternal medical risk factor
•
 Maternal personal risk factors includes.
• First pregnancy
• Obesity
• Family history of hypertension
• Chronic hypertension
• Age younger than 18 years or older than 35 years.
• Interpregnancy interval less than 2years or longer than 10years
Maternal medical risk factors:
• Obesity
• Thrombophilis.
• History of migraine.
• Renal disease.
• Chronic hypertension.
• Systemic lupus erythematous
Complication of Hypertension in
Pregnancy

This occurs on the mother and on the baby.

For the mother:
• Liver problem.
• Casarean delivery.
• Need for labor induction.
• Placental abruption ( placental separating from the wall of the
uterus causing bleeding in mother and distress on bio) ( Creang
al, 2014) .
For the Baby ( According to MacDonald. 2014):
• Preterm delivery: Birth that happens before 37weeks of
pregnancy.
• Low birth weight: Hypertension makes it difficult for baby
to get enough oxygen and nutrients to grow.
 Treatment

The treatment includes the following

• Medical procedure: Labour induction
• Surgery: Caesarean section
• Dietary Supplement
• Drug Therapy: Drugs to be aministered depends on the type of hypertension, it's severity,drug
interaction,comorbidities and drug reaction of the woman.
•
• Drugs may include:
• Centrally acting α2-adrenergic receptor agonist: Methyldopa
• Peripherally acting adrenergic-receptor antagonists: Labetalol
• Calcium channel blockers: Nifedipine
• Direct vasodilators: Hydralazine
• Magnesium Sulphate
 Prevention
Making simple lifestyle changes, such as getting more exercise and eating a more
balanced diet, can help prevent high blood pressure.

Some ways to lower the risk of high blood pressure during pregnancy include.
• Limiting salt intake.
• Staying hydrated.
• Eating a balanced diet that is rich in plant-based foods and low in processed foods.
• Getting regular exercise.
• Getting regular prenatal checkups.
• Avoiding smoking cigarettes and drinking alcohol.
• Medical professionals tend to recommend that people have regular blood
pressure screening, especially when they have risk factors, so that they can begin
to treat it early.
 Reference

• Brown M.A,Revter L,Smith B,Baddle M L,Morris.R,Withwort

J .A. (1994). Measuring blood pressure in pregnant women: A
comparison of direct methods.Am J Obstet Gynaecol.
• Report of the National High Blood Pressure Education Program
Working Group on High Blood Pressure in Pregnancy. (2000).
Am J Obstet Gynaecol
• Singh AK, Lascalzo J. (2014). The Essential and Secondary
Hypertension: The Brigham intensive review of internal
medicine second edition: Oxford university. 621-635
• American College of Obsterican and Gynecologist. (2019).
Preeclampsia and high blood pressure during pregnancy
• Taylor R.N, de Groot C.J, YK et al. (1996). American College
of Obsterican and Gynecologist Hypertension in Pregnancy
ACOG Technical Bulletin. No. 219 Washington DC.
• Kasper, D.L, et al. (2015). EDS Harrison principle of internal
medicine, 19th ed. United States, McGraw hill Education.
• Creanga AA, Berg CJ, KOJY, Farr SL, Tong VT, Bruce FC et
al. Maternal mortality and morbidity in the United States:
Women Health (Larchnat): 2014:23(1):3-9.
• MacDonald-WallisC, Tilling k, Trader A, Nelson SM,
Lawlor DA. (2014). Association of blood pressure change
in pregnancy with fetal growth and gestational age at
delivery: Finding from a prospective cohort. 63(1): 36-44.