Chronic hypertension in pregnancy is now considered mild if blood pressures do not exceed 159 mmHg systolic and 109 mmHg diastolic and severe if pressures are ≥ 160 mmHg systolic or 110 mmHg diastolic, although controversy also exists as to the most appropriate cutoffs for this definition.Because chronic hypertension can progress to more severe forms of disease, it is important to accurately diagnose the condition early, ideally prior to pregnancy, and initiate management to control parental blood pressure. This is often difficult, as many reproductive individuals may not regularly visit the doctor and, when pregnant, may initially present for prenatal care in the second trimester. Pre-eclampsia and eclampsia
Preeclampsia is a medical condition which usually develops after 20 weeks of gestation and traditionally involves both newly increased blood pressure (blood pressure > 140/90 mmHg) and proteinuria. Preeclampsia is a leading cause of fetal complications, which include low birth weight, preterm birth, and stillbirth. Women with preeclampsia are encouraged to deliver the child after 37 weeks of gestation to minimize the risks of the severe complications.Preeclampsia can also be diagnosed if a woman has both increased blood pressure and 1 or more signs of significant organ damage. Signs of significant organ damage include:
Severely elevated blood pressure (blood pressure > 160/110)
Thrombocytopenia
Increased or rapidly elevating levels of creatinine in the blood
Increased liver enzymes
Pulmonary edema
New or persistent headaches that do not respond to pain medication
Blurred or altered visionIf a woman with preeclampsia has any of these signs of significant organ damage, then her condition is classified as preeclampsia with severe features.
Certain medications may not be ideal for blood pressure control during pregnancy such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (AII) receptor antagonists. Controlling weight gain during pregnancy can help reduce the risk of hypertension during pregnancy.There is limited evidence to suggest that calcium supplementation may reduce the risk of pre-eclampsia or stillbirth but it is unclear if it has other benefits. Management
The only way to definitively treat a hypertensive disease of pregnancy (i.e. preeclampsia/eclampsia, gestational hypertension, etc. ) is to deliver the fetus. This prevents further development of complications related to the disorder in both the mother and the fetus. Therefore, the first line approach to management of these conditions is to consider induction of preterm labor. The exact timing of when to induce labor is dependent on the severity of symptoms related to the hypertensive disease, as well as the medical condition of both the mother and the fetus. Generally, in mothers with preeclampsia, labor is induced once the gestational age is >37 weeks. In patients with preeclampsia with severe features or eclampsia, labor is induced once the gestational age is >34 weeks. In patients with gestational hypertension and no other signs of severe disease, labor is generally induced at term.In cases where the fetus has not yet reached a safe gestational age to be delivered, management is focused on managing symptoms to give the fetus more time to mature.