Friday, May 20, 2011

Hypertension in pregnancy - Patient Education

Hypertension (high BP) is a common complication of pregnancy. It occurs in later months of pregnancy. It's progressive, albeit the rate of progress varies. 

The cause of hypertension is inherent in pregnancy itself, due to variation in mother's immunological reaction to the pregnancy. Mother's immunological status changes in pregnancy, in order not to reject the fetus, and to facilitate it's growth. In pregnancies with hypertension, this immune modulation is abnormal, causing widespread immunological changes in mother, which in turn causes systemic changes in maternal body. The obvious changes are hypertension, leaky capillaries, activation of coagulation system. They cause tissue edema (not just in legs, but all tissues are edematous), albuminuria, tissue hypoxia, and organ dysfunction. It affects all organs, including kidney, liver, lungs and brain.

Hypertension is associated with restriction of baby's growth, to some degree. Mother may have swelling in her legs.

If severe, hypertension can affect mother's kidney, liver, lung and brain. It can cause these organs to fail, and mother may throw up convulsions. Her coagulation (blood clotting) is affected and she may bleed profusely. Baby's growth, if severely affected, may cause it's death. Needless to say, hypertension is a dangerous conditions, if not properly followed up, and actions taken in due time.

Anti-hypertensive (tablets for BP) are only temporarily effective, the underlying disease progresses despite treatment. As the condition is caused by the pregnancy itself, the ultimate treatment is it's removal, that's baby's delivery. The obstetrician may wait as much as possible, to allow the baby time to mature, but not allow it to go to full nine months.

Restricting salt intake or fluid intake is not the treatment of the condition. Though absolute rest is not required, some restriction of activity may help. The mother can lie down in any position, not necessarily, in later position. She has to note her baby's movements, though she need not count them exactly. The obstetrician will call her frequently, to check her BP, to carry out urine and blood investigations, to do baby's ultrasound to note it's growth and detect it's restriction.With such due treatment, complications are rare and to a great extent avoidable.

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