Hypertension in Pregnancy
- Hypertension in pregnant is the elevation of the
blood pressure BP to be ≥ 140/90 mmHg.
- Hypertension complicates 10 – 20% of all
- It is the second leading cause of maternal death
and perinatal morbidity and mortality after severe
Grades of hypertension in Pregnancy
Normal blood pressure in pregnant woman is below
140/90 mm Hg.
- Mild: BP between 140/90 and 149/99 mm Hg.
- Moderate: BP between 150/100 and 159/109 mm Hg.
- Severe: BP 160/110 mm Hg or higher.
• Personal or family history of gestational hypertension or
• Obese mother.
• First time pregnancy (Nulliparity).
• Women younger than age 20 or older than age 40.
• Women with chronic renal failure or diabetes mellitus.
• Women how carry twins or multiple fetuses.
Risk Factors of Hypertension in Pregnancy
• Decreased blood flow to the placenta (poor placental perfusion):
- Slow growth fetus
- Low birth weight
- Preterm birth
- Normal vaginal labor become difficult or/and dangerous.
• Placental abruption (placenta separates from the inner wall of the uterus
before delivery) causing severe bleeding and damage to the placenta,
which can be life-threatening for both mother and baby.
• Premature delivery.
• Preeclampsia increases the risk of failure of liver, kidney, heart and blood
vessel (cardiovascular) disease.
• Stillbirth (The birth of an infant that has died in the womb)
• Cesarean delivery: Women with hypertension are more likely to have a
cesarean delivery than women with normal blood pressure.
Effects of Hypertension on Pregnancy:
Hypertensive disorders during pregnancy are classified
into 4 categories:
1- Chronic hypertension.
2- Gestational hypertension.
4- Preeclampsia superimposed on chronic hypertension.
Classification of hypertension
• Chronic hypertension is high blood pressure (BP ≥
140/90 mmHg) happen before pregnancy, or early in
pregnancy (before 20 weeks), or continue to have it
• Because high blood pressure usually doesn't have
symptoms, it might be hard to determine when it
1- Chronic hypertension
• Gestational hypertension is a high blood pressure that
develops after week 20 in pregnancy and goes away after
• There is no excess protein in the urine or other signs of
• Gestational hypertension is a relatively mild hypertensive
• The only potential complication of gestational hypertension
is the need to induce labor, resulting in a higher rate of a
2- Gestational hypertension
• Preeclampsia is an increase in blood pressure that typically starts after
the 20th week of pregnancy and related to increased protein in the
mother's urine (Proteinuria), and damage to another organ system.
• Sometimes chronic hypertension or gestational hypertension leads to
• Preeclampsia also known as toxemia or pregnancy-induced
• Preeclampsia can cause serious damage to the organs, including
placenta, liver, brain and kidneys.
• Eclampsia is a seizures (spasm) and/or coma happen due to
preeclampsia without other neurological condition. It can be deadly.
Symptoms of Preeclampsia:
• Increased blood pressure.
• Excessive protein in the urine.
• Sudden edema (swelling) in the hands, feet, and face.
• Sudden weight gain.
• Visual changes such as blurred or double vision.
• Nausea and vomiting.
• Changes in liver or kidney function tests.
• Severe headache.
• Decreased urine output.
• Upper abdominal pain.
• This condition occurs in women with chronic
hypertension; when their blood pressure develop
to be worse in the latter 20 week of pregnancy.
• In this type there excess protein in the urine or
other health complications during pregnancy.
4- Preeclampsia superimposed on chronic hypertension
• Non-pharmacological management
- Close supervision
- Limitation of activities
- Some bed rest in the left lateral position
- Avoid alcohol, drugs, caffeine, and smoking.
- Avoid stress and be nervous.
- Drink 8 glasses of water a day.
- Diet: Take food rich with Omega 3, Potassium, Calcium, and Magnesium to
decrease BP. Consume less salt and soda (Limit Sodium) and less fat.
• Delivery of the fetus and labor is the only “cure” for
preeclampsia. We should give the birth after the 34th week as
soon as possible to prevent any problems.
• If the pressure is high; it is better to induce labor or have
• Pharmacological management:
Hypertension medication during pregnancy can affect the baby; so that
drug treatment options are limited, but there are some drugs which
- 75 mg Aspirin from 12 weeks of gestation to delivery for
Hypertensive women who are: At high risk of pre-eclampsia, chronic
kidney disease, Diabetes mellitus, aged ≥40 years, multiple
- Calcium supplementation: appears to reduce the risk of high BP in
- In severe hypertension we can use; Hydralazine, Labetalol, and
• All women with hypertension in pregnancy should be offered an
appointment with a doctor at the postnatal check, around six
weeks after the baby is born.