Vital Health International
Nurse checking blood pressure of a pregnant woman in ambulances, close up

Hypertension in Pregnancy 1

It was Lydia’s first pregnancy and she was experiencing a cocktail of emotions. She had attended some ante-natal screenings and was told that she was progressing nicely. She experienced almost all the classic symptoms of pregnancy, such as fatigue, nausea, vomiting, breast tenderness, etc., but nothing significant was recorded within the first few weeks of her pregnancy.

However, at the beginning of her second trimester, she started experiencing severe headaches, blurry vision and occasional shortness of breath.  She also noticed swelling in her lower extremities. The “elders” told her that it was normal. ‘Stay off your feet’, ‘reduce your salt intake’, ‘take less water’, ‘drink ‘ugu’ and malt’, ‘minimize physical activity’- These and more were some of the ‘advice’ that she got as she went about her daily life; unsolicited for in many cases.  She started to get used to hearing those and tried almost everything; anything to keep away the terrible feelings she started having few weeks ago. However, despite her compliance with these recommendations, no significant improvement was noted.

Few days into her third trimester, her Doctor, Liv had placed her on bed rest. Her symptoms had not improved, and her blood pressure was consistently high. Dr. Liv decided it was best to schedule Lydia for an emergency C-section.  Lydia sat there trying to smile as she struggled with her pains, holding tightly to her husband’s hands, and listening to Dr. Liv ramble through why she thought it was a decision safe for her and the baby. Barely 5 minutes into the conversation, Lydia passed out with a seizure of which she had no recollection after it resolved.

Lydia’s story is very much like the stories of millions of women across the world who experience some form of the spectrum of hypertensive emergencies in pregnancy. While these hypertensive disorders in pregnancy can be fatal to both the mother and the baby, effective clinical management can help mitigate that risk.

To understand what counts as High Blood Pressure or Hypertension, read my previous blog on Hypertension. The following are the types of hypertensive disorders that can occur during pregnancy

  • Gestational hypertension (pregnancy induced hypertension)

This happens among women who don’t have preexisting hypertension. The hypertension is induced by pregnancy as the name suggests. The high blood pressure develops in the second trimester. After the 20th week of pregnancy. In this excess protein isn’t observed in the urine. There is also no end organ damage.

  • Chronic hypertension

While high blood pressure that develops after the 20th week of pregnancy is known as gestational hypertension, chronic hypertension is defined as long standing high blood pressure. It is seen before the 20th week of pregnancy.

  • Preeclampsia

This pregnancy induced hypertension is characterized with either proteinuria (protein in the urine) or damage to another organ (usually the liver or kidney). Preeclampsia usually begins after the 20th week of gestation. It is more common among women who have preexisting hypertension, diabetes and chronic renal disease.

  • Eclampsia

This is a complication of preeclampsia. It is simply preeclampsia with maternal seizures (traditionally called names like ‘giri’ by the Yoruba people).

Food for thought

How do you manage cultural expectations (e.g., clip on safety pins, do not walk in the sun etc.) in pregnancy?

Please do not hesitate to share your personal experiences, we want to hear from you.

 

Follow us next week as we shed some more light on these conditions, and how to manage them.

Dr. JoeTakon

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