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Hypertension In Pregnancy

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					High Blood pressure in pregnancy is a major cause of maternal death and
poor foetal outcomes. It is all the more dangerous because it does not
cause any symptoms till late in the course of disease.It is estimated
that 5-10% of pregnant women have higher blood pressures during
pregnancy. However in most of the women, it reduces back to normal by 12
weeks of pregnancy. So by definition high blood pressure in pregnancy is
taken as BP> 140/90 mm of hg.The causes and natural history are poorly
understood. It is believed that the hypertension in pregnancy is caused
by some inherent problems with the placenta and some circulating factors
which increase the blood pressure. A complete description of these causes
is beyond the scope of this article, but it would suffice to know that
hypertension in pregnancy is caused by unspecified neuro hormonal
changes.High blood pressure in pregnancy is silent till the very end when
it may present with catastrophic consequences. However some of the
symptoms which may be seen are swelling of feet, headache, blurred
vision, pain in the right side of abdomen (over liver).Hypertension in
pregnancy is classified in to 3 categories based on presence or absence
of protein in urine and fits. Simple rise in B.P> 140/90 without
protein in urine is called pregnancy induced hypertension. Any degree of
B.P with protein in urine is called Preeclampsia. And any B.P with fits
is called eclampsia.Since high BP in pregnancy causes symptoms late, the
only way to detect this is by regular ante natal checkups. Women must get
their B.P checked every month while they are pregnant. This is the only
way to diagnose high blood pressure in pregnancy and save avoidable
deaths.The presence of protein in urine and fits are ominous signs and
treatment should be instituted immediately. In a patient with eclampsia,
termination of pregnancy is the only option irrespective of the age and
maturity of the child. In eclampsia, fits are controlled using magnesium
injections.The treatment of hypertension in pregnancy along with protein
in urine depends on the severity of B.P and proteinuria. Severe raise in
B.P should necessitate treatment with blood pressure lowering drugs. Many
such drugs are harmful for the baby and hence such blood pressure
lowering drugs should only be taken under medical supervision. There are
many drugs which can be used for lowering blood pressure. Some of them
include Methyldopa(Aldomet), Labetolol and hydralizine.High blood
pressure in pregnancy without any proteinuria or fits is managed
conservatively. Women are admitted in a ward and advised absolute bed
rest. High protein and low salt diet is advised. They may also be
prescribed medicines to help them relax and sleep well.There are other
non pharmacological methods to prevent high blood pressure in pregnancy.
Eating a well balanced, nutritious diet will reduces chances of high
blood pressure in pregnancy. So does calcium supplementation. A pregnant
lady should remain calm and composed at all times. Yoga and meditation
lower stress and reduce B.P. Pregnant women must get at least 30 min of
moderate physical activity (walking is the best exercise in pregnancy).
This will have a beneficial effect on B.P.No specific diet has been
proven superior in preventing hypertension in pregnancy. However it's
advisable to maintain salt intake at the appropriate levels required.The
key to prevent deaths due to hypertension in pregnancy is early
diagnosis. It is important for pregnant women to understand the benefits
of regular ante natal checkups and should follow the schedule carefully.
Early diagnosis of high blood pressure in pregnancy will allow initiation
of treatment and save precious lives.

				
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