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in women with chronic hypertension. There is no way of preventing this type of hypertension. This condition occurs most often in young women with a first pregnancy. It occurs in about 5 percent to 8 percent of all pregnancies. placenta. It is clear that the condition affects blood flow to organs such as the kidneys. It is diagnosed when blood pressure readings are higher than 140/90 mm Hg after 20 weeks of pregnancy with normal blood pressure. Another type of high blood pressure is chronic hypertension . but regular prenatal care will usually catch it early. reducing the chances of complications. Some conditions may increase the risk of developing this. African-American women. Preeclampsia (also known as toxemia) is diagnosed when a woman with gestational hypertension also has increased protein in her urine.Definition: Gestational hypertension is high blood pressure that develops after the twentieth week of pregnancy. Gestational hypertension can develop into preeclampsia. WHO estimates 15% of pregnant women would have some form of hypertensive disorder in pregnancy. Causes and Risk Factors: The cause of gestational hypertension is unknown.high blood pressure that is present before pregnancy begins. labour and puerperium. diabetes. A major cause of maternal and perinatal morbidity and mortality in developing countries-12% of maternal mortalities worldwide. including the following: • pre-existing hypertension (high blood pressure) • kidney disease • diabetes • hypertension with a previous pregnancy • mother's age younger than 20 or older than 40 • multiple fetuses (twins. and in women who had hypertension in a previous pregnancy. brain. It is more common in twin pregnancies. triplets) • African-American race • Nulliparity • twin pregnancies • previous preeclampsia • obesity • hypertension • multiparous women conceiving with a new partner • extremes of age • black women • mother or sister with preeclampsia (suggests genetic factors) . in women over the age of 35. and liver.

vomiting • right-sided upper abdominal pain or pain around the stomach • urinating small amounts • changes in liver or kidney function tests Pathophysiology: The symptoms of PIH affect almost all organs. the cardiac system becomes overwhelmed and the heart is forced to pump against rising peripheral resistance. Poor placental perfusion results to inadequate nutrient and oxygen supply to the fetus. However. Symptoms may include: • increased blood pressure • headache • thirst • protein in the urine • edema (swelling) • sudden weight gain • visual changes such as blurred or double vision • nausea. In PIH there is a reduced responsiveness to blood pressure changes. specifically to the kidneys. pancreas. And if retinal hemorrhages occur. brain and placenta. Ischemia in the pancreas may cause epigastric pain and an elevated amylase-creatinine ratio. Spasm of the arteries in the retina leads to vision changes. liver. Vasoconstriction occurs and blood pressure increases dramatically. With elevated blood pressure. This in turn reduces the blood supply to the organs. The vasculature spasm may be caused by increased cardiac output that injures the endothelial cells of the arteries and the action prostaglandins (notably decreased prostacyclin and thrombexane). • renal disease • obesity and insulin resistance • polysystic ovarian syndrome (PCOS) • DECREASED risk in smokers • women who are pregnant for the first time • women who are pregnant with twins or triplets • women who have had gestational hypertension or preeclampsia in a prior pregnancy • women who are overweight before the pregnancy Signs and symptoms: The following are the most common symptoms of high blood pressure in pregnancy. . each woman may experience symptoms differently. it can result to blindness.

bilirubin. uric acid (increased) • hemoglobin (often elevated due to hemoconcentration) • platelets (decreased) • blood film for hemolysed cells • PTT. Extreme edema can lead to cerebral and pulmonary edema and seizures (as seen in eclampsia). Which is then further increased because as more protein is lost. Degenerative changes develop in the kidney glomeruli because of back pressure. This leads to increased permeability of the glomerular membrane. subsequent edema develops. Vasospasm in the kidney increases blood flow resistance. urea. INR. And because of tubular reabsorption of sodium along with fluid retention. D-dimer (increased) • ALT. in turn there is a decrease in urine output and clearance of creatinine. AST. The degenerative changes also result in lowered glomerular filtration rate. allowing the serum protein to escape in the urine. Treatment for gestational hypertension may include: • bedrest (either at home or in the hospital may be recommended) • hospitalization (as specialized personnel and equipment may be necessary) • magnesium sulfate (or other antihypertensive medications for gestational hypertension) . Laboratory Examination: • creatine. the osmotic pressure in the circulation drops and fluid diffuses from the circulatory system into the denser interstitial spaces to equalize pressure. fibrinogen. LDH (increased) • fragmented RBCs on smear urine dipstick • 2+ significant • 3-4+ severe 24 hour urine collection or a protein/creatinine ratio • >300mg/24hr • >5g/24hr severe Treatment: The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications.

If seizures begin. labetolol. A change in the number or frequency may mean the fetus is under stress. paralysis. • Hydralazine the drug of choice.type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel. Calcium is the antidote. respiratory distress. o Doppler flow studies . Seizures can occur up to 30 days postpartum. other drugs include methyldopa. • Avoid diuretics and ACE inhibitors due decreased intravascular volume.a test that measures the fetal heart rate in response to the fetus' movements. o biophysical profile . followed by continuous infusion. as it can cause toxicity. somnolence.a test that combines nonstress test with ultrasound to observe the fetus. Risk of seizures is highest in first 24 hours postpartum. Cesarean delivery may be recommended. in some cases. Medical Management: Medications • Always get repeat readings and assess the status of the baby before instituting medication treatment. called corticosteroids. • Further outpatient care and followup is important. and cardiac arrest. flushing.keeping track of fetal kicks and movements. This can include loss of reflexes. nitroprusside. nifedipine. • Magnesium sulfate (MgSO4) can be used for prevention of worsing eclampsia. o nonstress testing . • Do not give magnesium too quickly. • fetal monitoring (to check the health of the fetus when the mother has gestational hypertension) may include: o fetal movement counting . that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies) • delivery of the baby (if treatments do not control gestational hypertension or if the fetus or mother is in danger). requiring continued MgSO4 for 12- 24 hours. . • continued laboratory testing of urine and blood (for changes that may signal worsening of gestational hypertension) • medications. risk of uterine ischemia and teratogenicity for ACE. continue to treat with magnesium bolus.