High Blood Pressure and Pregnancy
What you should know about hypertension
But there are those who will argue that there is no such thing as mild PIH and advise delivery as soon as the baby is deemed lung-mature. If a patient has severe PIH, delivery will be indicated regardless of the gestational age, possibly creating peril for the baby. And in cases that are of intermediate severity, the judgment of the obstetrician will determine the decision—individualized for the patient’s unique situation.
The longer a patient is pregnant, the more severe PIH can become. This is not so much a matter of how long the patient has been pregnant, but rather how pregnant she is. For example, twins and triplets can cause PIH sooner than usual, and the severity can increase faster than usual. These are already high-risk conditions for premature delivery, so adding the complication of PIH makes a multiple gestation even more dangerous.
The flow sheet on how to handle hypertension in pregnancy is fairly straight-forward:
- If it’s chronic only, no changes need be made in the anti-hypertensive management unless the patient’s on ACE inhibitors. If the chronic hypertension worsens due to weight gain or other reasons, and there is no evidence of superimposed PIH, a change in blood pressure medicine is needed. Ultrasound can be useful in determining premature placental aging, appropriate growth of the baby, and appropriate amounts of amniotic fluid.
- If the hypertension is mild PIH, cases should be induced once cervical ripeness indicates the likelihood of a successful induction, any time after 37 weeks and definitely at 39 weeks; or alternatively, close observation with non-stress testing in anticipation of a spontaneous labor. Ultrasound can be useful in determining premature placental aging, appropriate growth of the baby, and appropriate amounts of amniotic fluid. Repeated 24-hour urine samples are helpful in determining the severity of disease.
- If it is severe PIH, the obstetrician must weigh the risk versus the benefit of delivering early. The mother’s health and the prematurity of the baby must be balanced, but there will be no perfect decision. Many perinatologists feel, however, that when the incubator (mom) is sick it is time to make a change. Especially if in doing so you’re taking a step to resolve the problem.
Pregnancy and delivery are natural events, but complications such as chronic hypertension and PIH are why prenatal care is so important. Watchful waiting is better than just waiting.
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