Can I prevent BP rise in pregnancy ?
Pregnancy with raised BP is not so good and can be life-threatening. We had discussed some basic nuances about raised BP during pregnancy which I have referred to as HTNP (hypertension In pregnancy ). And as promised here I am with the second blog in continuation which will deal with ::
How can I prevent the severity of hypertension and what are the at-risk situations?
Yes, friends, I haven’t written how can I prevent HTNP in the first place !! The reason is in many instances we actually do not know the exact cause, as to why the HTNP happens. So, what we can therefore do is try and prevent it’s severity and grave consequences. But looking into the better-understood basis of this disease process it is tempting to say that yes we can prevent the disorder too and therefore I decided to write this article to share the prevalent risk factors identified. These are some factors which can be prevented with careful planning and proper measures and would definitely be easy to then curb the menace of this dreadful disease of HTNP
Some women definitely seem to be at risk of developing the HTNP and these are enlisted here as factors
Age : extremes of age : when very young that is less than 20 and more than 35 age groups are at risk of developing HTNP
BMI: Body Mass Index is the proportion of weight to the woman’s height and if found to be less than 18 or more than 30 is associated with higher possibilities of HTNP
Underlying diseases such as known kidney disorder, anaemia ( haemoglobin less than 11g/dl ), Diabetes, thyroid abnormality, obesity, abnormal blood pressure before conception, any autoimmune disease in the mother such as SLE, Rheumatoid arthritis, Antiphospholipid syndrome, PCOS, Pregnancy diabetes ( gestational diabetes )
Genetic predisposition wherein there has been a similar disease in the family or any of the above-mentioned diseases
Nutritional deficiencies such as folic acid deficiency, calcium and vitamin D deficiency, protein deficient diet can predispose the woman to HTNP
Many a times cause is not known and it can be an adverse response to pregnancy
The short interval between marriage and first conception is being identified as a risk factor as well as increased interval between the previous pregnancy and the current conception also is one such a risk associated.
Are there any tell-tale signs during pregnancy which can help us identify the possibility of HTNP early ?
Following are the EMERGENT signs which the patient must share with the doctor and the doctor must monitor
Change in the blood pressure compared to the previous readings
Sudden swelling on the body especially on the face
Sudden swelling on the feet
Urine examination revealing protein in the urine
An excessive headache, blackouts and giddiness
Feeling of being sick
Are there any early warning signs that I need to know about?
Yes, one must report to the facility when one feels giddy, feels like vomiting, has a headache, blackout, sudden unconsciousness, fit, less or no urine, any pain in the tummy, bleeding or anything that one feels is bothersome.
What is my responsibility as a patient?
When the blood pressure is recorded to be abnormal the doctor usually suggests admission for observation. This way your resting blood pressure as well as over the period variations can be recorded. In addition, it gives the doctor the opportunity to observe your and baby’s condition for which some laboratory tests and sonography may be ordered. In addition, the doctor will discuss with you in details about the consequences and medications for the condition which you must listen to carefully, make a note of and follow diligently. Patient compliance and cooperation goes a long way in averting the adverse outcomes and helps in early detection of the disease.
Its indeed disheartening to note that many women decide not to get admitted for some trivial reasons and many a times land in problems which can be life-threatening( an example is depicted below )
How severe is the problem of HTNP in our country?
Nearly 10-15 % of mothers seem to get afflicted with this disorder and it needs to be therefore focused upon. In fact, the serious short-term consequences associated and the long-term consequences which commonly ensue mandate that the antenatal care has to be taken up scientifically with proper vigilance and the correctly timed investigations.
What are the serious consequences of HTNP?
Very high blood pressure can cause seizures or convulsions (fits) and this condition is called eclampsia and is responsible for sometimes even death in the mother. It is observed that some important brain tissue changes occur due to high blood pressure and cause such fits. In addition, there can be bleeding in the brain which can cause permanent damage and sometimes death. It can cause the heart, lungs kidneys and liver to fail and lead to serious complications. Excessive bleeding due to the separation of the placenta or due to reduced platelets and blood thinning can also occur.
The baby can be growth restricted, may have to be delivered prematurely to save the mother’s life or may succumb due to a continuous compromised blood supply.
The often encountered malady is many times women may have all the other symptomatology but the blood pressure may be normal and this is called as ‘Atypical preeclampsia’ truly a condition which is a huge challenge faced by both he health care provider as well as the mother.
Are there any earlier tests that can be performed to determine the occurrence of this complication?
Careful history taking, clinical assessment, risk stratification, timely screening tests such as double marker test, uterine Artery dopplers at specific times help in predicting the disease to some extent. These tests do better especially in mothers which have been classified as high-risk mothers.
Can I ensure that I don’t get the disease?
To an extent planned pregnancies and proper antenatal care helps in reducing the occurrence to a larger extent. Definitely, a proper and a vigilant antenatal care can prevent serious disease and definitely prevent eclampsia.
Following are some cases that we experienced and which I feel could have been avoided
Geeta is a first-time pregnancy mother who came for care at 2 months of conception. She was obese and was advised to undergo the screening test which she decided not to perform. She was also given dietary counseling based on her recall and she did not follow the care plan as designed. She also was detected with anaemia as she didn’t take her supplements on time and regular. At 7 months she developed swelling all over body and was found to have raised blood pressure. The doctor advised her admission for observation and laboratory tests which she refused as she wanted to discuss with her relatives. Her seniors in the family decided against hospitalisation and she did not inform the doctor. After 5 days she was brought in with seizures and a complication of HTNP which is called as HELLP Syndrome. In this condition the platelets drop substantially, the blood cells undergo fragmentation and the liver function gets seriously affected. Geeta was admitted in HDU ( High Dependency Unit ), was given medications to control her blood pressure and fits. further investigation revealed that the baby had succumbed and she was to be now readied for delivery and she was at severe risk of heavy bleeding during the process and possibility of needing a removal of the womb surgically. Alas wouldn’t it have been better if Geeta had taken medical advice more seriously !!
This article is essentially being written to help women understand the reasons why doc tell you certain tests and admissions. The intent is not to instill any kind of fear but to empower with the knowledge to better understand your own health during pregnancy. Of course, rational testing is mandatory and so is a correct interpretation.
Happy reading and feel free to ask queries
Dr Girija always at your service