Hypertension affects 5-10% of pregnancies  and may be classified into three groups based on both the time of onset and clinical manifestations:
Pre-eclampsia is a syndrome that affects 3% of pregnancies . It can be defined as PIH with proteinuria (>300 mg of protein in 24hrs) and with or without oedema  that presents after 20 weeks gestation in women with no previous hypertension.
Pre-eclampsia has considerable variability in presentation. The condition may be asymptomatic, so regular antenatal screening is important. On the other hand symptomatic pre-eclampsia may present with:
The severity of pre-eclampsia is based upon blood pressure. It is important to manage each patient individually with management based on disease severity.
The following breifly explains the management of the different degress of pre-eclampsia.
BP is between 140/90 and 149/99 mmHg
BP is between 150/100 and 159/109 mmHg
Severe pre-eclampsia is either-
a)BP>160/110 mmHg with proteinuria (>0.5g/day) or;
b) BP 140/90 mmHg with proteinuria and one or more symptoms
The only cure is delivery of the fetus.
At the time of labour - prescribe H2 blockers
It is important to monitor the patient after delivery as there is still a risk of developing eclamptic fits post partum .
Reducing the risk of pre-eclampsia:
Hypertension in previous pregnancy
Autoimmune disorder - systemic lupus erythematosus, antiphospholipid syndrome
Chronic kidney disease
How will pre-eclampsia affect future pregnancies?
The risk of developing the following complications in a future pregnancy in women who have had pre-eclampsia:
Pre-eclampsia may progress to eclampsia if not properly managed. Pre-eclamptic women are at risk of developing eclampsia; generalised seizures that can result in maternal death from the development of organ failure- renal, liver or heart. It can also cause cerebral haemorrhage and may also result in intrauterine death of the fetus. It is therefore important to prevent the onset of eclampsia in women who are thought to be at risk. The condition occurs more commonly in first pregenancy but can occur in multiparous women .
Careful management of the patient is important
HELLP - Haemolysis, elevated liver enzymes and low platelets
This is a variation of severe pre-eclampsia or may be regarded as a complication of the condition. It occurs in 10-20% of patients with severe pre-eclampsia. 0.5-0.9% of pregenancies develop HELLP syndrome .
Haemolysis is the result of microangiopathic haemolytic anaemia.
Raised liver enzymes is due to liver involvement, and haemolysis
Thrombocytopenia results from increased platelet consumption. Activated platelets attach to vascular endothelial cells that are damaged which causes platelet turnover to increase .
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(3) Collier JAB. Oxford handbook of clinical specialties. 8th ed. Oxford: Oxford University Press; 2009.
(4) NICE. Hypertension in pregnancy. The management of hypertensive disorders during pregnancy, NICE clinical guideline 107. Aug 2010; Available at:www.nice.org.uk/nicemedia/live/13098/50418/50418.pdf.
(5) Symonds EM, Symonds IM. Essential obstetrics and gynaecology. 4th ed. Edinburgh: Churchill Livingstone; 2004.
(6) Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy & Childbirth 2009;9:8.
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