Gestational hypertension

Gestational hypertension or pregnancy-induced hypertension (PIH) is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine.

Conditions

There exist several hypertensive states of pregnancy:

Gestational hypertension

Gestational hypertension is usually defined as having a blood pressure higher than 140/90 without the presence of protein in the urine and diagnosed after 20 weeks of gestation.

Preeclampsia

Pre-eclampsia is gestational hypertension (blood pressure greater than 140/90) plus proteinuria (>300 mg of protein in a 24-hour urine sample). Severe preeclampsia involves a blood pressure greater than 160/110, with additional medical signs and symptoms.

Eclampsia

This is when tonic-clonic seizures appear in a pregnant woman with high blood pressure and proteinuria.

HELLP syndrome

This is a dangerous combination of three medical conditions: hemolytic anemia, elevated liver enzymes and low platelet count.

Acute fatty liver of pregnancy

This is sometimes included in the preeclamptic spectrum.

Pre-eclampsia and eclampsia are sometimes treated as components of a common syndrome.^[1]

Risk factors

• Family history of pre-eclampsia
• Pre-existing hypertension
• Renal disease
• Diabetes mellitus
• Obesity
• Placental Abnormalities:

1. Hyperplacentosis:Excessive exposure to chronic villi.

2. Placental Ischemia.

• Multiple gestation (twins or triplets, etc.)
• Age 35 or greater
• Adolescent pregnancy
• New paternity
• African-American race
• Thrombophilias Thrombophilias(Anti phospholoipid syndrome,Protein C,S deficiency,Factor V Leiden)

Etiopathological Factors for Pre-eclampsia

• Failure to trophoblast invasion(abnormal Placentation)
• Vascular Endothelial Damage
• InflamatoryMediator(cytokines)
• Immunological intolerence between Maternal and Fetal tissues
• Coagulation Abnormalities
• Increased Oxygen free radicals
• Genetic Predisposition(Polygenic Disorders)
• Dietary Deficiency or excess.

Treatment

There is no specific treatment, but is monitored closely to rapidly identify pre-eclampsia and its life-threatening complications (HELLP syndrome and eclampsia).

Drug treatment options are limited, as many antihypertensives may negatively affect the fetus; methyldopa, hydralazine and labetalol are most commonly used for severe pregnancy hypertension.

The fetus is at increased risk for a variety of life-threatening conditions, including pulmonary hypoplasia (immature lungs). If the dangerous complications appear after the fetus has reached a point of viability, even though still immature, then an early delivery may be warranted to save the lives of both mother and baby. An appropriate plan for labor and delivery includes selection of a hospital with provisions for advanced life support of newborn babies.

References