PIH / Pre- Eclampsia

  • Pregnancy-induced hypertension (PIH): is a condition characterized by high blood pressure (more than 140/90 mmHg for 3 consecutive times) during pregnancy with or without proteinuria emerging after 20 weeks of pregnancy.

  • Gestational hypertension (GH): is diagnosed in women whose blood pressure reaches ≥140/90 mmHg for the first time during pregnancy (after 20 weeks gestation), but without proteinuria.

  • Preeclampsia (PE): PIH / Pre- Eclampsia is a condition that typically occurs after 20 weeks of pregnancy. It is a combination of:

    • Raised blood pressure (hypertension) (blood pressure ≥140/90 mmHg)
    • Protein in your urine (proteinuria).

  • Eclampsia (E): Eclampsia is defined as the onset of convulsions in a woman with Pre eclampsia that cannot be attributed to other causes. The seizures are generalized and may appear before, during, or after labor.

Pre – Eclampsia as a Hypertensive Disorder of Pregnancy

Hypertension in pregnancy

Hypertension in pregnancy

  • The exact cause of PIH / Pre- Eclampsia is not understood.

  • Although central to its development is believed to be the defective development of small arteries ( blood vasculature ) in placenta .(impaired trophoblastic invasion of the maternal spiral arteries and their conversion from narrow muscular vessels to wide non-muscular channel in placenta )

Causes of Pregnancy-Induced Hypertension

Causes of Pregnancy-Induced Hypertension

  • Mothers with
    • First pregnancy
    • Pre-existing hypertension (high blood pressure)
    • Kidney disease, obesity and Diabetes.
    • PIH in a previous pregnancy.
    • Mother’s age younger than 20 or older than 40.
    • Multiple fetuses (twins)
    • Unknown.

  • PIH / Pre- Eclampsia is common, affecting between two and eight in 100 women during pregnancy. It is usually mild and normally has very little effect on pregnancy.
  • However, in a small number of cases, it can develop into a more serious illness. Severe PIH / Pre- Eclampsia can be life-threatening for both mother and baby.
  • Severe PIH / Pre- Eclampsia may progress to convulsions or seizures before or just after the baby’s birth. These seizures are called eclamptic fits and are rare, occurring in only one in 4000 pregnancies.

  • The symptoms of severe PIH / Pre- Eclampsia include:
Symptoms of severe Pre-Eclampsia

Symptoms of severe Pre-Eclampsia

  • These symptoms are serious and you should seek medical help immediately.
  • In severe PIH / Pre- Eclampsia, other organs, such as the liver or kidneys, can sometimes become affected and there can be problems with blood clotting also.

  • Use of uterine artery colour doppler at 11-14 weeks of gestation is a helpful and non-invasive tool in prediction of preeclampsia at term in normal pregnancies.
  • Hence all pregnancies should be screened with uterine artery doppler at 11-14 weeks of gestation for identifying cases that could develop preeclampsia and hence introduce early interventions in the form of tab ecosprin 150 mg to prevent and reduce the severity of the same.
  • Antenatal ultrasound may show intrauterine growth restriction due to placental insufficiency.

  • Hypertension can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food.
  • This can result in low birth weight ( IUGR ). And less fluid around your baby ( oligohydramnios )
  • If the placenta is severely affected, your baby may become very unwell.
  • In some cases, the baby may even die in the womb. Monitoring aims to pick up those babies who are most at risk.

  • Currently, there is no sure way to prevent hypertension.
  • Some contributing factors to high blood pressure can be controlled, while others cannot be controlled.

  • If you are in high risk gp for developing pih ,
    • You should be advised to take low-dose aspirin 75 / 150 mg ( aspirin is commonly used to prevent blood clots forming in patient of heart attack or stroke ) once a day from 12 weeks of pregnancy, to reduce your risk.

  • If you are diagnosed with PIH / Pre- Eclampsia, you should attend hospital for assessment.
  • While you are at the hospital,
    • Your Blood Pressure will be measured regularly and you may be offered medication to help lower it.
    • Your urine will be tested to measure the amount of protein it contains and
    • You will also have blood tests done to assess involvement of other organs.
    • Your baby’s heart rate will be monitored and
    • You may have ultrasound scans to measure your baby’s growth and wellbeing.
    • You may be offered injection corticosteroids for lung maturity of baby .
  • If you are close to your due date and the baby is developed enough, your health care provider may want to deliver your baby as soon as possible.
  • If you have severe Hypertension, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely.
  • You are likely to be advised to have your baby at about 37 weeks of pregnancy, or earlier if there are concerns about you or your baby.

  • HELLP
Pregnancy induced hypertension signs & symptoms

Pregnancy induced hypertension signs & symptoms

  • PIH / Pre- Eclampsia usually goes away after birth.
  • However, if you have severe PIH / Pre- Eclampsia, complications may still occur within the first few days and so you will continue to be monitored closely.
  • You may need to continue taking medication to lower your blood pressure.
  • When you go home, you will be advised on how often to get your blood pressure checked and for how long to take your medication.

  • Overall, one in six women who have had PIH / Pre- Eclampsia will get it again in a future pregnancy.

Salt Restriction.

This information aims to helps you make the best decision regarding your care. It is not meant to replace advice from a doctor about your own situation.