How to treat high blood pressure during pregnancy

pre-eclampsia (Pregnancy-related high blood pressure, Pregnancy-related hypertension, Pregnancy-related hypertension)

Preeclampsia is a pregnancy disease in which the woman has high blood pressure (hypertension) and excretes too much protein in her urine. It occurs in around 5% of all pregnancies, and somewhat more common in late pregnancies over 35 years of age. Possible complications of preeclampsia are eclampsia or HELLP syndrome, which can be life-threatening for both mother and child.

Short version:

  • Around every tenth pregnant woman develops high blood pressure (hypertension) during the course of pregnancy.
  • Values ​​above 140/90 mmHg are considered to be abnormally elevated in pregnant women, with the second, diastolic value being particularly important.
  • In particularly severe cases, preeclampsia can take a life-threatening form in which the mother also has neurological symptoms. This is known as eclampsia and occurs in about 1 in 2,000 to 3,500 births.

High blood pressure in pregnancy

If a woman suffers from high blood pressure during pregnancy, a distinction must first be made between two forms:

  • The blood pressure values ​​were already increased before pregnancy. This is known as chronic or pregnancy-independent hypertension. There are many possible causes for this. You can find more information here.
  • The high blood pressure occurs for the first time in pregnancy; this is known as pregnancy-induced hypertension or gestational hypertension. The exact causes for this have not been clarified in detail, but there seems to be a connection with the metabolic change and the increase in blood volume during pregnancy. The risk of developing gestational hypertension is increased in overweight women, as well as women with family members who have high blood pressure and women with diabetes.

Both forms of high blood pressure can develop into preeclampsia in the course of pregnancy if, in addition to the increased blood pressure, there is an increased excretion of protein in the urine (proteinuria). Therefore, any form of high blood pressure during pregnancy must be closely monitored.

The risk of developing preeclampsia and a severe course is higher, the earlier in pregnancy the blood pressure increases.

What causes preeclampsia?

Preeclampsia is a clinical picture in which the maternal organism is unable to adapt to the numerous physiological changes of pregnancy. Several complex factors, such as immunological and hormonal influences as well as environmental factors, play together in the development, but the exact causes are in some cases still unclear.

What is certain is that this disease leads to a generalized narrowing of the blood vessels, which leads to high blood pressure and subsequently to circulatory disorders of tissues and organs, which restricts the oxygen supply.

Inflammatory processes and coagulation activation occur in the vessels throughout the body, damage to the inner vascular layer and loss of vascular elasticity. The consequence of the changed blood composition is a disorder of the kidney function with increased protein excretion (proteinuria) as well as impairment of other organ functions and the placenta (placental insufficiency).

Some diseases such as diabetes, high blood pressure, heart disease, obesity, autoimmune diseases, and chronic kidney disease increase the risk of preeclampsia. The higher age (over 40 years) or very early age of the pregnant woman as well as the "first" pregnancy can also increase the risk.

What are the symptoms of preeclampsia?

Preeclampsia is noticeable through increased blood pressure (higher than 140/90 mmHg) and increased protein excretion in the urine (more than 300 mg / 24 hours).

++ More on the topic: Symptoms of preeclampsia ++

When does therapy have to be initiated?

The clinical pictures of preeclampsia, eclampsia and HELLP syndrome are among the most dangerous complications of pregnancy if they are not recognized and treated in time. For this reason, the blood pressure and protein excretion in the urine are regularly measured for every pregnant woman as part of the preventive medical check-ups. In addition, every clinical warning sign (e.g. edema, neurological symptoms, upper abdominal pain) should be taken seriously.

++ More on the topic: When does therapy have to be initiated? ++

forecast

If preeclampsia or eclampsia is detected and treated in good time, permanent damage or even death will rarely occur. However, there is a certain risk of developing preeclampsia or full-blown eclampsia again in subsequent pregnancies.

prevention

Go for a pregnancy check-up regularly! Your blood pressure and urine will always be checked. Regular pregnancy examinations can identify any risk of eclampsia in good time.

Women who have already had preeclampsia in a previous pregnancy or in whom there is evidence of the development of preeclampsia very early in the pregnancy should be examined and cared for beyond the routine check-ups.

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Authors:
Dr. med. Kerstin Lehermayr
Medical review:
Dr. med. Alexander Just
Editorial editing:
Philip Pfleger

Status of medical information:
swell

Stauber M, Weyerstahl T: Gynecology and Obstetrics, Dual Series, 4th edition, 2013

Information sheet from the Medical University of Vienna, University Clinic for Gynecology, Department of Obstetrics and Feto-Maternal Medicine: Hypertension in Pregnancy; Version 02; valid from April 27, 2012; http://www.meduniwien.ac.at/frauenheilkunde/SOP/GH/Hypertonie_in_der_Schwangerschaft_2.pdf

Geist C., Harder U., Stiefel A .: Midwifery - textbook for pregnancy, childbirth, postpartum and work; Hippokrates Verlag in MVS Medizinverlage Stuttgart; 5th edition 2012

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ICD-10: O14, O14.0, O14.1, O14.9