- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Hypertension is defined as systolic blood pressure (SBP) above 140 mmHg or diastolic blood pressure (DBP) above 90 mmHg. In order to accurately diagnose arterial hypertension (AH), blood pressure (BP) must be elevated in at least two measurements taken at least 6 hours apart.
Preeclampsia is defined as the combination of hypertension during pregnancy and proteinuria (more than 300 mg of protein in a 24-hour urine sample).
Preeclampsia can present in a mild or severe form.
Sometimes, high blood pressure is present before pregnancy. In other cases, high blood pressure develops during pregnancy.
Gestational hypertension: Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. There is no excess protein in the urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia.
Chronic hypertension: Chronic hypertension is high blood pressure that existed before pregnancy, or that appears before 20 weeks of pregnancy. But because high blood pressure usually has no symptoms, it can be difficult to determine when it started.
Chronic hypertension with superimposed preeclampsia: This condition occurs in women who had chronic hypertension before pregnancy and then develop worsening high blood pressure and protein in the urine, or other complications related to blood pressure, during pregnancy.
Preeclampsia: Preeclampsia occurs when high blood pressure develops after 20 weeks of pregnancy and is accompanied by signs of damage to various organs, including the kidneys, liver, blood, or brain. Without treatment, preeclampsia can lead to serious — even life-threatening — complications for both the mother and the baby, such as the development of seizures (eclampsia).
Reduced blood flow to the placenta. If the placenta does not receive enough blood, your baby may get less oxygen and fewer nutrients. This can lead to slow growth (intrauterine growth restriction), low birth weight, or premature birth. Premature delivery may result in breathing problems, an increased risk of infection, and other complications for the baby.
Placental abruption. Preeclampsia increases the risk of this condition, in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding and may be life-threatening for both you and your baby.
Intrauterine growth restriction. High blood pressure can slow or reduce your baby's growth.
Damage to your other organs. Poorly controlled hypertension can damage the brain, heart, lungs, kidneys, liver and other major organs. In severe cases it can be life-threatening, and preterm delivery then becomes necessary.
Future cardiovascular disease. Preeclampsia can increase the risk of future heart and blood vessel (cardiovascular) disease. The risk of future cardiovascular disease is higher if you have had preeclampsia more than once or had a preterm delivery because of high blood pressure during pregnancy.
The goal of treatment is to maintain blood pressure at very good levels throughout the pregnancy, combined with continuous and thorough laboratory monitoring.
To manage high blood pressure in general, outside of pregnancy, antihypertensive medications are prescribed. Antihypertensive therapy is necessary in cases of severe hypertension, mainly to prevent cerebrovascular events.
Treating preeclampsia requires special caution, since aggressive management during pregnancy (e.g., sudden and uncontrolled decrease in blood pressure, early use of medication) may lead to maternal or fetal complications (e.g., stroke, myocardial ischemia, sudden intrauterine fetal death).
Pregnant women must be informed promptly by their obstetrician about the signs and symptoms of preeclampsia and report them immediately if they appear. They should also contact their doctor right away in cases of vaginal bleeding, severe abdominal pain, reduced fetal movements, or symptoms of threatened preterm labor.
Strict bed rest is no longer recommended, because it does not improve pregnancy outcomes and increases the risk of blood clots. Your doctor will tell you what level of activity is safe for you.
Preventive low-dose aspirin (usually 75 to 150 mg a day), ideally started before week 16, in women at moderate or high risk of preeclampsia significantly reduces the risk of developing it. More on the use of Salospir in pregnancy can be found in the related article.
Systematic monitoring of the pregnant woman with hypertensive disease is essential and should take place at intervals of approximately every 2 weeks, and in some cases every week.
At each visit, blood pressure must be measured, fetal growth must be assessed via ultrasound, and a urine dipstick test performed.
Laboratory testing in hypertensive disease during pregnancy must be performed very regularly and includes:
In hypertensive disorders of pregnancy, daily monitoring of fetal movements is recommended. Ultrasound assessment of fetal growth is performed every 1–2 weeks.
Fetal development is monitored using a biophysical profile along with uterine artery blood flow assessment, ultrasound measurement of amniotic fluid volume and cardiotocography (these tests are repeated at least weekly, or much more often if indicated). Doppler evaluation is essential for assessing fetuses with intrauterine growth restriction.
The administration of corticosteroids (betamethasone, CELESTONE CHRONODOSE) for enhancing fetal lung maturity before 34 weeks of gestation is mandatory in cases of mild or severe preeclampsia, as well as in cases of severe hypertension.
The definitive treatment for preeclampsia is the completion — termination — of the pregnancy.
When determining the timing of delivery, the risks to the mother and fetus, the gestational age, and the severity of the hypertensive disease are taken into consideration.
In cases of mild hypertension or preeclampsia without additional complications, delivery may be planned at a gestational age beyond 37 weeks.
In any case, delivery should not be delayed beyond 40 weeks. For severe hypertension or preeclampsia, delivery may be planned at 34 weeks of gestation, or earlier if clinically indicated.
Hypertensive disease in pregnancy — especially when the cervix is favorable — is not a contraindication to vaginal delivery, as long as the condition of the mother and fetus allows it and there are no other obstetric indications for cesarean section.
Prolonged labor should be avoided, especially in severe hypertension or preeclampsia.
In women with hypertensive disorders of pregnancy undergoing labor, we monitor at least every hour: vital signs, urine output/proteinuria, and any signs or symptoms of severe preeclampsia.
Routine laboratory tests are repeated at least every 6 hours.
The epidural and spinal anesthesia appear to be advantageous, provided there is no thrombocytopenia.
Preeclampsia can largely be predicted before it appears. At 11 to 14 weeks, along with the measurement of nuchal translucency, a risk calculation can be made that combines:
When the risk comes out high, low-dose aspirin every evening, started before 16 weeks and stopped around 36 weeks, significantly reduces the risk of preterm preeclampsia. In the large ASPRE trial, preterm preeclampsia was reduced by about half or more. The dose and duration are set by your doctor. Do not start aspirin on your own.
Home monitoring catches a rise in blood pressure early and avoids the falsely high readings often seen at the office. To make it reliable:
Antihypertensive treatment in pregnancy has a dual goal: to protect the mother from stroke and other damage, and not to cause a sudden drop in blood flow to the placenta.
If you have chronic hypertension and are planning a pregnancy, your medication should be changed before conception or as soon as the pregnancy is confirmed, always on medical advice. Do not stop your medications on your own.
In severe preeclampsia, intravenous magnesium sulfate is given at the maternity hospital. It does not lower blood pressure, but it prevents eclamptic seizures and protects the brain of the preterm newborn.
HELLP syndrome is a serious complication linked to preeclampsia. Its name comes from the initials of its three findings: Hemolysis (destruction of red blood cells), Elevated Liver enzymes and Low Platelets.
The difficulty is that blood pressure may be only slightly raised or even normal. The symptoms often resemble gastroenteritis or the flu:
In the third trimester, or in the first days after delivery, these symptoms need an urgent blood test at the maternity hospital. Do not put them down to something you ate. Treatment takes place in the hospital and usually includes delivery.
Blood pressure does not always drop right after the birth. It often peaks 3 to 6 days later, when the mother has already gone home. Preeclampsia can even appear for the first time after delivery, up to six weeks later.
A pregnancy with preeclampsia acts like a “stress test” for the blood vessels. That is why blood pressure checks at least once a year, cholesterol and blood sugar testing, maintaining a healthy weight and regular exercise are recommended. Tell every doctor who looks after you that you had high blood pressure in pregnancy. In a future pregnancy you will be offered early aspirin and closer monitoring, as is also the case for women with gestational diabetes (they also have an increased cardiometabolic risk).
140/90 mmHg or higher, on two readings. Values of 160/110 or more are considered severe hypertension.
In preeclampsia, along with high blood pressure there is protein in the urine or organ involvement, such as the liver, the kidneys and the platelets.
Severe headache, vision problems, pain in the upper abdomen, sudden swelling of the face and hands. They need immediate assessment.
Yes, in most cases. The timing and type of delivery depend on the severity.
It usually returns to normal within weeks. However, future cardiovascular risk remains higher, which is why regular checkups are recommended.
Strict bed rest is not recommended, because it has not been shown to improve outcomes and it increases the risk of blood clots. You may be advised to limit strenuous activity and rest more, depending on the severity.
It is a blood test that measures two substances produced by the placenta. It is used in women with suspected preeclampsia after 20 weeks and mainly helps rule out its onset in the following days, so that unnecessary hospital admissions are avoided.
The likelihood is higher, especially if the preeclampsia was severe or appeared early. In the next pregnancy, low-dose aspirin from early on, first trimester risk screening and closer blood pressure monitoring are recommended.
Strict salt restriction has not been shown to prevent preeclampsia. A balanced diet with sensible salt intake is recommended, as throughout pregnancy.
