Monique Rainford

DURING PREGNANCY

At each office visit a pregnant woman may notice that she gets blood pressure and urine checks and she may wonder about the importance of these tests. These are screening tools to identify some very important and sometimes very serious conditions in pregnancy.

A pregnant woman has hypertension if her systolic blood pressure is 140 mmHg or higher or her diastolic blood pressure is 90 mmHg or higher. The systolic blood pressure is the top number in the reading and measures the pressure in the arteries when the heart contracts or squeezes blood into them. The diastolic blood pressure, the bottom number, measures the pressure in the arteries when the heart relaxes after the contraction. If she has hypertension before 20 weeks (five months) of pregnancy, she has chronic hypertension. If hypertension develops after 20 weeks, she has gestational hypertension or preeclampsia.

Protein in urine

The urine test checks for protein in her urine. If she has hypertension without a certain level of protein in her urine she has gestational hypertension. If she has both hypertension and more than that certain level of protein in her urine, she has preeclampsia. About one in four women with gestation hypertension will develop preeclampsia.

Some of the factors which place a woman at a higher risk of developing preeclampsia include having her first pregnancy, if she is older than 35, has diabetes, has a kidney disease, is obese, is carrying two or more foetuses (the term for the baby in the womb), has a family history of preeclampsia, has chronic hypertension, had preeclampsia in a previous pregnancy or if she has lupus or similar conditions.

Effects of preeclampsia

Preeclampsia can affect many organs in the body. It may affect the functioning of the liver and in very severe cases she may have bleeding around her liver and the liver may even rupture. She may get seizures (eclampsia) or she may have swelling or bleeding in her brain, and in some cases even temporary blindness. The amount of urine she produces may decrease and in very severe cases her kidney may stop working. She may also have destruction of her blood cells.

The disease can also affect her baby because of the effect on the blood supply between the womb and the placenta. It may affect the growth of the baby, the amount of amniotic fluid around the baby and can cause problems with the placenta including separation of the placenta from the womb.

The symptoms of severe disease include headaches, blurry vision, spots in her vision and pain in her abdomen. Fortunately, the very severe complications of preeclampsia are rare and early intervention can usually prevent them.

The cure for preeclampsia is delivery of the baby. However, if a woman is several months from her due date doctors may choose to monitor in the hospital until the foetus reaches a safe age to survive. She may also be given medications to control her blood pressure if it becomes very high and another type of medication to prevent her from having seizures.

Although there is currently no medication to prevent preeclampsia and the cause is unknown, it is important that even if she is not high risk, a pregnant woman should keep her doctor's visits to ensure early detection and treatment if she develops this disease. It is usually advised that she visits every four weeks up until 28 weeks of pregnancy, every two weeks until 36 weeks and every week thereafter. However, she may need to visit more frequently at her doctor's discretion.