Pregnancy Induced Hypertension (PIH) is an increase in blood pressure after 20 weeks of gestation, occuring in about 5% to 7% of pregnant women. In PIH, vasospams of both the small and large arteries occur, resulting in various clinical manifestations. The cause of PIH is unknown but there are various risk factors that have been associated with it;
 

Pregnancy Induced Hypertension Risk Factors

• Multiple pregnancies
• Race (more common in women of color).
• Pregnant women who are younger than 20 years or older than 40 years.
• Women who have given birth more than five times.
• Pregnant women coming from low economic status background.
• Pregnant women with medical history of other conditions. Such as kidney or heart problems.
• Pregnant women with history of hypertension (essential hypertension).
• Pregnant women who have less than normal amniotic fluid (hydramnios).

Symptoms of Pregnancy Induced Hypertension 

The symptoms and signs experienced by a pregnant woman, depends on the stage of disease progression. Pregnancy Induced Hypertension is classified into four different categories; 
 

Gestational Hypertension 

A pregnant woman is said to be having a gestational hypertension when the blood pressure is 140/90mmHg, without presence of protein in urine or edema (swelling). In most cases, no medical treatment is ordered for such cases, since it is usually very mild and can be managed with other means.

 

Mild Preeclampsia 

A woman is said to be having a Mild Preeclampsia if the blood pressure is above 140/90mmHg, taken atleast in two occassion with 6 hours in between takings. Another way to assess is by looking at the woman's previous blood presssure readings. An increase in diastolic pressure of more than 30mmHg and diastolic pressure greater than 15mmHg from the base line readings, suggests a woman is developing a Preeclampsia.  

 

In normal pregnancy, most women may shows a trace of protein in urine samples. In Mild Preeclampsia, in addition to high blood pressure readings, there is presence of 1+ or 2+ protein in urine. Edema also develops due to protein loss and sodium retention. A woman may start to gain weight due to edema, more pronounced on the upper part of her body.  

 

A significant weight gain of more than 2 pounds in a week in the second trimester or more than 1 pound in a week in the third trimester may be another sign that a woman is having a Preeclampsia. 

 

Severe Preeclampsia 

A pregnant woman is considered to have developed a Severe Preeclampsia when the blood pressure increases up to 160/110mmHg or above, taken at least two times with 6 hours in between the takings, when the woman is at bed rest. 

 

In Severe Preeclampsia, there is presence of 3+ or 4+ protein in urine taken randomly or more than 5g in a 24 hours urine sample. The woman also develop a puffy face and hands due to extensive edema.

 

Other signs of Severe Preeclampsia include;  

Eclampsia 

This is the most fatal classification of pregnancy induced hypertension. A woman having eclampsia experience all other symptoms of PIH, plus seizure or coma. This is because at this stage, the cerebral edema is so intensive to cause cerebral hemorrhage, renal failure or circulatory collapse and eventually may lead to death. Maternal and fetal mortality rate with Eclampsia is as high as 20% and 25%, respectively. 

 

Pregnancy Induced Hypertension Treatment 

Treatment of Pregnancy Induced Hypertension depends on the stage of disease progression at the time of diagnosis. Gestational hypertension and Mild Preeclampsia may not require any medication and can be managed easily at home with proper follow ups.  

 

On the other hand, women with Severe Preeclampsia requires hospitalization for close monitoring. If the fetus is already passed 36 weeks and the fetal lung is mature, pregnancy can be terminated. If not, a woman is put under medication and frequent monitoring is maintained.  

 

In Severe Preeclampsia, hypotensive drugs, such as hydralazine may be prescribed for hypertension. For women under Eclampsia watch, magnesium sulfate is the drug of choice which is administered to prevent Eclampsia. 

 

Other non-pharmacology management of pregnancy induced hypertension are;