Pregnancy Induced Hypertension

 Also known as “Toxemia of Pregnancy”

 Most common medical complication of pregnancy.
 Affects 7-15% of all pregnancies.
 In 2000, the National High Blood Pressure Educational Program Working Group on High
Blood Pressure in Pregnancy defined three categories of hypertension in pregnancy:
1. Chronic Hypertension
2. Gestational Hypertension
3. Preeclampsia (Toxemia/ Pregnancy induced-hypertension)

Chronic Hypertension:

 High blood pressure that develops before the 20th week of pregnancy or is present before
the woman becomes pregnant.
 Primary cause: Essential hypertension (high blood pressure that doesn't have a known
secondary cause)
 Secondary cause: Result of other medical condition (ex. Renal disease)

Gestational Hypertension:

 It is the development of new hypertension in a pregnant woman after 20 weeks gestation

without the presence of protein in the urine or other signs of preeclampsia.
 Returns to normal within 12 weeks after delivery.
 50% of women diagnosed with gestational hypertension between 24 and 35 weeks
develop preeclampsia.

Pregnancy Induced-hypertension:
PIH develops after the 20th weeks of pregnancy. This condition can cause serious
problems for both the mother and the baby if left untreated.
The risk of PIH is higher in women carrying multiple babies, in teenage mothers and in
women older than 40 years of age. Other women at risk include those who had high
blood pressure or kidney disease before they became pregnant. The cause of PIH isn't
known.
It is the most serious form of hypertensive pregnancy complications, but it is not
primarily a hypertensive disease; it is a disorder induced by factors based on the
presence of placenta.
Preeclampsia is initiated by abnormal placentation and, therefore, a low prefunded
placenta, release of cytokines and other toxins, and vasoconstriction and platelet
 activation; so it is a syndrome of generalized endothelial dysfunction, and the
complications are associated with the vascular system

Pathophysiology:
Pregnancy-induced hypertension (PIH) is estimated to affect 7% to 10% of all
pregnancies in the United States.

Despite being the leading cause of maternal death and a major contributor of
maternal and perinatal morbidity, the mechanisms responsible for the pathogenesis
of PIH have not yet been fully elucidated.

The initiating event in PIH appears to be reduced uteroplacental perfusion as a result

of abnormal cytotrophoblast invasion of spiral arterioles.

Placental ischemia is thought to lead to widespread activation/dysfunction of the

maternal vascular endothelium that results in enhanced formation of endothelin and
thromboxane, increased vascular sensitivity to angiotensin II, and decreased
formation of vasodilators such as nitric oxide and prostacyclin.

The quantitative importance of the various endothelial and humeral factors in

mediating the reduction in renal hemodynamic and excretory function and elevation
in arterial pressure during PIH is still unclear.
 Investigators are also attempting to elucidate the placental factors that are
responsible for mediating activation/dysfunction of the maternal vascular
endothelium. Microarray analysis of genes within the ischemic placenta should
provide new insights into the link between placental ischemia and hypertension.

More effective strategies for the prevention of preeclampsia should be forthcoming

once the underlying pathophysiologic mechanisms that are involved in PIH are
completely understood.

What are the risks of PIH to the baby and mother?

PIH can prevent the placenta (which gives oxygen and food to your baby) from getting enough
blood. If the placenta doesn't get enough blood, your baby gets less oxygen and food. This can
cause low birth weight and other problems for the baby.

Maternal Impact: Fetal Impact:

• Intravascular Coagulation. • Malnutrition.

• Bleeding. • Low metabolism.

• Organ failure (hepatic and renal) following • May develop hypertension, coronary heart
poor perfusion. disease and diabetes later on in adult life.

• May be complicated by seizures. • Risk for cardiovascular disease (CVD)

• Development of HELLP Syndrome. • Low metabolism.

The HELLP syndrome, alongside preeclampsia, Many fetuses have to adapt to a limited supply of
accounts for most maternal deaths associated with nutrients. In doing so, they permanently change their
hypertension. structure and metabolism.
What are the symptoms of PIH?
• Severe headaches
• Vomiting blood
• Excessive swelling of the feet and hands
• Smaller amounts of urine or no urine
• Blood in your urine
• Rapid heartbeat
• Dizziness
• Excessive nausea
• Ringing or buzzing sound in ears.
• Excessive vomiting.
• Fever
• Drowsiness
• Double vision or Blurred vision
• Pain in the abdomen
• Sudden loss of vision

What are the signs of PIH?

 Rapid rise in blood pressure
 Papilledema
 Fluid retention (non-dependent edema)
 Hyper reflexia
 Clonus
 Uterus and fetus may feel small for gestational age.

Who is at risk for PIH?

 PIH is more common during a woman's first pregnancy and in women whose
mothers or sisters had PIH.
 The risk of PIH is higher in women carrying multiple babies, in teenage mothers
and in women older than 40 years of age.
 Other women at risk include those who had high blood pressure or kidney disease
before they became pregnant. The cause of PIH isn't known.
 The most obvious, a history of preeclampsia in previous pregnancies.
 Multiple pregnancies, expecting more than one baby.
  A history of chronic high blood pressure, kidney disease, diabetes or organ
transplant.
 Obesity, particularly in women with a Body Mass Index (BMI) over 30.
 Women with a family history of preeclampsia or placental abruption.
 Women who have undergone In Vitro Fertilization treatment (IVF).

Prevention & Treatment:

For mild preeclampsia:
 Rest, lying on your left side to take the weight of the baby off your major blood vessels.

 Increase prenatal checkups.

 Consume less salt

 Drink at least 8 glasses of water a day

 Change your diet to include more protein

 Don’t eat a lot of fried foods and junk food.

 Get enough rest.

 Exercise regularly.

 Elevate your feet several times during the day.

 Avoid drinking alcohol.

 Avoid beverages containing caffeine.

 Your doctor may suggest you take prescribed medicine and additional supplements.