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High Blood Pressure and Preeclampsia

High blood pressure (hypertension) and hypertensive disorders such as preeclampsia are common complications of pregnancy. Chronic hypertension (CHTN) may be seen in 5% of pregnant women with rates varying depending on the population studied. Hypertensive disorders such as gestational hypertension, preeclampsia, and eclampsia may develop during pregnancy or shortly after delivery. At Memorial Hermann, affiliated maternal-fetal medicine specialists offer advanced care and services for women with high blood pressure/preeclampsia.

Chronic Hypertension

Chronic hypertension (CHTN) is diagnosed when there is a persistent elevation of blood pressure, which may be diagnosed prior to 20 weeks of pregnancy or may have been diagnosed prior to pregnancy.

Complications

CHTN can have significant adverse effects on a patient’s pregnancy. Some of the more common complications include development of preeclampsia or toxemia, placental separation (abruption), fetal growth delay, poor perinatal outcome, and preterm birth. Women who have had high blood pressure for a long time have end-organ damage that can worsen in pregnancy. Maternal end-organ damage may include retinal (eye) changes, an enlarged heart, and evidence of kidney damage.

Treatment

Maternal-fetal medicine specialists affiliated with Memorial Hermann will follow the patient and her pregnancy very closely for development of worsening complications. Affiliated physicians will work with other adult medicine subspecialists as needed, and the patient may undergo additional testing based on her specific needs.

Some women require medications to lower blood pressure during pregnancy. Maternal-fetal medicine specialists may prescribe antihypertensive medications.

Preeclampsia

Preeclampsia is diagnosed when a patient’s blood pressure increases during pregnancy, but this increase occurs after 20 weeks and is associated with protein in the patient’s urine.

Causes

The causes of preeclampsia is not known; however, preeclampsia occurs more frequently in women with chronic high blood pressure, pregestational diabetes, vascular and connective tissue diseases, lupus, antiphospholipid antibody syndrome, kidney disease, multiple gestations, and obesity.

Complications

Complications that may occur with preeclampsia include fetal growth delay, low amniotic fluid, preterm birth, placental separation (abruption), and maternal complications such as ventricular (heart) enlargement and damage, kidney damage and stroke.

Treatment

Affiliated maternal-fetal medicine specialists will follow the patient and her pregnancy very closely for development of complications, and will work with other adult medicine subspecialists as needed, and additional testing will be performed based on the patient’s specific needs.

Often preterm delivery is recommended to avoid worsening of the patient’s health. In these situations, affiliated specialists will stabilize and treat the baby in the Level IV Neonatal Intensive Care Unit (NICU) at Children's Memorial Hermann Hospital. The affiliated team will develop a coordinated plan for both mom and baby before, during and after delivery.

Gestational Hypertension

Gestational hypertension is diagnosed when a patient’s blood pressure increases after 20 weeks of pregnancy, but there is no significant amount of protein in the patient’s urine. The affiliated specialists will closely monitor pregnancies complicated by gestational hypertension and will develop a coordinated plan for both mom and baby before, during and after delivery.

Eclampsia

With eclampsia, in addition to the patient’s blood pressure increase after 20 weeks of pregnancy and elevated urinary protein, convulsions or seizure activity can occur.

Treatment for eclampsia includes prevention of the seizures, blood pressure control, and delivery. Physicians affiliated with Memorial Hermann will coordinate patient care and the delivery of the patient’s baby. After birth, the affiliated specialists will stabilize and treat the baby in the Level IV Neonatal Intensive Care Unit (NICU) at Children's Memorial Hermann Hospital.