Hypertension during pregnancy is one of the leading causes of death for the mother. A pregnant woman with high blood pressure requires close monitoring throughout her pregnancy.
Monitoring You And Your Baby
Because of the fact that the only known cure for gestational hypertension or pre-eclampsia is the delivery of the baby (specifically the placenta), careful monitoring of you and your baby's vital signs must be done. Mothers diagnosed with gestational hypertension who do not have protein in their urine and have normal lab values may receive, depending on how far you are into your pregnancy:
- An ultrasound where your baby's estimated weight and volume of amniotic fluid will be measured. If the results are within normal limits, the tests do not have to be repeated unless there is a change in your condition.
- A non-stress test should also be performed at the time you are diagnosed. If the non-stress test is non-reactive, a biophysical profile should be done. The biophysical profile is normal when the score is eight out of eight. If the non-stress test was reactive, or the biophysical profile was normal, the tests do not need to be repeated unless there is a change in your condition.
For mothers diagnosed with mild pre-eclampsia (mildly elevated blood pressure), with normal lab values (liver enzymes and platelet count), and no other symptoms (headaches, vision problems, or pain in the upper right portion of your abdomen), doctors may order:
- An ultrasound that measures your baby's growth and amount of amniotic fluid should be performed at the time you are diagnosed. If the results are normal, an ultrasound should be repeated in three weeks. If the ultrasound reveals that your baby's estimated weight is less than the 10th percentile for his or her gestational age, or if there is less than the normal amount of amniotic fluid, the tests should be done twice a week.
- A non-stress test or biophysical profile (or both) should be performed at the time you are diagnosed. If the non-stress test is within normal limits (reactive) and/or your baby receives a biophysical profile score of eight out of eight, the tests should be repeated on a weekly basis. If you develop any new or worsening symptoms, the tests should be performed immediately.
Medical Treatment For Pre-Eclampsia
Medications are used to control your blood pressure in severe hypertension and pre-eclampsia until you are far enough into your pregnancy that will give your baby the best chance of survival and the best possible adjustment to life outside of the uterus. The medications include hydralazine, labetalol, nifedipine, and sodium nitroprusside. Magnesium sulfate is a mineral that may be given to mothers diagnosed with pre-eclampsia. This medication has a neuroprotective benefit for the baby, and may help reduce the risk of cerebral palsy that is associated with early preterm birth. In pre-eclampsia, it reduces the mother's risk of having a seizure. It is given intravenously (through the IV). Pre-eclampsia has progressed to eclampsia when the mother has a seizure. Seizure activity may be controlled with higher doses of magnesium sulfate. The mother will need to remain on the magnesium sulfate drip for at least 24 hours after delivery. If you are diagnosed with pre-eclampsia during or after your 24th week of pregnancy, or before your 34th week of pregnancy, you should be given steroid injections to speed up your baby's lung development. Betamethasone (Celestone) is usually given in two injections, 24 hours apart. The steroids also decrease the baby's risk of developing an intravascular hemorrhage (bleeding within the brain), as well as bowel problems. The best benefit to your baby occurs 48 hours after the second injection. Sometimes, the baby may need to be delivered before 48 hours after the last injection. Although the full benefit of the steroids may have not been achieved, any benefit to the baby is important.
Because pre-eclampsia and eclampsia are life-threatening conditions for the mother, there are instances where the baby must be delivered regardless of gestational age. If the baby is not delivered, the baby could sustain serious birth injuries as a result. In some cases, both the mother and fetus could die.
- Myatt, L., & Webster, R. (2009). Vascular biology of pre-eclampsia. Journal of Thrombosis and Haemostasis, 7(3), 375-384. doi: 10.1111/j.1538-7836.2008.03259.x