Hypertensive Disorders of Pregnancy

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What are the hypertensive disorders of pregnancy?

Hypertensive disorders of pregnancy can be broken down into 3 categories: Pre-existing hypertension, gestational hypertension and preeclampsia.

  • Pre-existing hypertension: elevated blood pressure existing prior to pregnancy or developed before 20 weeks of pregnancy (affects ~ 1% of Canadian pregnancies)
  • Gestational hypertension: elevated blood pressure developed after 20 weeks of pregnancy, without the presence of protein in the urine (affects ~ 5% to 6% of Canadian pregnancies)
  • Preeclampsia: elevated blood pressure developed after 20 weeks of pregnancy with the presence of protein in the urine or other organ complications (affects ~ 1% to 2% of Canadian pregnancies)

Elevated blood pressure means that the force applied to the walls of the body’s arteries and vessels is greater than usual. Normal blood pressure is 120/80 mmHg. Many of our clients will have blood pressure lower than these values, which is also normal. When a client’s average blood pressure is greater than or equal to 140/90 mmHg, your midwife will recommend assessment at the hospital for gestational hypertension and preeclampsia.

While it is still not fully understood what causes preeclampsia, some pregnant people are more at risk than others.

Risk factors for preeclampsia:

  • Developed preeclampsia in a past pregnancy
  • Have diabetes or an inflammatory disease (ex. Lupus) that affects the immune system
  • Twin pregnancy
  • Family history of preeclampsia (mother or sister had preeclampsia in pregnancy)
  • First pregnancy
  • BMI was above 30kg/m2 pre-pregnancy

However, as we do not know precisely what causes gestational hypertension and preeclampsia, any pregnant person could possibly be affected. Thus, it is important for all clients to be aware of the signs and symptoms of high blood pressure.

Symptoms of high blood pressure:

  • A headache that does not go away after doing all of the following: taking 1g of Tylenol, eating, hydrating, and/or taking a nap
  • Visual disturbances: stars in the eyes, blurry vision, flashes, and/or dark spots
  • Epigastric pain: a sharp/shooting pain on the upper right side of abdomen
  • More nausea or vomiting than usual
  • Pain in your chest or shortness of breath
  • Sudden facial swelling

Page your midwife: if you have one or a combination of these symptoms

If your midwife determines you need to be assessed in the hospital, she will run a variety of tests including:

  • Frequent monitoring of blood pressure
  • Urine tests
  • Blood tests
  • Consultation with the on-call obstetrician

If you are diagnosed with gestational hypertension or preeclampsia, the OB may prescribe medication (outside the scope of midwives). Some clients continue on this medication for the duration of their pregnancy, others will need to stay on the medication during the postpartum period. Additionally, your midwife may recommend more frequent blood pressure checks and ultrasounds.

In order to detect any issues with blood pressure, your midwife will check your blood pressure at every visit. With early detection and treatment of gestational hypertension and preeclampsia, the majority of pregnant people have normal births and healthy babies.