Hypertension and Pregnancy : an important issue
Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. It has effects both on expectant mother and foetus. The impact due to hypertensive disorders in pregnancy on maternal and neonatal mortality and morbidity is very high in India and other developing countries. The incidence of pregnancy induced hypertension in India is about 7-10% of all antenatal admission. Severe forms of hypertensive disorders of pregnancy like eclampsia is a major cause of maternal mortality. Hypertensive disorders in pregnancy complicate 1 in 10 pregnancies, often associated with maternal and neonatal mortality and morbidity. Pregnancy induced hypertension is one of the common medical disorders of pregnancy. It complicates 6 to 8% of pregnancies and is the third common cause for maternal mortality and morbidity next to haemorrhage and infections. 18% of maternal deaths are due to pregnancy related hypertension complications. It affects both mother and foetus. Hypertension during pregnancy predisposes to complications like eclampsia, abruptio placentae, disseminated intravascular coagulation, pulmonary oedema, blindness, cerebrovascular haemorrhages, HELLP syndrome, foetus growth restriction and foetal demise. Controlling hypertension in pregnancy prevents complications both in mother and foetus. There are various theories for the aetiology of pregnancy induced hypertension. The common pathophysiological changes seen are imbalance between vasoconstrictor thromboxane and vasodilator prostacyclin resulting in generalised vasospasm. This leads to endothelial damage resulting in release of vasoactive substances. This causes decreased intravascular volume and increased extravascular volume. The effects of this are placental insufficiency resulting in complications. Controlling hypertension in pregnancy using antihypertensive drugs brings down these complications. In this review, we will briefly discuss about Pregnancy induced Hypertension, its pathophysiology, diagnosis and its management.
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