Obstetric & Gynaecology Malaysia


What is high blood pressure?

Blood pressure(BP) is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your fetus.

What is chronic hypertension?

Chronic hypertension (Essential HT) is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. The guidelines for blood pressure are the following:

  • Normal: Less than 120/80 mm Hg
  • Elevated: Systolic between 120–129 and diastolic less than 80 mm Hg
  • Stage 1 hypertension: Systolic between 130–139 or diastolic between 80–89 mm Hg
  • Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mm Hg

What is gestational hypertension?

Gestational hypertension is high blood pressure that first occurs after 20 weeks of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

What kinds of problems can hypertension cause during pregnancy?

High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:

  • Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the fetus through the placenta. The fetus may have growth problems as a result.
  • Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
  • Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your fetus, it may be recommended that early delivery is better for your baby than allowing the pregnancy to continue.
  • Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
  • Cesarean birth—Women with hypertension are more likely to have a cesarean birth than women with normal blood pressure. A cesarean birth carries risks of infection, injury to internal organs, and bleeding.

How is chronic hypertension during pregnancy managed?

Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your fetus.

If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.

What is preeclampsia?

Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high BP (160/110 mmHg) also is considered a severe feature.

When does preeclampsia occur?

It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 34 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

What causes preeclampsia?

It is not clear why some women develop preeclampsia. Doctors refer to high risk and moderate risk of preeclampsia. Risk factors for women at high risk include

  • preeclampsia in a past pregnancy, being pregnant with more than one fetus
  • chronic hypertension, kidney disease, diabetes mellitus, autoimmune conditions, such as SLE

Risk factors for women at moderate risk include

  • being pregnant for the first time, obesity, family history of preeclampsia (mother or sister)
  • being older than 35, migrane

What are the risks for my baby if preeclampsia occurs?

If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications.

What are the risks for me if preeclampsia occurs?

Women who have had preeclampsia have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome, which stands for hemolysiselevated liver enzymes, and low platelet count, a medical emergency.

What are the signs and symptoms of preeclampsia?

  • Swelling of face or hands or sudden weight gain
  • A headache that will not go away or seeing spots or changes in eyesight
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting (in the second half of pregnancy)
  • Difficulty breathing
  • BP at home >=150/100 mmHg even no symptoms.

How is mild gestational hypertension or preeclampsia without severe features managed?

Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.

How is preeclampsia with severe features managed?

Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If your condition or the baby’s condition worsens, prompt delivery will be needed.

What steps can I take to help prevent preeclampsia?

If you have hypertension and are planning a pregnancy, see your ob-gyn for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy.

You should start taking low-dose aspirin 100 mg at bedtime between weeks 12 and 16 of your pregnancy.

Recent guidelines recommend that starting aspirin between weeks 12 and 16 of your pregnancy. Studies showed significant evidence of the prevention of preeclampsia, severe preeclampsia, and fetal growth restriction when initiated before 16 weeks’ gestation.

The use of aspirin during pregnancy is not associated with an increased risk of miscarriage, no increase in infant loss, growth problems, or cognition harm to the baby; No statistically significant impact on risk of placental abruptions, postpartum hemorrhage (bleeding), or miscarriage to the mother with aspirin use. No differences in developmental outcomes of the infants up to age 18 months.

Research also shows that aspirin is most effective at bedtime.

Aspirin should be discontinued at 36 weeks because of the possible bleeding risks associated with delivery.

But because most preeclampsia occurs after 36 weeks, that the aspirin may be beneficial to continue through delivery, into the postpartum period.