Gestational Hypertension

Gestational Hypertension

Gestational Hypertension (pregnancy induced hypertension) 

Gestational hypertension (pregnancy induced hypertension), preeclampsia and eclampsia are commonly encountered medical complications in pregnant women, after 20 weeks of pregnancy. If the woman is already suffering from hypertension it is called chronic hypertension in pregnancy.

These conditions produce high morbidity and mortality in the fetus (baby) and mother.

What is Gestational Hypertension (PIH)?

When a pregnant woman develops high blood pressure (above 140/90 mm of Hg) after 20 weeks of gestation (pregnancy) without both protein in urine and edema (swelling of the face, legs and hands), she is said to be suffering from Gestational hypertension.

hypertension-during-pregnancy

 

What is preeclampsia?

When a pregnant woman, after 20 weeks of pregnancy develops the triad of signs (3 main signs) namely Hypertension, protein in the urine (proteinuria)  and edema, she is said to be suffering from preeclampsia.

Preeclampsia can be mild (when blood pressure is from 140/90 up to 159/119) or severe (when blood pressure is above 160/110 mm of Hg).

What is Eclampsia?

Eclampsia is a complication of severe preeclampsia where the pregnant woman develops convulsions (seizures or through fits).

25% of patients develop convulsions before delivery.

50% may develop during delivery.

25% may have seizures after delivery.

Preeclampsia and eclampsia are together called as Toxemia of pregnancy.

What is HELLP syndrome?

Preeclampsia with haemolysis (destruction of blood), Elevated Liver enzymes and low platelets counts is called HELLP syndrome. It is a complication of preeclampsia.

What are the causes of Gestational hypertension/preeclampsia/eclampsia?

  • First-time pregnancy (nulliparous woman or prime). Can occur in second pregnancy also.
  • Age: Getting pregnant before 18 years or after 35 years.
  • Multiple gestations like twins and triplets.
  • Abnormal placenta.
  • Previous history of Preeclampsia. Having family history of preeclampsia.
  • Heredity.
  • Having other diseases like chronic hypertension, diabetes, chronic kidney disease and high cholesterol levels.

How does the disease develop? (pathophysiology)

When fetal trophoblasts do not invade deep enough into the mothers utrine wall, spiral arteries may not dilate fully. This increases the resistance to blood flow to the placenta. This leads to fetal hypoxia (not enough oxygen and nutrients to the fetus). This leads to the release of antiangiogenic factors and inflammatory mediators. This induces generalized endothelial damage and hypertension.

hypertension-while-pregnant

 

Signs and symptoms of Gestational Hypertension

Gestational hypertension may not show any symptoms. Patients may have a mild headache.

Blood pressure may be above 140/90 mm of Hg. Urine protein will be absent. Edema may be there as it is common in pregnancy.

Signs and symptoms of preeclampsia:

In preeclampsia patients may have a severe headache, blurred vision, fatigue, nausea/vomiting, pain abdomen and giddiness. Edema of nondependent area like face, hands and legs seen.

In severe preeclampsia, blood pressure may be very high (above 160/110 mm of Hg). Along with the above symptoms patients may have reduced urine output, breathlessness (shortness of breath) due to fluid collection in lung tissue, sudden weight gain and liver disorder.

Signs and symptoms of eclampsia

It is a complication of preeclampsia.

Along with the symptoms of preeclampsia, the pregnant woman may have seizures (convulsions). They may be disoriented and at times become unconscious. Sometimes it may be fatal for the baby and mother.

What are the investigations to be done

Tests for Gestational hypertension

Regular Blood pressure monitoring: Blood pressure above 140/90mm of Hg

Routine blood investigations like blood sugar and cholesterol to rule out other diseases.

Urine analysis for protein:  No protein in the urine.

Blood liver and kidney functions: may be normal.

Investigations (tests) for preeclampsia and eclampsia

More frequent blood pressure monitoring.

Blood tests as given above and 24 hours urine protein estimation: more than 300 mg / 24 hours or more than 1+ in a single urine sample.

Frequent blood count and Platelet count to find out thrombocytopenia.

Ultra sound scanning of the uterus to assess’ fetal growth and heart rate.

Ultrasound thorax to find out lung congestion (pulmonary edema) and

Utrine artery Doppler can be done.

Treatment

Delivery of the baby is the only treatment.

Treatment of gestational hypertension (pregnancy induced hypertension)

Salt restricted diet and rest. Mild hypertension is good for the baby. Sudden reduction of blood pressure to be avoided. For severe hypertension anti- hypertension drugs can be given.

Treatment for preeclampsia

Salt restriction and bed rest in lateral position (lying on sides) to avoid the weight of the baby on main blood vessels.

If the baby is mature, plan for delivery.

If blood pressure is very high anti hypertension drugs can be started.

Nifedipine or methyldopa can be given orally. Labetalol can be given intravenously or Hydralazine IV or IM can be given.

Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers and atenolol are contra indicated.

Magnesium sulfate infusion to be started to prevent seizures.

Treatment of Eclampsia

Magnesium sulfate 4-gram loading can be given intravenously (IV) followed by infusion of 1-3 grams/hour to control seizures or injection diazepam can be given slowly intravenously.

Induce delivery or go for cesarean delivery.

The blood pressure and signs and symptoms of these diseases will disappear within 4 to 6 weeks after the delivery of the fetus.

View similar articles here:

Low Blood Sugar

Diabetes During Pregnancy

How to Stop Hair Fall Naturally

No more Hair loss

How to Stop Hair Fall Naturally

Hair is an important part of the body that indicates a person’s gender, health, age, race, religion and social status. It plays an important role in their personal identity and is a symbol of youth and vitality. Hair loss is one of the biggest cause of concern among youngsters. So people spend a lot to prevent hair loss and improve hair growth.

Normal persons may have around 1,25,000 to 1,50,000 strands of hair on their scalp. The normal life span of a strand of hair is about 3 years after which it sheds naturally. Normally a person sheds around 80 to 100 hairs per day. When hair shedding is more it may lead to thinning of hair and baldness (Alopecia).

Causes of Hair fall (Alopecia)

There are many causes of Hair loss. They are advancing age, genetic factors, conditions where there is hormonal imbalance like pregnancy, people on birth control pills, and lactating mothers.

Mental and physical stress, sudden severe weight gain or weight loss can also produce hair loss.

Side effects of drugs like antibiotics, steroids, chemotherapy drugs for cancer and radiotherapy can increase hair loss.

Diseases like hyper thyroid and hypo thyroid, auto immune disease and other severe general infections can also induce hair loss.

Infections of scalp, lice infestation, dandruff, seborrheic dermatitis of scalp and allergic conditions can produce loss of hair.

Nutritional deficiencies like protein deficiency, deficiencies of iron, calcium, vitamins (mainly vitamins A, Biotin and pantothenic acid) and deficiency of minerals like Zinc can induce loss of hair. Over dose of vitamin A can also cause hair loss.

Other causes like vigorous massaging or vigorous combing of wet hair, using very hot hair dryers and hair straightening rods and tying hair very tightly can also cause hair loss.

Frequent hot water bath can cause hair loss. Using hair tonics, shampoos, conditioners, hair dyes and hair oils with lots of chemicals can cause hair loss.

How to Stop Hair Fall

Do’s to stop hair fall and promote hair growth

Correct nutritional deficiencies. Take high protein diet like eggs, fish, meat and nuts to correct protein deficiency.

Take milk and yogurt (contain Biotin)

Treat and prevent iron deficiency by eating lots of green leafy vegetables, dates, dry fruits and liver.

Eat lots of multi colored fruits and vegetables which are rich in antioxidants, vitamins and minerals. Add almonds, walnuts and ground nuts which are rich in protein, zinc, vitamins and minerals.

Drink plenty of water. Drink amla (Indian goose berry) juice and green tea.

Take bath with luke warm water. Give a gentle massage to the scalp.

Dry your hair gently. Allow it to dry naturally.

Use clean combs and brush.

Trim the split ends regularly.

Reduce stress and exercise regularly.

Treat the cause of hair loss and associated diseases.

Use natural remedies to stop hair fall.

Don’ts to stop hair fall and increase hair growth

Do not tie hair too tightly. Avoid shampoos, conditioners, hair oils and hair dye with lots of chemicals.

Do not use hair dryers, hair straightening rods or hot hair curlers.

Avoid vigorous combing and toweling wet hair.

Do not use chlorinated water for bath.

Avoid smoking. It will reduce blood supply to scalp and hair follicles.

Natural Ways to Prevent and treat hair loss

Coconut oil

Gently massage scalp with coconut oil or coconut milk and wash it after 1 hour. Coconut oil is a good conditioner.

You can also massage with olive oil, almond oil or mustard oil. Heat the oil a little and give a gentle massage to the scalp to improve circulation. A mixture of lemon juice and coconut oil can be used.

Oregano oil

oregano oil helps to treat dandruff. It stops hair fall and promotes hair growth. It acts as an antifungal and antibiotic.

Aloe vera gel

Massage scalp with aloe vera gel and wash it off after 45 minutes.

Curry Leaves

Curry leaves are rich in vitamins, anti-oxidants, proteins and minerals which prevent hair loss. Amino acids present in curry leaves strengthen hair follicles and promote hair growth. Curry leaves help to retain the luster and color of the hair.

Onion

Rubbing cut end of onion or massaging scalp with onion juice improves the blood circulation to hair follicles and scalp and promote hair growth. Onion acts as a good anti bacterial. An enzyme called catalase, present in onion prevent pre mature graying of hair. Sulfur and poly phenols present kills lice and prevents dandruff.

Garlic

Garlic destroys harmful bacteria and stimulates hair growth.

Indian goose berry (Amla)

Amla contains anti-oxidants, Vitamins, minerals and amino acids which strengthen hair follicles. It acts as a good conditioner and effective to treat dandruff. It stimulates hair growth and prevents premature graying of hair.

Hibiscus

Hibiscus flowers and leaves are rich in vitamins and amino acids. They stimulate hair growth, prevent dryness, breakage of hair and prevent premature graying. They add volume to hair and give color and luster to hair.

Best homemade hair oil to prevent hair fall and improve hair growth

Boil Amla (Indian goose berry) pieces, curry leaves and few hibiscus flowers and leaves in 100ml of organic coconut oil.

Filter it and store it. Gently massage it into scalp, cover scalp with a shower cap. Leave it overnight and wash it off with luke warm water.

Fenugreek seed paste, yogurt, and apple cider vinegar can be used as mask. They can be used individually or together to stop hair fall.