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.

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Causes, symptoms and treatment of Asthma

Bronchial Asthma

Causes, symptoms and treatment of ASTHMA

What is Bronchial Asthma?

Bronchial Asthma (Asthma) is a chronic (long-lasting) disease of the airway (Bronchus).

In bronchial asthma, the airway is hypersensitive (very sensitive) to allergens (Triggers producing allergy) and becomes narrow, thereby producing difficulty in breathing, cough and wheeze.

What causes Bronchial Asthma?

Bronchial Asthma can be due to Hereditary (Familial), Allergic or Seasonal.

The Triggers are the allergy to food, dust, smoke, pollen, cotton dust, perfumes, sprays, paint smell, pet’s hair, firecrackers, cooking smell, air pollution, etc…

Bronchial Asthma can also be triggered by infections like cold and flu, exercise, cold air, extreme changes in climates, emotional stress, anxiety, drugs like pain killers (NSAID) and beta blockers.

The acidity of the stomach (gastritis-acid reflux) can also trigger Asthma.

What happens to the airway in Bronchial Asthma?

Normal Airway                                    Bronchial Asthma

When the patient’s airway is exposed to triggers producing bronchial asthma, the following changes happen.

The airway becomes narrow due to bronchoconstriction (muscles of airway becomes tight).

The cells of the mucous membrane of the airway swell up. (Inflammation) and there is increased secretion of mucous inside the airway.

So the airway becomes very narrow and air passes through with difficulty. As the air passes through the narrow gap it produces a whistling sound called wheeze.

What are the Signs and symptoms of Bronchial asthma?

The Bronchial Asthma patient may have cough with or without wheeze, difficulty in breathing, shortness of breath, tightness of chest and may have chest pain.

What are the investigations for bronchial asthma?

The main investigation is Pulmonary Function Test. Spirometry is the PFT done. If the forced expiratory volume in 1 second is less than 80% of the normal value it shows airway obstruction.

The test is repeated after giving inhaled bronchodilators (medicine to widen airways) and if there is an improvement for more than 12% (reversibility) it is bronchial asthma.

Other tests done are X-ray chest, Arterial blood gas analysis (ABG), Blood oxygen saturation, Sputum examination and culture, White blood eosinophil count, Blood immunoglobulin E level etc…

What is the treatment for Bronchial Asthma?

For acute and severe asthma ( acute Exacerbation) hospitalization with oxygen support is necessary.

For milder form Bronchodilators ( Relievers) like salbutamol, theophylline, terbutaline or doxophylline can be given. These drugs widen the narrow airways.

Steroids( Preventers) like fluticasone or budesonide can be given to reduce swelling and mucous secretions. Other drugs like anticholinergics, montelukast, cromoglicate and anti-allergy medications can be given.

Inhalation Therapy is the best form of drug administration in bronchial asthma. Normally one Reliever and one preventer are given as inhalers for the regular treatment of Asthma.

How to prevent Bronchial Asthma?

Avoid triggers producing asthma, and regular breathing exercises can prevent Bronchial Asthma.