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Pregnancy and Childbirth: The answers

Hypertension and pre-eclampsia

 

Causes of chronic hypertension

Chronic hypertension is uncommon in the young and starts to become a significant feature in the mid to late 30s.  For the majority of people known to have chronic hypertension, the cause is unknown. That is why this is known as essential hypertension. For the remainder, the hypertension may be associated with such diseases as diabetes, kidney disease or SLE. Obesity is an associated factor.

 

Causes of pre-eclampsia

As mentioned before, pre-eclampsia is a purely pregnancy related condition. It does not occur otherwise.

 

We, do, however, have to be careful here. The classification of hypertensive conditions in pregnancy is not mutually exclusive. Women with pre-existing hypertension are cer­tainly more at risk of developing pre-eclampsia. This is when their uncomplicated hypertension evolves into pre-eclampsia. Otherwise, the cause of pre-eclampsia remains unknown.

The majority of pregnant women who develop pre-eclamsia will have no pre-existing hypertension.

Difference between hypertension and pre-eclampsia

One is part of the other.

Hypertension simply means above normal blood pressure. In pregnancy; this is generally taken to be a blood pressure of 140/90 or above. This is a convenient cut-off and not always significant. Its importance differs from individual to individual.

 

Pre-eclampsia is a syndrome which includes hypertension and loss of protein in the urine (proteinuria). Almost invariably (but not necessarily) there is edema.

 

Chronic hypertension as a risk factor in pregnancy

Pre-existing hypertension is regarded as a risk factor (in pregnancy) in its own right though not to the same extent as pre-eclampsia.

 

· Firstly, there is a tendency among hypertensive expectant mothers to have abnormal blood vessel development in the uterus and placenta. This may mean that the fetus does not get sufficient nutrients and oxygen and the intrauterine growth may be restricted to some degree. This, however, is uncommon in the presence of well-controlled hypertension and in the absence of pre-eclampsia.

 

· Secondly, chronic hypertension could evolve into pre-­eclampsia, where the normal antihypertensive medication is ineffective and which may lead to premature delivery.

 

· Thirdly, hypertension is associated with an increased risk of placental abruption, which is the premature separation of the afterbirth, with potentially grave consequences to the fetus and even the mother.                                      Next page