Hypertensive Disorders During Pregnancy (Pre-Eclampsia and Eclampsia)

Hypertensive disorders during pregnancy is one of the major causes of maternal death both in developed and developing countries. It is also a major contributor to intrauterine growth restriction and intrauterine foetal death.

Classification of Hypertension During Pregnancy

Hypertension which will occur during pregnancy is classified into two categories, depending on their time of occurrence.

a) Pregnancy-induced hypertension (gestational hypertension): This is hypertension which will occur after 20 weeks of gestation on the mother with no history of hypertension previously and last immediately after the mother gave birth. In this case, the mother experiences hypertension after she gets pregnant and she has no any history of hypertension before.

b) Chronic hypertension: is the one which will be diagnosed before pregnancy or before 20 weeks of gestation during the periods of pregnancy or if hypertension persists for six weeks after the baby was born. In this case, the mother was hypertensive during her non-pregnant state.

Pregnancy-induced hypertension is defined as single blood pressure measurement of 140/90 mmHg or more for a mother with normal blood pressure before 20 weeks of gestation in two consecutive blood pressure measurements of 6 hours or more apart but not more than seven days.

Severe hypertension in pregnancy is defined as the single measurement of diastolic blood pressure of 120 mmHg or more OR diastolic blood pressure 110 mmHg or more on two occasions measured 4 hours or more apart.

Significant proteinuria in pregnancy is defined as urinary protein excretion of 300 mg or more per 24 hour (quantitative) or 1+ on dipstick OR 2+ or more protein on dipstick or two random urine protein concentrations of 100 mg/dl collected 4 hours or more apart of two clean-catch midstream specimens of urine collected 4 hours or more apart (qualitative).

Pathologic oedema is defined as dependent oedema that persists after nights rest OR any non-dependent oedema that involves the face, the hands or the whole body OR abnormal weight gain of more than 2 pounds per week.

Pre-Eclampsia

Pre-eclampsia is the occurrence of hypertension, proteinuria and/ or oedema which occurs after 20 completed weeks of gestation that will resolve within six weeks after the delivery of the baby. Preeclampsia before 20 weeks is associated with molar pregnancy. It is classified into mild and severe forms. The presence of any of the following classifies it as severe pre-eclampsia.

  • Severe hypertension (refer definition).
  • Proteinuria of 5 grammes or more in 24 hours (quantitative) or 3+ or more on dipstick on two random specimens (qualitative).
  • Urine output of fewer than 400 millilitres in 24 hours (Oliguria).
  • Epigastralgia or right upper quadrant pain.
  • Cerebral symptoms like persistent frontal or an occipital headache resistant to ordinary analgesics, blurring of vision, altered consciousness.
  • Intrauterine growth restriction.
  • Signs and symptoms of a pulmonary problem.
  • Others.

Eclampsia

  • Eclampsia is described as the development of grand mal-seizures or coma (loss of consciousness) in a woman with preeclampsia.
  • It is mainly characterised by convulsion (like seizure seen on an epileptic person) and coma (complete loss of consciousness).

Last modified: Tuesday, 21 February 2017, 4:16 PM