Pregnancy-Induced Hypertension (PIH)

I. Definition

Pregnancy-induced hypertension (PIH) is a condition characterized by a systolic blood pressure (SBP) of ≥ 140 mmHg or a diastolic blood pressure (DBP) of ≥ 90 mmHg that develops after the 20th week of pregnancy, accompanied by negative proteinuria.

II. Classification

PIH is classified based on blood pressure criteria, proteinuria, and complications:

• Gestational Hypertension (GH):

• Blood pressure ≥ 140/90 mmHg developing after the 20th week of pregnancy.

• Negative proteinuria.

• Preeclampsia:

• GH from the 20th week, blood pressure ≥ 140/90 mmHg (measured twice, at least 4 hours apart).

• Positive proteinuria.

• Eclampsia:

• Presence of all three factors: seizures + coma + history of preeclampsia.

• Chronic Hypertension:

• Blood pressure ≥ 140/90 mmHg present before the 20th week of pregnancy or before pregnancy.

• Preeclampsia Superimposed on Chronic Hypertension:

• Development of preeclampsia in a patient with pre-existing chronic hypertension.

Note:

• There is no classification of mild or severe preeclampsia. Instead, preeclampsia is assessed based on severe features or mild features.

• Severe preeclampsia may be defined when:

• Blood pressure ≥ 160/110 mmHg (measured twice, at least 4 hours apart).

• Liver enzymes are doubled from the normal range, platelets < 100,000/µL, creatinine > 1.1 mg/dL.

• Neurological, ophthalmic, or pulmonary complications.

• HELLP Syndrome (Hemolytic Anemia, Elevated Liver enzymes, Low Platelet count): A severe complication of preeclampsia, causing hemolytic anemia, elevated liver enzymes, and low platelet count.

III. Symptoms and Clinical Evaluation

• Gestational Hypertension: Usually no obvious symptoms.

• Preeclampsia:

• Mild features: Headache, blurred vision, dizziness, nausea, vomiting, edema, rapid weight gain, decreased urination.

• Severe features: Epigastric pain, right upper quadrant abdominal pain, shortness of breath, blurred vision, altered consciousness, seizures.

• HELLP Syndrome:

• Anemia, jaundice, nausea, vomiting, epigastric pain, right upper quadrant abdominal pain, edema, decreased urination.

• Clinical Evaluation:

• Blood tests: Hb, Hct, platelets, blood type, coagulation, creatinine, urea, uric acid, liver enzymes, total bilirubin, LDH, haptoglobin.

• Doppler Ultrasound: Evaluate fetal health.

• Urine tests: Proteinuria.

• Electroencephalography (EEG): Assess brain activity.

IV. Approach to a Pregnant Woman with Hypertension

• Step 1: Ask about medical history before pregnancy, especially chronic hypertension. Determine the onset of high blood pressure.

• Step 2: Perform a general physical examination, measure blood pressure, and perform urine tests (proteinuria).

• Step 3: Inquire about severe features of preeclampsia: epigastric pain, right upper quadrant abdominal pain, decreased urination, shortness of breath, blurred vision, altered consciousness, seizures.

• Step 4: Perform clinical evaluation, monitor the fetus with Doppler ultrasound.

• Step 5: Choose an option for outpatient monitoring or hospitalization depending on the mother’s and fetus’s condition.

V. Outpatient Monitoring

• Indication:

• Mother: blood pressure < 160/110 mmHg, no severe features, no labor, no emergencies.

• Fetus: < 37 weeks, healthy.

• Monitoring: Monitor for severe features, blood pressure, and re-examine twice a week.

VI. Hospitalization

• Indication:

• Severe preeclampsia.

• Fetal jeopardy.

• Maternal emergencies.

• Treatment:

• Blood pressure control: Lower blood pressure if ≥ 160/110 mmHg.

• Brain protection: Use Magnesium sulfate (MgSO4).

• Fetal lung maturation: Use corticosteroids.

• Cesarean delivery: In cases of severe maternal and fetal jeopardy.

• Induction of labor: If the fetus is full-term, the mother is stable, and labor has not started.

VII. Notes

• Preeclampsia and HELLP Syndrome can occur in the postpartum period, requiring blood pressure monitoring and postpartum preeclampsia prophylaxis.

• PIH is a serious condition that can affect the health of the mother and the fetus.

• Early diagnosis and treatment are crucial to minimize complications.

• Adhere to monitoring and treatment guidelines provided by a healthcare professional.

VIII. References

• Guidelines for the Diagnosis and Management of Preeclampsia/Eclampsia from the Ministry of Health.

• Obstetrics professional literature.

Note: This article is for informational purposes only and should not be considered as a substitute for professional medical advice. You should consult with a healthcare professional for accurate and complete advice.