Types of hypertension in pregnancy | Causes and Risk factors | Treatment and Prevention

Symptoms and Diagnosis of Hypertension in Pregnancy in sub-Saharan Africa

By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health), Freelance Medical Writer.  Medically reviewed By: Dr. ‘Kunle Soyemi. MBBS, FWACS; FRCOG. Consultant Obstetrician & Gynaecologist.

A black pregnant woman having blood pressure check.

Symptoms of Chronic Hypertension

You may have chronic hypertension without being aware. This is because it does not usually cause symptoms. This is why it is good to check your blood pressure regularly.

However, when the blood pressure is very high, you may have symptoms like:

• Headache
• Dizziness
• Nose bleeds
• Chest pain
• Difficulty seeing
• Awareness of heartbeat (palpitation)

 Symptoms of Preeclampsia

If you have mild preeclampsia, there may not be any symptoms.

Severe preeclampsia however is associated with symptoms like:

• Severe headaches
• Problems with vision. You may have light sensitivity or see black spots in the field of your vision.
• Nausea and vomiting

The headache, blurring of vision, nausea and vomiting are due to swelling (oedema) of the brain and the increased brain fluid pressure on the back of your eyeball.

• Difficulty in breathing. This is due to the collection of water in the lungs leading to pulmonary oedema.
• Pain on the upper right abdomen: This is due to stretching of the capsule covering the liver due to oedema
• Swollen face, legs and fingers
• Reduced quantity of urine
• Convulsion (eclampsia) may also be the first sign of preeclampsia.

When your doctor checks (examines) you, the following will be observed

• Elevated blood pressure
• Yellowness of the eyes (Jaundice)
• Paleness, especially if you have HELLP syndrome
• Swollen legs, fingers and face. The swelling may be generalised in severe cases.
• Evidence of fluid collection in your lungs (crepitations)
• An enlarged liver that is painful to touch in the right upper abdomen
• Reduced fundal height (size of the womb). This is because hypertension can affect the growth of the baby
• Abnormal heart rate of the baby

How Would Your Doctor Diagnose Hypertension During Pregnancy?

Hypertension in pregnancy is diagnosed by measuring the Blood Pressure (BP). Both manual and digital blood pressure measuring devices can be used. It is better to measure it while sitting.

The blood pressure is recorded as a fraction with the systolic blood pressure up and the diastolic blood pressure below. (i.e., 120/80mmHg) 

The systolic value represents the pressure in blood vessels when your heart contracts. The diastolic number represents the pressure in the vessels when the heart is at rest (in between two beats). [3]

The history and blood pressure reading alone is enough to diagnose chronic hypertension. 

If you’ve had chronic hypertension for a long time, your doctor may also find evidence of damage to organs like your eyes, kidneys and heart.

In addition to the symptoms and examination findings, you may need more tests to be done to establish the diagnosis of the other types of hypertension in pregnancy.

These include:

• Urine tests for protein
• Blood tests to assess your blood count, and liver and kidney functions. 

Blood count: Your blood percentage and platelet count may be low especially if you have developed HELLP syndrome. 

Liver Function Test: There may also be evidence of liver damage, hence a test of your blood liver enzymes.

Blood tests may also show evidence of raised bilirubin (a pigment in your blood). This shows increased destruction of your red blood cells. If the disease is very severe, the blood tests will also show evidence of blood clotting problems.

Kidney Function Test: If there is kidney damage, the urea and creatinine levels in your blood would be raised.

•  Monitoring of the baby: This involves serial ultrasound and cardiotocography to monitor the growth and heart rate of the baby respectively.

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References

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Watch this video to learn more about Hypertension in Pregnancy

Published: October 25, 2024

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