Hypertension affects 10% of pregnancies and is a leading cause of maternal and fetal morbidity. Early detection and management are critical to prevent progression to preeclampsia, eclampsia, or HELLP syndrome.
Definition & Classification
BP ≥140/90 mmHg after 20 weeks in previously normotensive woman.
| Type | Key Features |
|---|---|
| Gestational HTN | After 20w, no proteinuria |
| Preeclampsia | HTN + proteinuria/organ damage |
| Eclampsia | Preeclampsia + seizures |
| Chronic HTN | Before 20w or persists >6w postpartum |
Pathophysiology
Defective placentation → ischemia → antiangiogenic factors → endothelial dysfunction → vasospasm, leak, coagulation.
Risk Factors & Clinical Features
Primigravida, obesity, chronic HTN, family history.
Symptoms
- Headache
- Visual changes
- Epigastric pain
- Edema
Signs
- BP ≥140/90
- Proteinuria
- Hyperreflexia
Investigations & Complications
Urine protein, LFTs, platelets, ultrasound.
Maternal
- Eclampsia
- HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count)
- Abruption
- DIC (Disseminated Intravascular Coagulation)
Fetal
- IUGR (Intrauterine Growth Restriction)
- Preterm
- Hypoxia
Management
Stabilize, control BP, prevent seizures, time delivery.
| Drug | Dose | Comments |
|---|---|---|
| Methyldopa | 250–500 mg 8-hourly | First-line |
| Labetalol | 100–400 mg 8-hourly | Safe, effective |
| Nifedipine | 10–20 mg 8-hourly | Avoid with MgSO₄ |
Prevention & Delivery
Aspirin 75–150 mg from 12w in high-risk. Deliver at 37w (mild), earlier if severe.
Key Takeaways
- BP ≥140/90 after 20w
- Preeclampsia = HTN + proteinuria
- MgSO₄ for seizures
- Labetalol, methyldopa safe
- Delivery = cure
- Aspirin prevents in high-risk
Conclusion
Hypertension in pregnancy requires aggressive monitoring and timely intervention to protect mother and baby.
Hypertension in pregnancy is a silent threat — vigilance saves lives.