Today is World Health Day and this year focus is on Hypertension .
Hypertension is one of the common medical complication of pregnancy and contributes significantly to the maternal and perinatal morbidity and mortality .
Pregnancy induced hypertension ( PIH ) , Transient hypertension of pregnancy or Gestational hypertension are terms used to describe new hypertension which appears after midterm ( 20 weeks ) and resolves after delivery .
Chronic Hypertension is used to describe the condition of long term high blood pressure .The usual cause is ‘ essential hypertension ‘, meaning an inherited condition with no underlying pathology .
The threshold for diagnosing Hypertension in pregnancy is 140/90 mm Hg . In second half of pregnancy cut off is 170 / 110 mm Hg . However 170 / 110 or higher is considered to be severe Hypertension ( Davey & MacGillivray 1988 ) .
Thus hypertension in pregnancy has three possible aetiologies :
1) It may be caused by pregnancy itself
2) It may be long term problem present before pregnancy began
3) It may be a new medical problem by chance coinciding with pregnancy
Pre-eclampsia , pre – eclamptic toxaemia ( PET) or gestosis are roughly synonymous terms, a common syndrome that becomes detectable in the second half of pregnancy ( although origins may lie in the first half ) and which is defined in terms of the new development of hypertension and proteinuria . It is common , dangerous to both mother and baby .
The cause of pre-eclampsia is not yet known but must lie within the gravid uterus . Hence , although pre – eclampsia is conventionally defined as hypertension is not primarily a hypertensive disease . The signs of pre-eclampsia are therefore best considered as secondary to a uteroplacental disorder affecting specific maternal target systems . The targets include the maternal cardiovascular , renal , coagulation and hepatic systems .
Definition of Pre-eclampsia as accepted by the International Society for the Study of Hypertension ( Davey & MacGillivray 1988 ) is :
Hypertension : Diastolic pressure :
≥ 90 mm Hg o two or more consecutive occasions ≥ 4 hr apart or ≥ 110 mm Hg once
Or two MSU ( mid stream urine ) sample collected more than 4 hr apart with ≥ + 1 on stick test .
Pre – eclampsia : New hypertension and new proteinuria developing after 20 weeks gestational age and regressing remotely after delivery .
RISK FACTORS FOR PRE-ECLAMPSIA :
MATERNAL FACTORS :
Primipaternity ( There is partner specificity about the occurance of pre-eclampsia . Hence , it is not simply the first pregnancy that is an important risk factor but the first by the current partner) .
Short period of co habitation ( Stable co habitation with a single partner seems to reduce the risk of pre – eclampsia in the first pregnancy by the partner ) .
Laboratory evidence of excessive activation of the clotting system : Reduced plasma concentration of anti thrombin III , Thrombocytopenia , Increased circulating fibrin D-dimer
Increased circulating concentrations of liver enzymes .
FETAL SYNDROME :
Intra uterine growth restriction
Intra uterine hypoxaemia
COMPLICATIONS OF PRE – ECLAMPSIA :
Central Nervous System :
Renal System :
Renal cortical necrosis
Renal tubular necrosis
Respiratory System :
Coagulation System :
Retroplacental bleeding and Abruptio placentae
MANAGEMENT OF PRE-ECLAMPTIC HYPERTENSION AND ASSOCIATED PROBLEMS
The principles of management are :
Screening of the symptomless patient , diagnosis and well timed delivery .
In general , symptomatic pre-eclampsia ( symptoms , hypertension and proteinuria ) justifies an emergency admission .
Symptomless proteinuric pre- eclampsia demands urgent admission on the day of diagnosis .
Pre – eclampsia without proteinuria , which has been confirmed by biochemical testing ( eg hyperuricaemia ) is usually best managed in a day assessment unit where frequent detailed checks are routine .
Mild hypertension with no other complicating factor can be managed conservatively from routine clinics .
Though there is no direct mention of PIH in Ayurveda , but some symptoms as complication of pregnancy have been described . It can be termed as Garbhajanya Vishamayataa .The main symptoms are :
Shopha ( Oedema )
Paad Shotha ( Pedal oedema )
Mutra alpata ( Oliguria )
Aakshepa ( Convulsions )
Sangyanasha ( Coma )
In PIH , Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .