Pregnancy Induced Hypertension And Ayurveda


                                 

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

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PRE-ECLAMPSIA :

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

Proteinuria :  24 hr urine collection : ≥ 300 mg protein ;

                         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 :

  • Primigravidity

  • 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 ) .

  • Increasing maternal age

  • Previous pre – eclampsia

  • Obesity ( Syndrome X , PCOS )

  • Medical disorders :  Diabetes , Chronic Hypertension , Chronic Renal disease , Antiphospholipid antibody syndrome & thrombophilia , Migraine , Asthma .

  • Family history of Pre – eclampsia

  • Stressful job

PLACENTAL / FETAL FACTORS :

  • Advancing gestational age

  • Poor placentation

  • Multiple pregnancy

  • Hyaditiform mole

  • Triploidy

  • Trisomy 13

  • Trisomy 16 mosaic

  • Placental hydrops

RECOGNITION OF THE PRE – ECLAMPTIC SYNDROME :

MATERNAL SIGNS :

  • PIH

  • Excessive weight gain ( > 1.0 kg / wk )

  • Generalized oedema

  • Evidence of haemoconcentration : Increased haematocrit

  • Disturbance of Renal function : Hyperuricaemia , Proteinuria , Raised plasma creatinine – reduced creatinine clearance , Hypocalciuria

  • Increased circulatory markers of endothelial dysfunction : Plasma vonWillbrand factor , Plasma cellular fibronectin

  • 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

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COMPLICATIONS OF PRE – ECLAMPSIA :

Central Nervous System :

  • Eclamptic convulsions

  • Cerebral haemorrhage

  • Cerebral oedema

  • Cortical blindness

  • Retinal oedema

  • Retinal detachment

Renal System :

  • Renal cortical necrosis

  • Renal tubular necrosis

Respiratory System :

  • Laryngeal oedema

  • Pulmonary oedema

Liver :

  • Jaundice

  • Hepatic infarction

  • HELLP Syndrome

  • Hepatic rupture

Coagulation System :

  • DIC

  • Microangiopathic haemolysis

Placenta :

  • Placental infarction

  • 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 .

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AYURVEDA :

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 )

MANAGEMENT :

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 .

Herbs : Garlic ( Allium sativum ) , Punarnava ( Boerhavia diffusa ) ,   Gokshur      ( Tribulus terrestris ) , Shatavari ( Asparagus racemosus ) ,                       Jatamansi            ( Nordostachys jatamansi ) , Brahmi ( Centella asiatica ) etc can be given under supervision .

Other activities such as walk , meditation , deep breathing etc are also helpful .

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Preventing Acute Kidney Attack During Pregnancy Through Ayurveda


World Kidney Day aims to raise awareness of the importance of our kidneys to our overall health and reduce the frequency and impact of kidney disease and its associated health problems worldwide .

This year’s focus is on Acute Kidney Attack ( earlier called Acute Renal Failure ) .

Although some diseases of the kidney and urinary tract may be associated with pregnancy by chance , pregnancy induced changes may predispose to the development of renal tract disorders . Acute Kidney Attack is a life threatening complication of pregnancy . 

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  Causes of Acute Kidney Attack during pregnancy

A) Early pregnancy :       Hyperemesis gravidarum ( Severe Vomitting )   

                                               Septic abortion

B) Late pregnancy :     Pregnancy induced hypertension (PIH),Pre eclampsia                  

                                         HELLP Syndrome

                                         Antepartum haemorrhage (bleeding during pregnancy) 

                                         Post partum haemorrhage ( bleeding after delivery )

                                         UTI ( Urinary tract infection ) : It is the most common cause of renal disease and ranges from asymptomatic bacteriuria to pyelonephritis .

      Oliguria is an important sign of acutely impaired renal function .

According to Ayurveda , it  is considered as Mutra apravrittijanya roga .

 Prevention through Ayurveda :

a)      Garbhini Paricharya ( Ayurvedic Antenatal Regimen ) should be initiated as soon as pregnancy is confirmed .

b)      Herbs which can be taken under supervision are – Amla ( gooseberry ) , Punarnava (Boerhavia diffusa ) , Chandan ( Santalum album ) , Ushir ( Vetiveria zizinioides ) , Bala ( Sida cordifolia ) ,Shatavari ( Asparagus racemosus ) , Gokshur ( Tribulus terrestris ) etc .

  c)     Diet : Eatables which can be included are – Cucumber , Pumpkin , Pomegranate , Fennel , Small cardamom , Coconut water , Buttermilk , Sugarcane juice , Raisins , Mishri ( candy sugar ) , Coriander , Water chestnut ( Singhara ) etc.

 As the physiological status is altered during pregnancy , significant changes both in structure and function take place in urinary tract . So special care for even minor complaints should be taken .