High blood pressure –BP (PIH- Pregnancy Induced Hypertension) affects the health of both pregnant mother and the unborn child adversely.
Management with medicines, adequate rest, hospitalisation and regular visits to the Gynaecologist will help in controlling PIH, pregnancy-related high BP in most of the cases.
This article will provide an insight into the complications that are associated with this clinical condition, which happens if medical advice is not followed and hypertension remains uncontrolled.
- One needs to understand that in severe disease, unfortunately, complications occur in spite of best and regular medical treatment of PIH- Pregnancy Induced Hypertension.
- Another pointer to understand is that in any one particular patient only one of the following or a combination of the complications may be present.
The topic is written in easy language and terminology is such that the information provided will be useful to a large number of people. However, medical terminology is an inseparable part of this article. To make understanding simpler ( ) are used for medical terminology
EFFECTS ON THE MOTHER
The organs and systems get affected in many ways
1. THE BRAIN
Swelling of the brain (Cerebral edema)
Clinically the symptoms are-
- A headache- which will not get OK by taking painkiller tablets
- Blurred vision
In late stages
- Fits (Eclampsia)- This is a dangerous clinical situation. It may be associated with significant brain injury and dysfunction.
Changes in brain at structural level include bleeding (Hemorrhage), Blockage of blood supply (Infarction), Decreased blood flow (Ischemia), shrinkage of blood vessels (Vasospasm)
These patients are prone to sudden increase in BP which may worsen their condition further
Investigations like CT Scan or MRI will show following features
- Swelling (Edema) of the brain
- Fluid channels of brain get blocked (Obliteration of central ventricles)
- Brain matter will come out (herniate) through its coverings-life threatening (Transtentorial herniation)
2. EYES-VISUAL CHANGES AND BLINDNESS
Women will complain of
- Seeing black spots before eyes (Scotomata)
- Seeing things as double (Diplopia)
- Blindness- in most of the cases, it will last for 4 hours to up to 8 days. It is reversible. The dysfunction occurs in the brain where the centre for vision lies.
In some cases, partial or total blindness persists.
- Eyeball changes-Inner lining of eyeball gets disrupted (Retinal detachment)-one more reason of blindness-Blood supply to eyeball is stopped retinal artery occlusion)- causes permanent blindness
3. LIVER CHANGES
- There may be bleeding inside the liver (Periportal haemorrhage)
- Blood may collect below its capsule( Subcapsular hematoma)
- There may be rupture of liver with dire consequences
Clinically patient presents as
- Pain in upper abdomen
- Blood investigation for liver function will reveal raised liver enzymes ( SGOT,SGPT)Liver complications are associated with higher death rate of pregnant woman (maternal mortality.) In rare cases, liver transplantation only will save the life of the woman.
- HELLP syndrome is associated with liver disorders (Hepatocellular necrosis)H (Hemolysis) EL ( Elevated Liver enzymes) LP (Low Platelets count)
Patient suffering from this complication will require intensive care and may have prolonged recovery time
4. KIDNEY CHANGES
- Blood supply to the kidneys (Renal perfusion) and its filtration process, both are reduced
- Factors like blood loss, redirection of the blood to more vital organs like brain, increased blood pressure leading to widespread contraction of blood vessels (Vasospasm) are responsible for it.
- On a microscopic level, basic functional units of kidney like Glomeruli and Tubules are damaged.
Kidneys secrete many harmful substances of the body through urine. Consequences of decreased kidney functions are many –
- Urine output is decreased
- Blood levels of Creatinine, Uric acid and Calcium rise
The accumulated toxic substances in blood will eventually affect the mental status of the patient and she will appear dull and lethargic
5. CHANGES IN BLOOD
- Decreased platelet count (Thrombocytopenia-Platelet is a component of blood)The normal platelet count is 1.5-4-5 Lakh/ml. Platelets play a very important role in stopping the flow of blood at the site of injury or bleeding. During delivery or caesarian section, the amount of bleeding is more if platelet count is less and it puts the life of the mother in danger.If serial monitoring of blood shows a decreasing trend of platelet count, it becomes an indication for delivery. After delivery recovery of platelets will take 2-5 days.
- Destruction of blood (Hemolysis)- In high BP pregnant patients, the lining of small blood vessels gets damaged.- Platelets and fibrin (blood component) get deposited on these sites to seal these sites.- Blood corpuscles get damaged while passing through these vessels.- Destruction of blood will lead to fall in Hemoglobin level (Anemia)- Microscopic slide examination of blood will show abnormal Red Blood Corpuscles (RBC) like (Schizocytosis,Spherocytosis,Reticulocytosis).
- Blood clotting (Coagulation) changes- There is a widespread blood clotting and blood destruction happening at a multi-organ level in these patients.- As a result blood levels of clotting factors are deranged .- The tests which are abnormal include- PT- Prothronbin Time, PTT-Partial Thromboplastin Time,Fibronectin, D-Dimers, Factor VIII, Fibrinogen etc
6. HEART AND CIRCULATORY SYSTEM (CARDIOVASCULAR) CHANGES ALONG WITH LUNGS (RESPIRATORY SYSTEM)
The heart is made up of two types of chambers
- Contractile chambers to push blood out into the system-Ventricles –They are two in numbers, left and right.
- Receptive chambers to receive blood from the system- Atrium- They are also two in numbers, left and right.
When BP is high the ventricles will need to work against more resistance. As a result of their muscle mass increases (Ventricular hypertrophy). Their lumen gets diminished in size. The final result is that fluid accumulates in lungs (Pulmonary Edema)-leading to difficulty in breathing (respiratory distress.) It also results in accumulation of fluid in the body (Edema)
There are other factors too which will lead to accumulation of fluid in the lungs like injury to the lining of breathing units (Alveoli)
7. LUNG CHANGES
- There may be accumulation of fluid in lungs (Pulmonary edema.)
- Patient may have difficulty in breathing and at times may require ventilator support ( ARDS-Acute Respiratory Distress Syndrome)
EFFECTS ON THE UNBORN CHILD ( FETUS )
Here we will tell you about Uterus-Placenta unit’s blood supply-(Utero-placental perfusion.)
- Uterine artery is the main blood vessel supplying uterus and in turn to placenta and growing baby (fetus.) In a normal pregnancy, the uterus and placenta allow uterine artery to supply extra blood to it for healthy growth of baby (fetus.)In cases of high BP, both uterus and placenta will resist this extra supply, resulting in less blood available to baby (utero-placental insufficiency) which will lead to low birth weight of newborn (IUGR- Intra Uterine Growth Retardation.)At times water around baby also becomes less (Oligohydramnios.)This compromised placenta sometimes separates from its attachment to uterus prematurely, even when the patient is not in labour (Abruptio Placentae). This will lead to bleeding (Ante Partum Hemorrhage) putting life of both mother and baby in danger (Maternal mortality and IUFD-Intra Uterine Fetal Death)
- Preterm birth- at times it becomes necessary to deliver the pregnant woman even before her 9 months are not complete. This kind of decision is taken if all the medical management including tablets to control the BP, rest at home or even hospitalisations are failing to control the high BP of pregnancy (PIH-Pregnancy Induced Hypertension)
Note from Author
- Expert and timely medical care and patient’s compliance towards taking medicines and regular check up with prescribed investigations have improved the outlook in most of the cases . In urban settings where the facility for ICU- Intensive Care Unit,NICU-Neonatal Intensive Care Unit for the newborn and blood banks are available, both mother and child have a good outcome.
- Rural areas which are yet to have these facilities have a scope for improvement towards ‘Healthy Mother-Healthy Child’ initiative.