Definition

Hypertension in pregnancy is hypertension or high blood pressure ( 140/90 mmHg) in pregnancy. This condition occurs at about 6-8% of all pregnancies or 3 out of 50 pregnancies; and is one of the important causes of morbidity and maternal mortality.

There are several forms of hypertension in pregnancy, namely:

• The chronic hypertension is hypertension that has existed since before pregnancy or before the gestational age of 20 weeks or hypertension that continues beyond 12 weeks after giving birth.
• Gestational hypertension is hypertension in pregnant women that arises after a gestational age of 20 weeks and returns to normal within 12 weeks of childbirth. At gestational hypertension, no protein is found in the urine.
• Preeclampsia, namely hypertension in pregnant women accompanied by protein in the urine, kidney disorders, liver disorders, blood disorders, as well as other hypertension complications of pregnancy
• Eclamsia is a form that is heavier than preeclampsia, which is characterized by seizures or decreased consciousness in pregnant women. Eklamsia occurs in about 1 in 1600 pregnancies. Even though it can be experienced at pregnancy age less than 20 weeks or 48 hours after childbirth, Eklamsia most often occurs in the last trimester of pregnancy.
• HELLP syndrome. Actually, HELLP stands for the following 3 conditions: Hemolysis 'destroying of blood cells', Elevated Liver zymes 'increased levels of liver enzymes', and Low Platelet count 'low blood plate' or thrombophilia.

Cause

The cause of hypertension in pregnancy is still unknown, but it is estimated that there is a disturbance in the flow of blood between the uterus and the placenta and the decrease in the function of blood vessels that mediate.

Risk Factors

In general, conditions that can disrupt blood flow and blood vessels between the uterus and the placenta can increase the risk of a mother suffering from hypertension in pregnancy, namely:

• Already experienced hypertension before pregnancy
• Kidney disease
• Diabetes mellitus
• Obstructive sleep apnea (OSA)
• Decreased blood chip (trombophilia) levels
• Autoimmune disease 

Gestational & Pre-Eclamptical Hypertension

Here are some conditions that can increase the risk of a mother to experience gestational hypertension and increase her chances of experiencing pre-excellence

• Already experienced hypertension before pregnancy
• Having experienced hypertension in pregnancy in a previous pregnancy
• Having experienced pre-eclamacy in previous pregnancy
• Having had HELLP syndrome in a previous pregnancy
• First pregnancy
• Twin pregnancy, or more than 2
• Mother's Age is less than 20 years pregnant or more than 35 years old
• Body mass index (IMT) >30 kg/m²
• Kidney disease
• Kidney blood vessel disease
• Aorta Disorders
• Diabetes mellitus
• Autoimmune diseases, such as lupus disease, mechanics, sleptroderma or connective tissue disease
• Hyperaldoseronism
• Cushing Syndrome
• thyroid disease
• Feocromostoma
• Obstructive sleep apnea

Symptoms

Every pregnant woman with hypertension can experience different symptoms and some are asymptomatic. The most common symptoms are:

• High blood pressure with or without protein in the urine, found in the middle of the two pregnancies
• Swelling mainly on both legs
• Suddenly gaining weight
• Visibility disorders, such as blurred vision or ganta
• Headache
• Nausea, vomiting
• Upper right abdomen pain or pain around the stomach
• The amount of urine decreased
• Changes in liver or kidney function examinations
• Kejang. Preeclampsia that is not handled properly can develop into a more severe form, namely eklamsia. Women with eklamsia will experience seizures or decreased consciousness.

Diagnostic

Hypertension in pregnancy is diagnosed when blood pressure is higher than 140/90 mmHg which is measured at least twice at different times of time.

Additional examinations carried out on mothers with hypertension of pregnancy are:

• Blood tests
• Urine examination, liver function, kidney function, and blood clotting (to check for more serious conditions, namely preeclampsia)
• Examination to assess swelling
• Weight measurements

Laksana Procedure

Specific treatment and therapy for hypertension in pregnancy will be determined by the doctor taking into account:

• General status of pregnancy, health, and medical history
• The severity of the disease
• Tolerance with certain drugs, procedures, or therapies
• Mother's Hope For Her Disease
• Mother's Preferences or Opinions

The purpose of therapy is to prevent worsening conditions and prevent complications. The therapy that can be given includes:

• Bed rest 'tirah baring', can be at home or at the hospital
• Hospitalization if needed monitoring with certain tools or with the supervision of health workers
• Regular blood pressure monitoring
• Magnesium sulfate or other blood pressure reduction drugs if blood pressure is very high
• Examination of the fetus to determine the health of the fetus. This examination includes:
  • Calculating fetal movement. Monitoring movement and kick of the fetus is necessary due to changes in the amount or frequency of movement that could indicate existence stress in the fetus
  • Nonstress testing. This examination is carried out to measure fetal heartbeats in response to fetal movement
  • Biphysical profiles. This check is a combination nonstress test with ultrasonography to observe fetal well-being
  • Check the flow DopplerThis examination includes ultrasonicography that uses sound waves to measure blood flow through blood vessels
• Continuous examination of urine and blood to detect changes indicating worsening from hypertension of pregnancy or development towards preeclampsia or eclamia
• Giving a corticosteroid to help maturate the lungs of the fetus (the absence of the lungs is a major problem in premature babies)

If there have been complications, it may be necessary to give birth to a baby premature (less than 37 weeks).

Complications

Blood pressure that can affect blood vessels so that blood flow to mothers' organs including liver, kidneys, brain, uterus, and placenta 'ari-ari' will decrease. Hypertension in pregnancy that is severe and not handled properly can result in complications of HELLP syndrome, namely syndrome consisting of damage to red blood cells, liver disorders, and low blood keeping cells (cells in the blood needed to help blood clots to control bleeding).

Another problem that can arise from hypertension in severe pregnancy (blood pressure above 160/110 mmHg) is:

• The release of the placenta from the uterus before its time
• Problems in fetuses such as fetal growth disorders to fetal death
• Deaths of ibiu and fetuses

Although blood pressure returns to normal after giving birth, a mother who has had hypertension in pregnancy has a higher risk of suffering from hypertension in the future.

Prevention

To date, there is no definite way to prevent hypertension. However, some factors that can trigger hypertension can be controlled by:

• Reducing salt consumption
• Drink at least 8 glasses per day
• Increase protein consumption and reduce fried food consumption and junk food
• Get enough rest
• Regular exercise (discussed with your doctor about what exercise you can do while you are pregnant)
• Raise your legs several times a day
• Avoid alcohol and drinks that contain caffeine
• Consumption of drugs or supplements prescribed by doctors

Early identification of women who are at risk of hypertension in pregnancy can help prevent complications of disease. In addition, studying symptoms and danger are also important because early therapy will help prevent disease worsening.

Therefore, it is important to carry out routine pregnancy checks to maintain the health of the mother and fetus.

When Do You Have To Go To A Doctor?

If you have high blood pressure signs and symptoms as mentioned above, then seek medical help immediately. Consult with an obstetrician to confirm it. Symptoms that can occur include non-vanishing headaches, blurred or multiple views, swelling, or reduced frequency of urination.

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