Hypertension during pregnancy is the second most common medical disorder, after anaemia that poses significant risk to maternal safety. In recent years, it is observed that significant percentage of maternal deaths and near miss cases occur due to complications of hypertension during pregnancy.
Hypertension is detected in 10-15 percent of pregnancies, which are either occurring at teen age or in elderly women .Large number of antenatal indoor beds and HDU beds are occupied by the pregnant women with varied severity of the disease.It is also seen in multiple gestation and in cases with polyhydramnios. Women who are primi-gravida, overweight and having genetic predisposition are at increased risk. It is usually a problem of later half of gestation. Some women may develop early onset of hypertension. The hormonal changes associated with pregnancy, immunological factors and imbalance in the intrinsic prostaglandin activity are proven factors for development of this complication.
Prediction of development of hypertension is very much possible with certain clinical and biochemical markers. Careful and serial recording of blood pressure and maternal weight during first visit and during each subsequent antenatal visit are important to detect this abnormality.Oedema over feet associated with proteinuria and hypertension form a well known diagnostic triad.
If remain un-diagnosed or diagnosed late, it result into various serious maternal and fetal complications. Hypertension being a multi-systemic disorder, affects all vital organs and its function. Maternal kidney, liver, brain, coagulation system and placenta are predominantly affected as per severity of disease process. When woman develops convulsion, condition is called as eclampsia develops, which is a life threatening condition.
Maternal mortality and severe morbidity due to this multi-system disorder can be prevented by early detection of hypertension during regular antenatal visits, timely referral to higher centers which are equipped to manage them, hospitalization and anti-hypertensive medication as per advice of obstetrician, timely intervention in the form of induction of labour or caesarean section. Too much of conservative approach for prolongation of pregnancy in severe cases,in order to achieve fetal maturity may result in complications like eclampsia and HELLP syndrome. Maternal safety should always be prioritized in cases with severe hypertension.
The health care providers at all levels of health care facilities must remain vigilant while providing antenatal care to women, who have predisposition for the development of hypertension. This approach will go a long way in saving precious lives.