May 2016
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Changes in blood pressure during pregnancy – Part 1

During pregnancy, it is recommended to have a medical appointment on a regular basis. At each antenatal appointment, the Doctor / midwife takes a note of the blood pressure of the pregnant lady to measure the level of BP; it should be normal. Normal BP is a vital part of ensuring the health of the mother and baby during pregnancy.

Change in BP in pregnancy

A little change in the Blood Pressure (BP) is usual in pregnancy. These variations can be due to hormonal changes. The Progesterone hormone relaxes the blood vessels walls, thus reducing the BP in the 1st trimester and 2nd trimester. There is a fainting sensation or dizziness associated with low BP, especially when there is a long period of standing or when the lady gets up too suddenly.
In the midst of the pregnancy, the BP reaches its lowest level and then later rises back gradually after 24 weeks of pregnancy. During this time, you might have made that extra liter of blood that the heart pumps all around the body. It might return to normal or to pre pregnant level in the last few weeks prior to the birth of the baby.

Causes of change in BP

• Blood circulation expands in pregnancy
• Hormonal changes
• Dilation of blood vessels
• Alterations in Progesterone hormone levels

Measurement of BP

Monitoring is done at every antenatal appointment and a record of the measure of the level of BP is done by the mid wife / nurse. Depending on these values, further examination, tests and care is prescribed.

The BP is measured by the midwife / nurse using the following steps

• She will advise you to remove any tight clothing worn on the arm.
• She will cuff a wrap around the arm at a level above the elbow.
• She will then pump air into the cuff.
• This inflates the cuff temporarily hindering the blood flow for a brief period.
• The blood flow stops in the primary blood vessel in the cuffed arm.
• There is a tightening feeling but it does not hurt too badly.
• This cuff filled with air is gradually released.
• This cuff is connected to the monitor that analyses and gives the measure of BP.
• The final value is displayed on the screen of the monitor.
• The value displayed on the screen is noted by her.
• There are 2 values: systolic BP and Diastolic BP
• The first one or the systolic BP is the value of BP as the heart pumps the blood out around the body.
• The second one or the diastolic BP is the value of BP as the heart relaxes in between the beats.
• The BP value on an average should be about 110/70 for systolic and 120/80 for diastolic.
• Once the values are obtained and studies, she would inform you regarding the results – high or low BP.

Why emphasize on measuring the BP during pregnancy

• BP value tells you the condition of pregnancy – whether normal or with issues. If there are serious issues like preeclampsia then the midwife shall be looking for its symptoms as it is a risk in pregnancy.
• Preeclampsia can cause high BP and related issues. Along with BP, even urine tests are done in this condition. Protein presence in the urine and high BP are signs of preeclampsia. Earlier gestational hypertension poses a higher chance of getting preeclampsia.
• Both ways, regular BP check up and urine checkups are done during antenatal appointments for monitoring mother’s health.

Low Blood Pressure

A drop in BP is also not uncommon in pregnancy. The dilation in blood vessels due to hormonal changes leads to decrease in BP in pregnancy. It starts to lower in initial stages of pregnancy.

Symptoms experienced during Low BP in pregnancy

• Dizziness
• Lightheadedness
• Fainting
• Tired

A severe lowering of BP can lead to organ damage which includes:
• Stroke
• Kidney failure
• Heart attack

In pregnancy, the BP drop is variable. In general the systolic BP lowers by 5-10Hg whereas the diastolic BP lowers by 15mmHg which return back to normal after pregnancy.

What is Polyhydramnios? (part 2 ..)

Read the first part of this article (What is Polyhydramnios – Part 1)

Diagnosis of Polyhydramnios

Polyhramnios is diagnosed based on various factors associated with the condition of mother and associated illness like diabetes, overweight etc. A Doctor would consider the following factors to diagnose Polyhydramnios in a pregnant woman:

• Maternal history of Diabetes Mellitus
• Rh incompatibility
• Intrauterine infection
• Multiple pregnancies

Clinical signs associated with Polyhydramnios

• Increased abdominal size, out of proportion with weight gain and gestation age
• Uterine size outpacing gestational age
• Shiny skin with stria
• Dyspnea
• Chest heaviness
• Fetus has a faint fetal heart sound

Associated conditions

With the condition of Polyhydramnios, the fetus may have an increased risk of developing the following:
• Cord prolapsed
• Placental abruption
• Premature birth
• Prenatal death
• Congenital abnormalities

Management of Polyhydramnios

Polyhydramnios management depends on how severe the condition is and the cause behind it. If the condition is mild, there is a chance that the condition subsides as the pregnancy progresses. In most cases, the Doctor will advise you to take rest.
In the case where sugar levels are raised in the blood stream and you are not undergoing any treatment for diabetes, doctor may suggest you to go to specialists for further examination and advice. Through this process, the Blood sugar level will lower this way, and thereby it will also reduce the amniotic fluid volume.
Doctor shall advice you on the schedule of regular check up to monitor the volume of the amniotic fluid. In a severe condition, hospital admission may be required. Undergoing an ultra sound scan shall help in spotting any associated problems in baby and also in monitoring the amniotic fluid levels. If everything seems fine, then the cause of polyhydramnios is certainly something else.
But if there is any identification done regarding a problem with baby, then the treatment shall be identical to that in twin-to-twin transfusion syndrome. Based on the cause of the excess volume of the fluid, a medication might be suggested in order to minimize the urine amount produced by the baby.
In case of an abnormality in the baby, if a surgery has to be performed, then labor might be induced and the baby kept in a neonatal surgical unit. The baby undergoes an operation under a specialist. Thereafter, due care and process is taken for the baby and mother.
In certain severe cases of polyhydroamnios, draining of amniotic fluid is possible in order to reduce the overall volume of the amniotic fluid. This shall help the mother by reducing the risk of preterm labor or even placenta going away from the uterus wall. This technique is considered risky and there are chances of infection building up, which would cause the mother to have contractions and going into labor. Also, there is no guarantee of further build up of excess amniotic fluid in the womb. Sometimes even rest might not help as the uterus is swollen. This may lead to premature labor. Consultation with the Doctor or midwife shall help in getting all the knowledge of preterm labor symptoms and what to do if you have these signs. In case of preterm labor, contact the hospital immediately.

Coping with Polyhydramnios

In breathlessness:
• Things you require should be kept in handy.
• Do household chores in bits
• Take your time doing things
• Take plenty of rest

In heartburn:
• Eat small meals
• Don’t get into bed to sleep immediately after having a meal
• Having food just before going to bed is to be avoided.
• Don’t eat or drink anything that worsens heartburn
• Sleep propped up in bed
• Take an antacid prescription from the doctor.

Treatment of Polyhydramnios

It has to be managed and the woman might need admission into a hospital in severe cases. For relief from nausea and heartburn, antacids may be prescribed. Amniocentesis may be suggested which is a process of amino-reduction.