Obstetrical Hypertension Management

Frequently Asked Questions

1. What is hypertension in pregnancy?
2. If I have gestational hypertension or preeclampsia, how will my pregnancy be watched?
3. What are the warning signs?
4. What should I do if I experience these warning signs?
5. How do I cope with the emotional aspects of hypertension?
6. What should I expect if my doctor prescribes Matria's homecare program for obstetrical hypertension?

1. What is hypertension in pregnancy?

Your circulatory system is made up of the heart and blood vessels. Each time your heart beats (contracts), it pumps oxygen-rich blood into the arteries. This circulatory system functions because of blood pressure, which is necessary to push blood through the arteries. Your heart supplies some of the pressure when it beats and forces blood into the arteries. The arterioles (smallest branch of the arteries) also supply pressure. Arterioles are lined with a layer of muscle. When this muscle layer is relaxed, blood pressure is normal and blood flows easily through the arterioles. At times, this muscle layer constricts (tightens) and the arterioles close. As a result, blood pressure in arteries is increased.

Blood pressure readings are checked with either a manual or an electronic device. The readings are expressed with two numbers. The first reading is called the systolic pressure. This number is the pressure in the arteries when the heart is contracting. The second number refers to the pressure in the arteries when the heart is relaxed. This is called the diastolic pressure.

Blood pressure usually varies during pregnancy. During the middle part of the pregnancy, blood pressure tends to be low. For this reason, it is important that your doctor know what your pre-pregnancy or early pregnancy blood pressure readings are. In general, a blood pressure reading of 140/90 or higher is a sign of hypertension in pregnancy and may signal a problem.

There are two types of hypertension. The first, chronic hypertension, affects both men and women, is long-lasting, and may require treatment with drugs. The second is a group of conditions with symptoms of hypertension that can occur in pregnancy. You may only have elevated blood pressure, which is called gestational hypertension, or you may have preeclampsia, which is elevated blood pressure (with puffiness or swelling of the hands, feet or face), and extra protein in your urine.

Preeclampsia affects about seven out of every 100 women. It occurs most often with a first pregnancy but may occur in a later pregnancy, especially if you are carrying more than one baby or have diabetes. Pregnant women in their teens or over age 30 have a higher risk of developing preeclampsia. Other risk factors include women whose mothers have had high blood pressure and women with kidney disease or other medical conditions.

Hypertension during pregnancy may affect the wellbeing of your baby. Hypertension causes decreased blood flow to the placenta because of the constriction of maternal arteries. Because less nutrients and oxygen reach the baby, growth may be slowed.

2. If I have gestational hypertension or preeclampsia, how will my pregnancy be watched?

Since gestational hypertension or preeclampsia may affect your baby, your doctor may choose to evaluate and/or monitor your baby more often. For example:

• Fetal movement counting. This is a simple technique of having you count your baby's movements for a certain time period every day.
• Ultrasound or sonogram. Ultrasound allows your doctor to determine if the size of the baby is right for the age of your pregnancy. It can also show whether or not there is enough amniotic fluid and looks at the placenta also. This helps to know whether or not your elevated blood pressure has affected the growth of your baby and/or how the placenta is working.
• Nonstress test (NST). Records the baby's heart rate on a monitor and looks for increases that occur when the baby moves. When this happens, it is called a "reactive" NST. If any of these tests show that the baby is having problems, your doctor may choose to check you more closely by having you come to the office more often. If you need to be watched more closely, you may be admitted to the hospital.

3. What are the warning signs?

There are certain warning signs that go along with worsening gestational hypertension or preeclampsia. A sudden weight gain can be a result of your body holding fluid because of the effects of high blood pressure on the kidneys. This weight gain may be seen as swelling, which is called edema. You may see it most in the fingers, face and above the ankles. Because the kidneys may not work as well, protein may spill into the urine. This condition is called proteinuria. Severe headaches, blurred vision and pain in the upper abdomen are also signs that may mean you are getting sicker.

• Edema. Most women have some swelling of their feet during pregnancy. But swelling of the face, hands or feet early in the morning should be reported to your doctor.
• Headache. Headaches can be caused by stress, too much reading, close-up work or not eating. A headache that does not get better after taking an over-the-counter analgesic is a cause for concern. Severe headaches may be because of fluid (edema) in and around your brain and are usually around the forehead area or toward the back of your neck.
• Visual disturbances/eye problems. Blurry vision or seeing "spots" or "silver waterfalls" could mean a problem and your doctor should be called immediately. Visual disturbances can be a result of arteriole spasms in your brain or retina (part of the eye).
• Epigastric pain. Pain in the upper right stomach area can also mean you are having complications. With severe hypertension, your liver can become swollen with fluid and may have a small area of bleeding. Pain in the liver area (upper right stomach) should be reported immediately to your doctor.

4. What should I do if I experience these warning signs?

These warning signs may signal complications and should be checked often. Any changes should be reported to your doctor. There are several steps that you can take to help you become aware of your condition:

• See your doctor as scheduled. Regular visits are important.
• Follow your doctor's instructions carefully. Especially important is paying attention to instructions for decreasing activity, bed rest and taking medications.
• Notify your doctor if you have any of the warning signs listed above.

5. How do I cope with the emotional aspects of hypertension?

Knowing you have gestational hypertension or preeclampsia can be difficult – especially if your pregnancy has been trouble-free until now. You may have a hard time believing you have a pregnancy complication since you do not look or feel sick. Feelings of denial, anger, fear, anxiety and helplessness are common reactions. Your doctor may prescribe medication, bed rest or other treatments to help manage your condition.

Changing your activity level will likely impact your lifestyle. Although activity restrictions and/or bed rest are often necessary, it can be hard to cope with drastic changes such as leaving a job, getting child care, or living on one less income. However, your compliance with treatment is vital to you and your baby's health.

6. What should I expect if my doctor prescribes Matria's homecare program for obstetrical hypertension?

Your doctor may prescribe the Matria Obstetrical Home Care program. This program allows Matria to monitor you closely for any signs of worsening hypertension in pregnancy and to notify your doctor of any change in your condition.

Criteria for service:

• Gestational hypertension
• Mild preeclampsia

Matria services:

• Gestational hypertension plan of care
• Patient education on hypertensive disorders of pregnancy
• Daily and as needed monitoring of urine protein, weight and blood pressure
• 24-hour nursing support
• Individualized care management
• Mild preeclampsia plan of care
• All gestational hypertension plan of care services
• Daily assessment for changes in patient's clinical status
• Fetal movement counts
• Compliance management support, including bed rest or restricted activity
• Non-stress tests as ordered
• Monitoring device for all patients, which transmits patient information daily so nurses can see blood pressure, weight, etc…
• Reports to physicians

Benefits of service:

• Experience and expertise in obstetrical homecare
• Pregnancy outcomes comparable to hospital management
• Cost savings based on reduced hospital days before birth