It is important that your midwife regularly checks your blood pressure (BP) at all appointments during your pregnancy. This is one of the standard assessments to check how you and your baby are doing.
If you are told that your blood pressure is raised during pregnancy (called hypertension) this can be quite worrying. The advice you will be given, including monitoring and treatment options, will depend on how severe your hypertension is.
If you know that you have hypertension and want to get pregnant, you should speak to a doctor before trying to conceive. They can advise you on anything that you need to be aware of and make any changes that may be needed to your medication, to ensure your pregnancy is as healthy as possible.
The NHS defines the three levels of hypertension as:-
- mild – BP between 140/90 and 149/99mmHg;
- moderate – BP between 150/100 and 159/109mmHg
- severe – BP of 160/110mmHg or higher
Whilst a raised BP reading may not be anything to worry about generally, in pregnancy, it can be a warning of a serious condition.
If my BP stays over 140/90mmHg, what will likely happen?
This is called chronic hypertension. If either the top or bottom number, or both stay over 140/90mmHg, you may be given medication such as labetalol or aspirin to try and lower it. You may also have appointments every one to four weeks so your BP can be measured regularly and ultrasound scans every two to four weeks from 28 weeks onwards to check your baby’s growth.
If your BP remains high when you reach 37 weeks in your pregnancy, your doctor should discuss whether giving birth earlier is in your and your baby’s best interests. They should explain the risks and benefits of both giving birth early and waiting for labour to start naturally.
If your BP is over 160/110mmHg (severe hypertension) you should be given medication to lower this and you will be admitted to hospital so you and your baby can be monitored. If your BP remains high, you may be recommended to give birth early depending on how far along in your pregnancy you are and how well you and your baby are coping.
What is pre-eclampsia and what happens if I am diagnosed with it?
Pre-eclampsia is a serious BP condition that needs to be diagnosed quickly and treated straight away as it can stop your baby from growing properly (called growth restriction) if they don’t get enough oxygen and nutrients. It is often diagnosed by high BP measurements, protein in your urine and a range of other symptoms including; sudden swelling of your hands/face/feet, a severe headache that doesn’t go away, pain just below your ribs, blurred vision or seeing flashing lights, and vomiting. A blood test, called a placental growth factor test (PLGF), may be performed to confirm the diagnosis if you are between 20 and 35 weeks pregnant.
If you are at high risk of developing pre-eclampsia (for example you have had hypertension in a previous pregnancy), you should be recommended to take aspirin daily from the 12th week of your pregnancy until your baby is born.
If you are diagnosed with pre-eclampsia, your treatment will depend on whether your BP is consistently above or below 160/110mmHg. If it is below this threshold, you will be treated in largely the same way as anyone with chronic hypertension, although you will be monitored more closely. This could mean staying in hospital or having a BP check every 48 hours and ultrasound scans every fortnight. If your BP is over 160/110mmHg, you will likely stay in hospital as you are more at risk of developing severe complications such as eclampsia (fits). In both cases, you will likely have regular urine tests and a blood test.
The only way to cure pre-eclampsia is to give birth, although you may still need to take medication for a few weeks, until your BP goes back to normal. Therefore, your doctors and midwives will keep a close eye on you and your baby so they can recommend the safest time for this to happen. This will likely be at 37 weeks. If your pre-eclampsia is not responding to medication and/or it is causing health concerns for you or your baby, you may need to give birth before 37 weeks.
What is HELLP and what happens if I am diagnosed with it?
HELLP syndrome is a dangerous condition which can occur in women with severe pre-eclampsia. Luckily it is quite rare, occurring in 0.5-0.9% of pregnancies. It causes red blood cells in the blood to break down and impacts your liver.
HELLP syndrome can occur during pregnancy or immediately after you give birth. If it occurs during pregnancy, your baby will likely need to be delivered straight away to avoid you or your baby coming to serious harm.
With the correct diagnosis and treatment, you should be able to make a full recovery.
What support is available?
If you have been diagnosed with a BP related condition in pregnancy, you can get support from charities such as Tommy’s Pregnancy Hub and Action on Pre-eclampsia
How Enable Law can help you?
We have acted for mums whose HELLP syndrome or preeclampsia was either not diagnosed at all, or was diagnosed but not treated correctly and these failures sadly caused the death of their babies.
We recognise the devastating impact that the death of a baby has. A medical negligence claim is an opportunity for parents and their families to make sure the same mistakes aren’t made again. Enable Law can work with you to determine what happened, whether the care provided was appropriate and are committed to helping you get the answers you need.
This article has been written based on the current NICE (National Institute for Health and Care Excellence) Guideline: Hypertension in pregnancy: diagnosis and management published 25 June 2019.
