Proper Management of Preeclampsia & High Blood Pressure during Pregnancy to Prevent Birth Injuries, Infant Brain Damage & Cerebral Palsy
High blood pressure (hypertension) and preeclampsia during pregnancy are very risky because the conditions can cause the placenta to provide insufficient blood flow to the baby, which means the baby will receive inadequate nutrients and oxygen. In addition, high blood pressure increases the risk of dangerous pregnancy conditions, such as poor fetal growth, intrauterine (fetal) growth restriction (IUGR / FGR), placental abruption, and premature birth. Preeclampsia, which is a more serious form of hypertension, adds the additional risks of the mother having kidney failure, a hypertensive crisis, HELLP syndrome and eclampsia. Due to the risks associated with hypertension and preeclampsia, the obstetrician and maternal-fetal specialist must closely monitor the mother and baby during delivery, properly manage blood pressure issues and related conditions, and they often need to plan for early delivery of the baby. Improperly managed hypertension and preeclampsia can cause serious injury to the baby, which can cause brain damage and lifelong problems for the child.
Listed below are some common birth injuries caused by mismanaged hypertension and preeclampsia.
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL)
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders and low muscle tone
- Periventricular leukomalacia (PVL)
Indeed, hypertension and preeclampsia require very careful management. Blood pressure medication is often necessary, but can be harmful to the baby if not properly given. In this article, we discuss different types of high blood pressure problems, how these issues are treated, and the effects high blood pressure and the treatments (or improper treatments) can have on the baby.
AWARD WINNING BIRTH INJURY LAWYERS HELPING CHILDREN WHO HAVE BRAIN DAMAGE FOR ALMOST 3 DECADES
If your baby has HIE, developmental delays, a seizure disorder, cerebral palsy or any other birth injury, email or call the award winning attorneys at Reiter & Walsh ABC Law Centers. Unlike other firms, the attorneys at Reiter & Walsh focus solely on birth injury cases and have been helping children throughout the nation for almost 3 decades. The partners of the firm, Jesse Reiter and Rebecca Walsh, were recently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized Reiter & Walsh ABC Law Centers as one of the best law firms in the nation. In fact, U.S. News and World Report has given Mr. Reiter the honor of being one of the “Best Lawyers in America” every year since 2008.
TYPES OF HIGH BLOOD PRESSURE DISORDERS DURING PREGNANCY
Normal blood pressure is 120/80 mmHg. The top number is the systolic blood pressure (BP) and the bottom number refers to diastolic BP.
Long-term high blood pressure. When a pregnant woman has long-term high blood pressure, it is called chronic (preexisting) hypertension. A mother is diagnosed with chronic hypertension when her systolic BP was ≥140 and/or diastolic BP was ≥ 90 before becoming pregnant, or these high BP numbers are present before the 20th week of pregnancy. Chronic hypertension is also diagnosed when these elevated BP numbers persist longer than 12 weeks after delivery.
Gestational hypertension. A pregnant woman is diagnosed with gestational hypertension when high BP is first detected after 20 weeks of pregnancy and there is no protein in the urine (proteinuria) or other indications of preeclampsia. Some mothers with gestational hypertension may develop end-organ dysfunction or proteinuria and may then be considered preeclamptic, while other mothers will be diagnosed with preexisting hypertension due to persistent high blood pressure after delivery.
Preeclampsia and eclampsia. Preeclampsia refers to high blood pressure newly diagnosed during pregnancy and either proteinuria or end-organ dysfunction. Preeclampsia is typically diagnosed after 20 weeks of gestation in a mother who previously had normal BP. Eclampsia is diagnosed when a mother has preeclampsia and seizures.
Preeclampsia-eclampsia superimposed upon chronic hypertension. This condition is diagnosed when a pregnant woman with chronic hypertension develops worsening high BP with a new diagnosis of proteinuria or other features of preeclampsia.
PROPER MANAGEMENT OF HYPERTENSIVE DISORDERS & PREECLAMPSIA TO PREVENT NEWBORN BRAIN DAMAGE & CEREBRAL PALSY
When deciding on treatment for high blood pressure and preeclampsia, the risks and benefits for both the mother and baby should be considered. The most important factor is how high the mother’s BP is. Treatment of severely high BP (systolic ≥ 160 and/or diastolic ≥ 110) reduces the risk of stroke in the mother. This is important because maternal stroke can cause the baby to have birth injuries. Another factor to consider when treating high BP and preeclampsia is the cause of the high BP. A mother with chronic hypertension, for example, may be able to tolerate higher blood pressures better than mothers who previously had normal blood pressure with a sudden onset of high BP caused by preeclampsia. The decision regarding when to deliver the baby is important for a number of reasons. If a prompt C-section delivery is planned, medications for high BP may not be needed since anesthesia and/or magnesium sulfate may lower blood pressure.
The decision to use medication to treat mothers who have mild hypertension (140 – 150 systolic BP and 90 – 100 diastolic BP) or moderate hypertension (150 – 159 systolic BP and 100 – 109 diastolic BP) requires very skillful assessment and close monitoring of the mother and baby. In some cases, aggressive lowering of the mother’s BP – and the drugs themselves – can cause poor fetal growth and can expose the baby to the harmful effects of the medications. The mother’s physician should consider all the mother’s medical issues as well as her symptoms when making treatment decisions for mild to moderate hypertension.
Medications used to treat high BP are called antihypertensive drugs. These drugs cross the placenta. Listed below are some common antihypertensive medications given during pregnancy:
- Calcium channel blockers (e.g., nifedipine and labetalol)
- Thiazide diuretics
Certain drugs are injurious to babies and can cause birth injuries. Antihypertensive drugs to avoid during pregnancy are:
- ACE inhibitors (angiotensin converting enzyme inhibitors)
- ARBs (angiotensin II receptor blockers)
- Direct renin inhibitors
Although the risks to the unborn baby often outweigh the benefits of using antihypertensive medications to treat mild to moderate hypertension, severe hypertension must always be treated. Treatment should be given to mothers whose systolic pressure is 150 or higher or whose diastolic pressure is 100 or higher. Medication should be given at a lower threshold to younger pregnant women whose BP is lower or who had a lower baseline BP. In addition, mothers who have symptoms that may be caused by high BP (headache, visual disturbances, chest discomfort) should be treated. Pregnant women who have hypertension or preeclampsia should have a target BP of 140 – 150 systolic and 90 – 100 diastolic. When end-organ damage is present, the target BP is 140/90 or as low as 120/80.
Methyldopa or labetalol are usually the drugs of choice for treatment of high BP, with nifedipine added if needed. When a pregnant woman has sudden onset hypertension, IV labetalol or hydralazine should be given.
TIMING OF DELIVERY & HOSPITALIZATION FOR MANAGEMENT OF HIGH BLOOD PRESSURE DISORDERS & PREECLAMPSIA DURING PREGNANCY
When hypertensive disorders are present during pregnancy, the mother and baby must be closely monitored, with frequent prenatal testing to assess the growth and health of the baby. In many cases, a planned, early delivery is necessary to prevent the baby from being in sub-optimal conditions for longer than necessary.
The time of delivery is based on the severity of the high BP / preeclampsia, how well-controlled the mother’s BP is, whether complicating factors are present (e.g., placental abruption), and the gestational age of the baby. Preeclampsia at 37 weeks or later requires delivery. If there is any evidence of significant maternal end-organ dysfunction or nonreassuring tests of the baby’s well-being, the baby is delivered, regardless of gestational age. When non-severe preeclampsia is present, expectant management is reasonable, but delivery must occur as soon as the mother develops signs or symptoms of severe preeclampsia / eclampsia (or at 37 weeks if the disease does not progress to the severe stage).
As soon as a mother is diagnosed with a hypertensive disorder or preeclampsia, she and the baby must be monitored more closely than normal so that delivery can occur if the baby has nonreassuring tests or the mother’s condition becomes severe. Hospitalization is the best way to ensure close monitoring, testing and prompt delivery, and this is typically required when a mother has severe hypertension or preeclampsia. Hospitalization also helps the medical team establish the severity and rate of disease progression.
If the mother chooses outpatient monitoring, she must receive check-ups and evaluations as well as fetal testing every 1 – 3 days, and she must have quick access to medical care and a labor and delivery unit. These pregnant women should be aware of the signs and symptoms of significant blood pressure changes and preeclampsia and they should monitor the baby’s movements every day. Mothers should be told to call their obstetricians immediately if they develop severe or persistent headache, visual changes, shortness of breath, or have pain in the upper abdomen. As with any pregnancy, the mother should go to the hospital right away if there is decreased movement of the baby, vaginal bleeding, abdominal pain, rupture of the membranes or uterine contractions.
When a mother has a hypertensive disorder, failure to carefully manage her blood pressure and properly monitor and assess the health of the baby can cause the baby to have severe birth injuries, such as hypoxic ischemic encephalopathy (HIE), seizures, permanent brain damage and cerebral palsy. Indeed, it is crucial to give correct medications to the mother and deliver the baby at the appropriate time.
AWARD WINNING LAWYERS HELPING CHILDREN WITH BIRTH INJURIES & CEREBRAL PALSY FOR ALMOST 3 DECADES
If you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth Injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.
VIDEO: PREVENTING BIRTH INJURIES & CEREBRAL PALSY
Watch a video of Michigan birth injury lawyer Jesse Reiter discussing the causes of cerebral palsy, which include mismanaged preeclampsia and failure to schedule an early delivery when indicated.
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