Our service at the UW Medicine Maternal and Infant Care Clinic
will evaluate, monitor and manage your high blood pressure
(hypertension) while you are pregnant. We will also work with you to
decrease your likelihood of developing preeclampsia (pree-ee-clamp-see-uh – a high blood pressure pregnancy complication) during pregnancy.
We will partner with you to:
- Improve your blood pressure.
- Monitor your baby’s well-being.
- Achieve delivery at or near term.
The Care Team
The care team includes maternal-fetal medicine doctors (also called
perinatologists or high-risk obstetricians), registered nurses, and a
medical assistant. We will work with you to obtain the best possible
outcome for you and your baby.
The care team will teach you and your family about:
- Normal blood flow changes during pregnancy.
- Your risk status and what you can do to help manage these risks.
- How to recognize the signs and symptoms of preeclampsia, its treatment, and how we can work together as a team to manage it.
- Your care plan and treatment options to maintain a normal blood pressure and to optimize your health and your baby’s health.
- What you can expect during labor, after delivery, and with breastfeeding.
Your Clinic Visits
You will see a doctor at each visit. Your doctor will go over your
prenatal records, medical history, labs, test results, and explain your
plan of care. The test results and plan of care will be shared with your
prenatal provider through a phone call and with a letter that will be
placed in your medical file.
You will be seen several times during your pregnancy. Your medical
condition and gestational age (how far along you are in the pregnancy)
will determine the date of your next visit. A treatment plan will be
tailored just for you.
Your treatment plan may need adjustments as you move through pregnancy.
It is important to your health and your baby’s health to come to all of
your scheduled visits.
Cardiac Output Measurement and Your Blood Pressure
Your cardiac output will be measured at every visit to the Hypertension
Consult Clinic. A specialized ultrasound machine will measure the amount
of blood that is pumped through your body each minute (cardiac output).
The test takes about 15 minutes.
Blood pressure is a combination of cardiac output and the amount of
constriction or tightness in your blood vessels (peripheral resistance).
If either your cardiac output or peripheral resistance is higher than
average, it can cause your blood pressure to increase.
It is normal for a woman’s blood flow to change dramatically throughout
pregnancy to meet the demands of a growing baby (or babies). Usually
these changes start in the first trimester of pregnancy and stabilize
after 14 to 16 weeks of pregnancy.
Your cardiac output measurement provides information about your blood
flow during your pregnancy. Each measurement will be plotted on a
pregnancy blood flow graph and compared with the expected values for
that point in pregnancy. The results will give you and your providers
more information about your risk for developing preeclampsia later in
pregnancy, and how to best treat you. The results will help the doctor
decide if medications are needed, and show which one(s) would be most
effective for you and your baby.
Preeclampsia is a high blood pressure complication of pregnancy that can
happen any time after the 20th week of pregnancy. If untreated, it can
affect many systems of the body, including the kidneys, liver, and
brain. Delivery of the baby is necessary if preeclampsia has advanced to
a stage where it threatens the health of the mother and baby.
This can be a major problem if it occurs when the baby is not mature, or
preterm. We use medications and rest to delay its development or slow
its progression so that baby can be delivered as close to term as
possible. A woman with preeclampsia will likely have increased blood
pressure, protein in her urine, and other changes in her blood, measured
through specific lab tests.
Our goal is to decrease your risk for developing preeclampsia instead.
Women who have these conditions are at a higher risk of developing
preeclampsia during pregnancy:
- Chronic hypertension
- History of preeclampsia (especially preterm)
- Kidney disease
- Autoimmune disease
- Borderline blood pressures early in pregnancy (most often greater than 120/80)
- Blood pressures that don’t decrease in the second trimester
- First pregnancy
Warning Signs of Preeclampsia
If you have any of these symptoms, you should call your doctor or provider right away:
- Headaches, which are more frequent or different than are usual
for you, especially if they don’t go away with Tylenol or other
- Swelling that doesn’t resolve overnight or with rest and goes
past your feet and ankles to your hands and face. Rapid weight gain may
also happen with swelling.
- Visual problems such as seeing stars, spots or flashing lights (much like what you may see when you stand up too fast).
- Epigastric pain (like “heartburn”) felt more on your upper right
side and not related to what or when you eat. This type of “heartburn”
does not get better with antacids. You may have nausea and/or vomiting.
Things That You Can Do
These are some things that you can do to help lower your risk for
preeclampsia or to help us identify problems early so you can avoid a
- Come to all of your scheduled prenatal and consult visits.
- Give a thorough medical history.
- Eat healthy foods. Avoid salty foods such as chips, canned soups and vegetables, frozen entrees, and soy sauce-based dishes.
- Take rest breaks. Listen to your body and rest when you’re tired.
- Take your prescribed medicines regularly.
- Call your provider to report warning signs and other concerns.
Daytime Rest Breaks
Most women benefit from increased rest late in pregnancy. Begin thinking
about ways to lighten your load at home, work, and with childcare. It
will be easier to find time for the rest breaks if you have help from
the people around you. Make plans in advance with family members,
coworkers, and friends to make this possible.
If you are asked to get some additional rest during the day, it is most
helpful if you take it in blocks of 2 to 3 hours. You don’t have to
sleep during these breaks, but it is important to lie down on your side
(not sit) and to not get up and down during the rest break.
These rest breaks help to keep your blood pressure down, increase your
blood flow, which can help baby to grow well, and can help reduce your
swelling. Listen to your body and don’t push yourself.
Here is a list of the main blood pressure medicines used to treat high
blood pressure in pregnancy. The doctor will recommend the medicine(s)
that is best for you.
- Lowers blood pressure by slowing your heart rate down and
decreasing your cardiac output, putting less stress on your blood
- May decrease headaches, racing heart, or shortness of breath.
- Is taken at the same time every day – we sometimes suggest taking it at night since it makes some women feel a little tired.
- Can slow your baby’s growth if blood flow becomes too low. This
is one of the reasons that it’s important to come back for follow-up
visits. We can monitor your blood flow/cardiac output and make changes
in your treatment to ensure that it does not become too low.
- Lowers blood pressure by relaxing blood vessels.
- Is taken 3 times per day. It is important to take this medicine as close to every 8 hours as possible.
- May cause drowsiness for the first few days.
- Lowers blood pressure by relaxing blood vessels.
- Increases blood flow, which is important in maintaining baby’s growth.
- Is taken 4 times a day either at breakfast, lunch, dinner, and bedtime or every 6 hours.
- May cause headaches – it is fine to take acetaminophen (Tylenol)
for relief, but call your health-care provider if headache pain is not
relieved by Tylenol or persists longer than 3 days.
- Lowers blood pressure by reducing extra body fluids through increased urine output.
- May be taken once or twice a day. Taking it in the evening may cause you to wake up to urinate during the night.
- May require potassium supplements (taken with the morning meal). Increased urine output can lower potassium in the blood.