Attention to nutrition and vitamin and mineral status may reduce the incidence of pre-eclampsia as does a diet without excessive or added salt. Mildly elevated blood pressure often responds to yoga, meditation, acupuncture, homoeopathy and bed rest. Epidural anaesthesia is effective in lowering the blood pressure in labour. Drugs are used by women with underlying hypertension, throughout pregnancy or to lower blood pressure if there is an acute problem during pregnancy. They are powerful agents and mother and baby require frequent assessment. If the situation is acute anti- hypertensives are administered by intravenous infusion in combination with anticonvulsant medication to prevent eclamptic fits.
Treatment during labour and birth
If severe hypertension is causing placental insufficiency, the baby is delivered early, usually by caesarean section. If the mother develops , eclamptic convulsions or very severe pre-eclampsia immediate operative delivery may be needed. lf the hypertension is less severe the labour may be induced using prostaglandin with frequent maternal and foetal heart monitoring, but induction is not necessary if the hypertension is mild and the baby is healthy. Ultrasound scans are used to monitor the baby’s wellbeing. During labour blood pressure is monitored frequently and high levels are managed with epidural anaesthesia and anti- hypertensive agents. Contraction-enhancing drugs are used with extreme caution. After the birth the risk of postpartum eclamptic convulsions continues for up to seven days – medication must continue during this time. lf the hypertension is pregnancy specific the blood pressure will return to normal within six weeks; if it remains elevated further investigations are needed. The baby is carefully examined at birth to check for prematurity or placental insufficiency.