Evaluating High Blood Pressure During Pregnancy

High blood pressure caused by pregnancy can be either a simple, uncomplicated issue or may be an early sign of more serious problems like preeclampsia or eclampsia. In order to know if early high blood pressure is a simple problem or sign of more serious issues to come, a complete evaluation must be done.

The process is relatively routine and will involve several steps. Typically, no complicated or long-term steps are required, but some lab work and imaging may be needed.


Establish Baseline Blood Pressure

Nurse checking pregnant woman's blood pressure

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The initial evaluation of pregnancy-induced hypertension must include a set of introductory measurements that document the baseline blood pressure. More correctly, these measurements are taken to establish exactly how elevated the current blood pressure is compared to pre-pregnancy values. These initial measurements are essential because they allow tracking and evaluation of any changes in the blood pressure as the pregnancy progresses. Since evidence of consistently increasing pressures or a total increase that is too large both mean that treatment might be necessary, establishing this baseline is a required first step in evaluation.


Gather History and Symptom Information

Patients with newly elevated blood pressures during their pregnancy need to have a full interview with their physician. During this talk he will ask many questions about the history of the elevated pressure, focusing on topics that might indicate that high blood pressure is causing problems in other organ systems. These questions are necessary because certain symptom profiles may indicate that the baby could be at risk or that treatment for high blood pressure is needed. Specifically, your physician is likely to ask about things like:

  • Headache
  • Abdominal pain
  • Nausea and vomiting
  • Changes in urinary amount or frequency
  • Visual changes (blurry vision, double vision)

Get Tested

Along with taking an in-depth symptom history, your physician will probably want to run a set of laboratory tests. Lab tests can help distinguish whether treatment may actually be needed. The laboratory tests your physician is likely to order are all routine and will require both blood and urine samples. Some common tests include:

  • Hemoglobin/Hematocrit: to assess oxygen-carrying capacity
  • Platelet Count: to evaluate potential clotting problems
  • Creatinine level: a measure of kidney function and status
  • Transaminase levels: an indicator of liver function
  • Lactic acid dehydrogenase concentration: an enzyme related to metabolism and liver function

Evaluate the Fetus

An important part of evaluating pregnancy-induced hypertension is to ensure that the baby is not suffering any ill effects from the elevated blood pressure. While the role of ongoing fetal monitoring during pregnancy is debated because its benefit is unclear, an initial checkup of the baby's status is normal and appropriate. The most common way to make this initial checkup is with a simple ultrasound along with amniotic fluid estimation. These tests check to make sure the baby is developing normally and is the appropriate size. If any unusual findings are detected, more tests may be conducted, or a longer term of monitoring might be needed.


Make Decisions

The most important thing your physician needs to evaluate is whether your high blood pressure is "just" high blood pressure, or whether there are signs that you might be in the initial stages of preeclampsia. Typically, if there are no signs of more serious problems, a "wait and see" approach is common. There is evidence to suggest that unless blood pressure is very high, it may be better to avoid treatment in order to reduce the risk of affecting the baby's growth.


Monitor for Preeclampsia and Eclampsia

The purpose of carefully and completely evaluating high blood pressure during pregnancy is to ensure that there are no signs indicating that simple high blood pressure may be progressing towards the more complicated, and dangerous, conditions of preeclampsia and eclampsia.

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  • Barton, JR, ​O'Brien, JM, Bergauer, NK, Jacques, DL, et al. Mild gestational hypertension remote from term: progression and outcome. Am J Obstet Gynecol 2001; 184:979.