Caring for women with chronic hypertension
The number of women entering pregnancy with chronic hypertension is increasing, predominantly because of rising rates of obesity and pregnancy at advanced maternal age. ‘Chronic hypertension’ is often used interchangeably with the term ‘pre-existing hypertension’, but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy. Chronic hypertension significantly increases the risks in pregnancy for both the mother and the fetus, and these risks are considerably higher than those associated with gestational hypertension or pre-eclampsia alone; therefore, differentiation is important. The midwife is in an ideal position to improve the care of pregnant women with chronic hypertension. This article reflects on and explores the ways in which a midwife might provide support. It outlines the critical role of the midwife in the accurate and prompt identification, assessment, referral and care of the woman with chronic hypertension in pregnancy.
Hypertension in pregnancy affects approximately 10% of women. The reported incidence varies between studies, but it is estimated that 1.3-3% of pregnant women will have chronic hypertension (Sibai, 2002; Roberts et al, 2008; Bateman et al, 2012) and 8.3% will have gestational hypertension (Roberts et al, 2008). The number of women entering pregnancy with chronic hypertension is rising, predominantly because of increasing rates of obesity and pregnancy at advanced maternal age (Seely and Ecker, 2011). Women with chronic hypertension can be sub-divided into those with essential hypertension (ie with no known secondary cause) and hypertension secondary to another medical condition. ‘Chronic hypertension’ is often used interchangeably with the term ‘pre-existing hypertension’, but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy.
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