Blood Transfusions During Pregnancy
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A Blood transfusion is a frequently performed procedure where you receive blood through an intravenous (IV) line into one of your blood vessels. Receiving a blood transfusion while pregnant is not something most women want to think about. However, there are two conditions that may warrant a blood transfusion during pregnancy.
What are the Reasons to Have a Blood Transfusion During Pregnancy?
There are two primary reasons you may need a blood transfusion while pregnant. These include the development of severe anemia close to your due date, or hemorrhaging at some point during your pregnancy.
You can find more information on both below:
Once a hemoglobin estimate has been performed, a medical professional can diagnose the extent of your anemia. For patients diagnosed with severe anemia, it is important to determine the causes and best course of treatment.
While it may be difficult to pinpoint exact causes of anemia, particularly if a combination of factors has resulted in anemia, sometimes the frequency of anemia in a given region may give a clue as to its cause. For instance, in areas where malaria is common, the course of treatment will be tailored to take into account the possibility of malaria. Your doctor will prescribe antimalarials possibly in combination with another treatment.
If you have a Hemoglobin count lower than 7 g/dl and are 34 weeks along in your pregnancy or more, the possibility of transfusion will be discussed. A Hemoglobin measure lower than 5 g/dl greatly increases your risk of mortality. It is crucial you receive a transfusion before very severe anemia develops. In addition, it is imperative that severe anemia is effectively treated before labor. Often, relatives who are willing to donate blood are asked to provide the transfusion.
Hemorrhaging is bleeding excessively in an urgent situation. This bleeding can lead to severe anemia. A transfusion is often required in order to counteract excessive blood loss. Hemorrhaging can occur at any time during pregnancy. If you experience a miscarriage or ectopic pregnancy, it can lead to hemorrhaging early in your pregnancy.
It is also possible to experience hemorrhaging after your 24th week of pregnancy. You are probably more familiar with the possibility of hemorrhaging during delivery and immediately following delivery, known as intrapartum hemorrhaging and postpartum hemorrhaging respectively. While doctors will try to prevent the need for a blood transfusion, under some conditions it is absolutely necessary to save you and your baby’s life.
Having a Blood Transfusion During Pregnancy
Most often, the transfusion required for pregnant and recently pregnant women only involves red blood cells. It is less likely platelets and plasma will be needed. In order to receive the transfusion, a small tube will be inserted into a vein in your hand or arm.
The transfusing blood will move through a drip into your body. Each bag contains approximately 1/3 of a liter of blood and takes an estimated 3 hours to fully transfuse. In some cases, this rate of transfusion can be expedited.
What are the Side Effects of a Blood Transfusion While Pregnant
You will be closely monitored during any blood transfusion while pregnant by a health care professional.
Minor side effects include:
These side effects can be alleviated by medication and typically get better in one day.
More serious complications include the following:
- Difficulty breathing
- Severe headache
- Abrupt drop in blood pressure that may be characterized as life-threatening
Once you experience side effects, the transfusion will be halted, and your current situation will be assessed before proceeding. Under conditions of massive transfusion or multiple transfusions, more severe pregnancy complications may arise.
These complications include:
- Hyperkalemia – electrolyte imbalance involving low potassium levels
- Hypocalcemia – low calcium levels
- Coagulopathy – clotting factors are diluted leading to weakened or impaired coagulation
- 2, 3-DPG depletion – depletion of a blood component that regulates how easily oxygen is moved from hemoglobin into tissue
- Transfusion Reactions
When these severe side effects are experienced, a medical team will intervene.
Blood Transfusions During Pregnancy: Final Notes
If you’re asked to undergo a blood transfusion, make sure to get a full understanding of all of the options available to you. If it is an emergency situation, a doctor will likely make an educated decision for you. You can decline a blood transfusion or change your mind about receiving one at any time, but be aware that under some circumstances a blood transfusion may be the only way to keep you alive. If you have any questions about your options or concerns about the safety of blood transfusions, you can ask your doctor or midwife.
Compiled from the following sources:
Cohen, Wayne R. (2000). Postpartum Hemorrhage and Hemorrhagic Shock in Cohen, Wayne R. (Ed.), Complications of Pregnancy, 5 th edition (812-3). Philadelphia, PA: Lippincott Williams & Wilkins.
MacDonald, R. (1977). Red cell 2,3-diphosphoglycerate and oxygen affinity. Anaesthesia, 32(6). Retrieved from: http://www. ncbi. nlm. nih. gov/pubmed/327846
Royal College of Obstetricians and Gynaecologists. (2009, Feb. 20). Blood transfusion, pregnancy and birth – information for you.
Royal College of Obstetricians and Gynaecologists. (2009, Feb.). Blood transfusion, pregnancy and birth – information for you.
Walraven G. Treatments for iron-deficiency anaemia in pregnancy: RHL practical aspects (last revised: 20 June 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.
High Blood Pressure During Pregnancy
What is considered high blood pressure during pregnancy?
In a healthy individual, the systolic blood pressure should ideally range below 120 mmHg while the diastolic blood pressure should be lower than 80 mmHg  . Ideally, the BP range should remain within these limits throughout the pregnancy. Having a BP reading over 140/90 mmHg is considered high blood pressure in a pregnant woman  while a BP reading above 120/80 and below 140/90 calls for a visit to your doctor.
High blood pressure and pregnancy: Is it an early sign?
Although a little high BP is quite common while pregnant, it is not considered an early sign as it can occur anytime in pregnancy. Women with blood pressure too high are more at risk of various complications.
Your Normal Blood Pressure while Pregnant
Your body produces around 1 liter of extra blood by the 24th week (sixth month) of pregnancy to transport oxygen and nutrients to the developing fetus and to carry the fetal waste products away  . As a result, your blood pressure may rise a little with your heart working extra hard to pump the additional blood. Progesterone (pregnancy hormone) relaxes the blood vessel walls to allow the extra blood to pass, which may lower your BP around the mid weeks of pregnancy. However, there is nothing to worry about as your BP becomes normal again in later third trimester  . Your doctor may get concerned only if your BP reading remains higher than normal over several weeks.
High Blood Pressure during Pregnancy Stage Chart
Severity Level 
Systolic Pressure 
Diastolic Pressure 
What are the different types of high blood pressure in pregnancy?
The following classification depends on the underlying causes, possible outcomes and the stage of onset of the condition:
- Pre-existing or chronic high blood pressure 
- Gestational hypertension
- Preeclampsia (earlier referred to as toxemia of pregnancy)
- Preeclampsia superimposed on chronic hypertension 
What causes high blood pressure in pregnancy
As the name suggests, the pre-existing form refers to high blood pressure that continues from before pregnancy. High BP diagnosed before the 20th week is considered to be pre-existing and not caused by pregnancy  . On the other hand, gestational high blood pressure develops during pregnancy after the 20th week, with the exact triggering factors still remaining unknown. The pregnancy induced form may later advance to complications like preeclampsia, HELLP syndrome and eclampsia.
Risk Factors for High Blood Pressure While Pregnant
- Chronic high BP or kidney disease before conceiving
- First pregnancy
- A family history of pregnancy induced hypertension 
- Being younger than 20 years or older than 40 years
- Twin pregnancy (2-3 times more at risk) 
- Too much smoking and/or alcohol consumption
- Overweight or obesity 
- Thyroid and adrenal disorders
- African-American race 
- Drinking lots of water to stay hydrated
- Consuming salt only as necessary 
- Following a diet containing fresh fruits and vegetables 
- Avoiding gaining too much weight in pregnancy 
- Following a regular exercise routine
- Avoiding alcohol, caffeine and smoking
- Getting plenty of rest
- Keeping your feet elevated when resting
- Doing pre-natal yoga  and practicing relaxation techniques to reduce stress 
How to prevent high blood pressure during pregnancy?
Women suffering from chronic hypertension should consult a health care practitioner to lower the BP before planning to have a baby  . The above healthy lifestyle changes are also recommended for ensuring a healthy pregnancy. Taking calcium supplements (FDA recommended RDA of 1200 mg) is also believed to help to avoid extremely high BP (preeclampsia) in high risk pregnancies  ; although, no supplements should be used without consulting the doctor.
What are the signs and symptoms of high blood pressure during pregnancy?
In many cases, it does not lead to any signs and the high BP is only detected during a regular pre-natal check-up  . But, you should look out for symptoms like:
- Severe persistent headache 
- Changes in vision (sensitivity to light, flashing lights, blurred vision or vision loss)
- Severe upper abdominal pain (especially on your right side) 
- Severe nausea and vomiting in later pregnancy
- Sudden swelling (edema) of the face, hands and feet
- Sudden weight gain (over 5 pounds a week) 
- Reduced urination 
- Lower back pain 
- Chest pain
- Breathing difficulty
- Nosebleeds 
Make sure to call your doctor immediately in case you have one or more of the above signs as they may indicate serious complications like preeclampsia.
How is high blood pressure diagnosed during pregnancy?
Your blood pressure is checked as a routine procedure during the pre-natal visits to your doctor. High BP is diagnosed if:
- Two BP readings taken 4 hours apart are 140/90 or higher 
- The BP shows a reading of only the diastolic pressure of 110 or higher (a higher than normal diastolic reading is enough to diagnose high BP) 
You may be asked to stay at the healthcare facility for several hours so the doctor can monitor your BP on an hourly basis. Other tests like ultrasound scans, blood tests  , urine tests, non-stress tests  and biophysical profile may be necessary for assessing the maternal and fetal health as well as for checking the heart and kidney functioning.
Urine tests are vital for detecting protein in the urine, which (along with high BP) confirms the diagnosis for preeclampsia  . Women who have high BP with no protein in the urine are also at risk of developing the complication.
High Blood Pressure during Pregnancy Differential Diagnosis
What are the risks of high blood pressure during pregnancy?
Effects on the baby
- Lower than normal birth weight due to decreased blood flow to placenta that lowers the oxygen and nutrient supply to the developing fetus 
- Various birth defects (especially neural tube defects and heart malformations) 
Dangers to the Mother
- Developing preeclampsia, a serious complication that may endanger the lives of both mother and child 
- Placental abruption 
- Premature labor and delivery (before the 37th week of pregnancy) 
- Miscarriage, especially in later pregnancy 
- Elevated risk of stroke as well as various heart diseases, kidney disorders and diabetes in the mother in future 
How to reduce high blood pressure during pregnancy?
Close monitoring with tests and medications is necessary depending on how high the BP is and when it is diagnosed  . Mild cases of high BP are often managed by bed rest and going for frequent prenatal check-ups.  . The treatment for severe chronic or gestational high blood pressure involves both prenatal and postnatal care with its main object being preventing the condition from getting any worse  .
Medication for Lowering High Blood Pressure during Pregnancy
Women with chronic hypertension are often prescribed medicines to keep their BP below the 149/90 mark. Those already on BP medication before conceiving should consult a doctor to determine whether it is safe to take the same medicine in pregnancy. Regular BP medications like ACE inhibitors, angiotensin II receptor blockers  And renin inhibitors are not recommended to pregnant women as they can cause serious side effects both in the mother and the baby (especially in the second and third trimesters)  . Possible risks include kidney damage and potassium accumulation in the mother as well as fetal death  .
Medications considered safe during pregnancy include:
Magnesium sulfate is often used to prevent seizures (eclampsia) associated with extremely high blood pressure  .
Regular home remedies used for managing high BP are often Not recommended during pregnancy. Those considered relatively safe include herbal teas like dandelion, nettle and lime flower as well as fresh beetroot juice  . But, never consider any of these remedies without consulting your doctor.
Treatment of Severe Cases
Hospitalization may be necessary to prevent the condition from advancing to serious complications in women with unusually high BP readings. Early delivery by a c-section (cesarean section) or induction of labor is an option in women past the 38th week of pregnancy with preeclampsia. Those between the 34th and 37th week are monitored closely at the hospital for development and functioning of the fetal organs. Steroid medicines (e. g. betamethasone, dexamethasone) can be used for accelerating the fetal lung maturation so that the baby can be delivered as soon as possible.
Diet for High Blood Pressure during Pregnancy
The National Heart, Lung and Blood Institute (NHLBI) recommend the DASH Diet (Dietary Approaches to Stop Hypertension)  for lowering the sodium intake and fight high BP. Additionally, it increases the intake of calcium, potassium and magnesium, the three minerals known to help control BP. The principal food items included in this diet plan are whole grains, fresh fruits and vegetables, low-fat dairy, poultry, fish and meat products nuts, beans as well as small helpings of sweets.
Foods to avoid: Mainly fatty and salty foods  as sodium causes more fluid to remain in your body, requiring the heart to work harder 
Treatment of High Blood Pressure after Pregnancy
Although the blood pressure gradually comes down to normal after delivery in most women with severe high blood pressure (or preeclampsia) late in pregnancy, some women may need medical treatment even after the baby is born. In some cases, a woman may develop extreme high blood pressure along with abnormally high amounts of protein in the urine following pregnancy (postpartum preeclampsia)  . Like during pregnancy, magnesium sulfate is used to manage seizures after childbirth. Other antihypertensive medicines may also be prescribed while the patient may even have to stay at the hospital for a few days longer so the doctors can monitor their BP. It is recommended to consult your doctor regarding whether it is safe to breastfeed your baby while taking the medications  .
How common is high blood pressure in pregnancy?
It affects 1 out of every 10 pregnant women  . Around 1 in every 20 woman has pre-existing high BP while 1 in every 20 women develops high BP without preeclampsia while pregnant. The high BP advances to preeclampsia in 2-8 pregnant women out of 100 while eclampsia develops in about 1 in 200 women  .
High Blood Pressure ICD-9 and ICD-10 Codes
The ICD-9 code used for identifying high BP is 401  while its ICD-10 codes are I10, I11, I12, I13, I15 
High Blood Pressure During Pregnancy
When you are pregnant, it is a joyful time for you and your family, and it is not a time when you necessarily want to think about pregnancy complications. But high blood pressure during pregnancy is one of those issues that you must take seriously and monitor carefully. If you are diagnosed with high blood pressure while you are pregnant, and if it gets out of control, it can create an extremely dangerous situation for both you and your baby.
Your blood pressure refers to the amount of pressure that your blood exerts on your artery walls. Your blood pressure is high if you have a reading that is greater than 140 mm Hg for the top (systolic) number or greater than 90 mm Hg for the bottom (diastolic) number. High blood pressure can cause all sorts of health complications, including heart disease, stroke, or kidney disease. But one of the biggest concerns about high blood pressure during pregnancy is that it can lead to preeclampsia, a potentially life-threatening condition for mother and baby.
According to the National Institutes of Health, approximately 6 to 8 percent of pregnant women have problems with high blood pressure. You are more susceptible to high blood pressure during pregnancy if you had hypertension problems in the past, if you are a smoker or heavy drinker, if you are overweight, if you are younger than 20 or older than 40, or if you are carrying multiples. Generally there are two different kinds of high blood pressure issues in pregnancy: chronic hypertension, which is when a woman has been diagnosed with high blood pressure before her pregnancy; and gestational hypertension and preeclampsia, which develop after the 20th week of pregnancy.
Those women who had high blood pressure problems before pregnancy will be monitored closely throughout their pregnancies, and in some cases will continue taking medicine to keep their blood pressure under control. For all other pregnancies, doctors routinely check for increases in blood pressure and/or protein levels in a woman’s urine, which can both be warning signs related to gestational hypertension and preeclampsia. If a woman develops high blood pressure past her 20th week, her doctor will watch carefully for additional symptoms such as increased swelling in the hands and feet, blurred vision, headaches, and lower back or abdominal pain.
If you develop a mild case of preeclampsia, your doctor may prescribe bedrest or possibly a hospital stay to monitor you and keep your activity levels down. If your preeclampsia is severe, the doctor may induce labor and need to deliver the baby (which is why preeclampsia increases the risk of prematurity and associated complications). The most severe manifestations of preeclampsia include eclampsia, in which the pregnant woman has seizures, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, which causes blood and liver problems. In those cases the baby would be delivered as soon as possible to protect the mother and the baby.
The best way to keep your blood pressure in check is to follow preconception and prenatal health guidelines carefully. Before you become pregnant, you should do your best to get your blood pressure and weight under control, limit your salt intake, and quit smoking or excessive drinking. If you are taking medication for high blood pressure, you should work with your doctor to determine if you should keep taking it while you are pregnant. Once you are pregnant, you should follow healthy prenatal diet and exercise guidelines, continue to avoid alcohol and tobacco, and go in for regular prenatal checkups.
High blood pressure doesn’t have to cloud your excitement about your pregnancy; in fact, most women who suffer from high blood pressure go through their pregnancies without a hitch. But – as with all other issues in pregnancy – you must make a commitment to taking care of yourself and your baby. When you stay healthy, you will feel better and you will be able to give your new little one a better start in life.
High Blood Pressure During Pregnancy
High blood pressure, or hypertension, is defined as blood pressure higher than 140/90 mm Hg. The condition is a serious concern for some pregnant women.
High blood pressure during pregnancy isn’t always dangerous. But it can sometimes cause severe health complications for both mother and developing baby. According to the Centers for Disease Control and Prevention, an increasing number of pregnant women in the United States have this condition.
According to the National Heart, Lung, and Blood Institute (NHLBI), there are several possible causes of high blood pressure during pregnancy.
- Being overweight or obese
- Failing to stay active
- Drinking alcohol
- First-time pregnancy
- A family history of pregnancy-related hypertension
- Carrying more than one child
- Age (over 40)
- Assistive technology (such as IVF)
Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or not staying active, are major risk factors for high blood pressure.
Women experiencing their first pregnancy are more likely to have high blood pressure. Fortunately, there’s a lower chance of this condition in subsequent pregnancies with the same partner.
Women carrying multiples are more likely to develop hypertension, as their body is under additional stress.
Maternal age is also a factor, with pregnant women over the age of 40 being more at risk.
According to the American Society for Reproductive Medicine, using assistive technologies (such as IVF) during the conception process can increase chances of high blood pressure in a pregnant woman.
Women who had high blood pressure before pregnancy are at higher risk for related complications during pregnancy than those with normal blood pressure.
- Chronic hypertension: Sometimes a woman has pre-existing high blood pressure, or hypertension before she gets pregnant. This may be referred to as chronic hypertension, and is usually treated with blood pressure medication. Doctors also consider hypertension that occurs in the first 20 weeks of pregnancy to be chronic hypertension.
- Gestational hypertension: Gestational hypertension develops after the 20th week of pregnancy. It usually resolves after delivery and the most common complication is induced labor. When diagnosed before 30 weeks, there’s a higher chance it will progress to preeclampsia (see below).
- Chronic hypertension with superimposed preeclampsia: Another variation of chronic hypertension is when a woman has hypertension before she becomes pregnant, then also experiences protein in her urine or additional complications as her pregnancy progresses.
A blood pressure reading is a fraction: your systolic blood pressure over your diastolic blood pressure.
- The top number is your systolic pressure, which is a measurement of the pressure on your heart’s arteries when the heart is beating or squeezing blood forward through your body.
- The diastolic or lower number is a measurement of the force of blood pressure in your heart when the heart is at rest.
What is considered normal blood pressure during pregnancy?
To determine what your “normal” blood pressure is during pregnancy, your doctor will likely take a baseline blood pressure measurement at your first visit. Then they will measure your blood pressure at every visit that follows.
Normal blood pressure is usually somewhere close to 120/80 mm Hg.
What is considered high blood pressure during pregnancy?
A blood pressure that is greater than 140/90 mm Hg, or that is 15 degrees higher on the top number from where you started out before pregnancy, may be cause for concern.
Early in pregnancy, usually from 5 weeks’ pregnant to the middle of the second trimester, a pregnant woman’s blood pressure may actually decrease. This is because pregnancy hormones can stimulate blood vessels to widen. As a result, the resistance to blood flow isn’t as high.
What is considered low blood pressure during pregnancy?
While there isn’t a definitive number that is too low, there are symptoms that are associated with low blood pressure:
As a woman progresses in her pregnancy, her blood pressure may change or return to prepregnancy levels. Reasons for this may include the following.
The amount of blood in a woman’s body increases. According to the journal Circulation, a woman’s blood volume increases by as much as 45 percent during pregnancy. This is an extra amount of blood that the heart must pump throughout the body.
The left ventricle (left side of the heart that does a significant amount of pumping) becomes thicker and larger. This temporary effect allows the heart to work harder to support the increased blood volume.
The kidneys release increased amounts of vasopressin, a hormone that leads to increased water retention.
In most cases, high blood pressure during pregnancy will subside almost immediately after the baby is delivered. In cases where blood pressure remains elevated, your doctor may prescribe medication to get it back to normal.
Tips for tracking blood pressure during pregnancy
There are many ways that you can track your blood pressure during pregnancy. Try out the following ideas:
If high blood pressure continues after 20 weeks of pregnancy, there can be complications. Preeclampsia can develop.
What is preeclampsia?
This condition can cause serious damage to your organs, including your brain and kidneys. Preeclampsia is also known as toxemia or pregnancy-induced hypertension. Preeclampsia with seizures becomes eclampsia. This can be fatal.
Thorough prenatal care, including regular doctor’s visits, should be able to address preeclampsia symptoms. Symptoms include:
- Protein in a urine sample
- Abnormal swelling in hands and feet
- Persistent headaches
HELLP is an acronym that stands for hemolysis, elevated liver enzymes, and low platelet count. This condition is severe and life-threatening, and can be a complication of preeclampsia. Symptoms associated with HELLP include nausea, vomiting, headache, and upper abdominal pain. Because HELLP syndrome can severely damage organ systems vital to life, emergency medical care is aimed at reducing blood pressure for the health of the mother and the baby. In some cases, a premature delivery is required.
High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:
- Placental abruption, a medical emergency during which the placenta detaches from the uterus prematurely
- Preterm delivery, defined as delivery prior to 38 weeks of pregnancy
- Caesarean delivery
Common risk factors for high blood pressure, such as obesity and a history of high blood pressure, can be minimized through diet and exercise. Of course, during pregnancy, it is inevitable that you will gain some weight. It’s recommended that pregnant women consult with their doctor to identify a weight gain target that is healthy for them.
Dietary guidelines for pregnant women vary from person to person. Speak with a nutritionist who will keep your specific height and weight in mind when creating a nutrition plan for you.
The NHLBI emphasizes that it’s important to take steps to lessen your risk of high blood pressure. You should steer clear of smoking and drinking alcohol, both of which have been known to raise blood pressure.
Pregnancy causes hormone shifts, as well as psychological and physical changes. This can bring on stress, which can make high blood pressure harder to manage. Try stress reduction techniques such as yoga and meditation.
Some traditional blood pressure medications can cause problems in pregnant women.
According to Mayo Clinic, these medications for lowering blood pressure should be avoided when you are pregnant:
These drugs in particular will be passed through the bloodstream to the developing baby. They can negatively impact the baby’s health. These medications may also cause blood to thin, which can compromise the mother’s ability to carry the baby to term.
Methyldopa and labetalol are both drugs that have been deemed safe for use to manage blood pressure during pregnancy.
Talk to your doctor about how to control your blood pressure if you develop hypertension during pregnancy.
High blood pressure during pregnancy doesn’t usually lead to serious problems. However, if it goes untreated, hypertension can become life-threatening for both mother and baby. Unfortunately, hypertensive disorders resulting from high blood pressure are the second-leading cause of U. S. maternal death during pregnancy.
Always talk to your doctor about your concerns. Plan to stay on top of your prenatal care to have the healthiest pregnancy outcome possible.
Take the time to understand the risk factors and possible causes of high blood pressure before you get pregnant — and take preventive measures to keep your blood pressure down during pregnancy.
Http://www. pregmed. org/high-blood-pressure-during-pregnancy. htm
Http://www. justmommies. com/pregnancy/concerns-and-complications/high-blood-pressure-during-pregnancy
Http://www. healthline. com/health/high-blood-pressure-hypertension/during-pregnancy