Ten percent of women will develop a blood pressure elevation towards the end of their pregnancy. This problem has many names: PIH (pregnancy induced hypertension), pre-eclampsia and toxemia. In its most severe form, it is called HELLP syndrome with Hypertension, Elevated Liver function tests and Low Platelets. This problem can become very dangerous with bleeding, strokes and seizures. If a seizure occurs, the disease is then called eclampsia.

In the past, this was a frequent cause of both maternal and fetal mortality, and still can be today. The cause of this malady is still a mystery. It is thought to be related to the woman's ability to provide blood flow to the placenta and give the baby adequate oxygen and nutrients. The placenta doesn't function properly at normal blood pressures and needs the higher pressures to do its work. The placenta releases hormones into the mother to increase her blood pressure. Blood pressure medicines have not been shown to be helpful. The condition is cured only by delivering the baby and removing the placenta.

The problem is most ominous when it occurs in the sixth or seventh month of pregnancy. At that time, the option of delivering the baby is not an easy choice because of the risks of prematurity. The woman can be put at complete bed rest, this tends to improve the pressure problem and slows the progress of the disease. You then must walk a fine line between prolonging a premature pregnancy and subjecting the mother and baby to the risks of the hypertension. I have managed many such pregnancies. The decisions involved are frequently not clear-cut. This can really intensify the normal waiting and watching of pregnancy; for you and your doctor.