Shazia Bhatti

Consultant in Obstetrics and Lead for Patient Safety
Shazia Bhatti

It’s extremely satisfying to look after a woman throughout her pregnancy, and then see her with her baby.

High blood pressure (hypertension)

Your blood pressure (measured in millimetres of mercury, or mm Hg for short) is recorded regularly during your pregnancy. It is recorded as a higher (systolic) pressure and a lower (diastolic) pressure, for example 120/70 mm Hg, or 120 over 70.

If you have high blood pressure, or hypertension, your heart has to work harder to pump the blood around your body. This can affect the heart muscle.

Hypertension affects around 10-15% of pregnancies. There are different types of hypertension in pregnancy, including: 

  • chronic hypertension (where the high blood pressure was present before pregnancy)
  • pregnancy-related high blood pressure (gestational hypertension)
  • pre-eclampsia 

While the type of treatment you are given will depend on the cause of your high blood pressure, the key to a healthy pregnancy is to make sure that your blood pressure remains under control. Having check-ups with your antenatal team is the best way of monitoring your condition. You should be offered additional antenatal appointments based on your needs and the needs of your baby.

Placenta praevia

The placenta develops along with the baby in the uterus (womb) during pregnancy. It connects the baby with the mother’s blood system and provides the baby with its source of oxygen and nourishment. The placenta is delivered after the baby, and is also called the afterbirth. In some women the placenta attaches low in the uterus and may cover a part or all of the cervix (entrance to the womb). This attachment often shows up in early ultrasound scans, when it is called a low-lying placenta. In most cases, the placenta moves upwards as the uterus enlarges. For some women, however, the placenta continues to lie in the lower part of the uterus in the last months of pregnancy. This condition is known as placenta praevia. If the placenta covers the cervix, this is known as major placenta praevia.

Because the placenta is in the lower part of the womb, there is a risk that you may bleed in the second half of pregnancy. Bleeding from placenta praevia can be heavy, and so put the life of the mother and baby at risk. However deaths from placenta praevia are rare. You are more likely to need a caesarean section because the placenta is in the way of your baby being born.

If your placenta remains low-lying in the second half of pregnancy, you will have at least one more scan to check whether the position of the placenta has moved with the development and stretching of the uterus. Additional care will be given based on your individual circumstances. If you have major placenta praevia (the placenta covers the cervix) and you have had recurrent or heavy bleeding, you may be offered admission to hospital after 34 weeks of pregnancy. Even if you have had no symptoms before, there is a small risk that you could bleed suddenly and severely, which may mean that you need an urgent caesarean section. 

If your placenta is known to be low lying, you should come to hospital immediately if there is any bleeding. If the bleeding is heavy, you should call 999 for an ambulance.

Obstetric cholestasis

Obstetric cholestasis (OC) is a potentially serious liver disorder that can develop in pregnancy. Normally, bile salts flow from your liver to your gut to help you digest food. In obstetric cholestasis, the bile salts don’t flow properly and build up in your body instead. It is usually diagnosed when there are abnormal liver blood tests and raised bile salts. There’s no cure for OC, but it clears up once you’ve had your baby.

The main symptom is severe generalised itching (all over your body) usually without a rash, most commonly in the last four months of pregnancy. Some women get itching and a severe rash. For some women with OC, the itching is non-stop or unbearable, and can be worse at night. Sometimes the itching is more pronounced on the palms of your hands and the soles of your feet.

Some studies have found that babies of women with OC are more likely to be born prematurely or to be stillborn. It’s not known how much higher the risk of stillbirth is compared to women who don’t have OC. There is no reliable way to work out your baby’s individual risk of stillbirth.

Because of the link with stillbirth, if you have OC you may be offered induction of labour or a caesarean section after 37 weeks of pregnancy. You are most likely to be advised to give birth in hospital, under a consultant-led maternity team. 

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