Previously known as toxemia of pregnancy, pregnancy-induced hypertension is a potentially life-threatening disorder. It usually develops late in the second trimester or in the third trimester. Clinical manifestations of PIH include rapid weight gain, edema, high blood pressure, excretion of albumin in the urine, and convulsions.

PIH complicates about 5% of pregnancies and is among the leading causes of maternal deaths, prenatal deaths, and low birth-weight infants. It is categorized into two classifications:

1. Pre-eclampsia is the non-convulsive form of toxemia. It develops in about 7% of pregnancies and can either be mild or severe. It is characterized by hypertension with proteinuria (excretion of protein in the urine) and/or edema.
2. Eclampsia is the convulsive form of toxemia. About 5% of females with pre-eclampsia develop eclampsia. Of these, about 15% die from toxemia itself or its complications. This condition is characterized by convulsions or coma, both are usually associated with hypertension, proteinuria, and edema.

An unusually high incidence of pre-eclampsia seems to exist among socio-economically deprived groups. Epidemiologists interpret this as meaning that the high incidence is related more to the degree of nutritional deficiencies than to any other environmental factors. In fact, several studies have indicated that calcium and magnesium deficiency may play a role in the development of pre-eclampsia.

Therapy for pre-eclampsia is designed to halt the disorders progress, specifically the early effects of eclampsia such as convulsions, residual hypertension, and renal shutdown, and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach.

Therapy may include sedatives, such as Phenobarbital, along with complete bed rest, to relieve anxiety, reduce hypertension, and evaluate response to therapy. If renal function remains adequate, a high-protein, low-sodium, low-carbohydrate diet with increased fluid intake is recommended.

If the patient’s blood pressure fails to respond to bed rest and sedation and persistently rises above 160/110 mmHg, or if CNS (central nervous system) irritability increases, magnesium sulfate may produce general sedation, promote diuresis, reduce blood pressure, and prevent convulsions. If these measures fail to improve the patient’s condition, or if fetal life is endangered (as determined by stress or non-stress tests), cesarean section or oxytocin induction may be required to terminate the pregnancy.

Emergency treatment of eclamptic convulsions consists of immediate administration of Diazepam IV, followed by magnesium sulfate via IV drip, oxygen administration, and electronic fetal monitoring. After the patient’s condition stabilizes, a cesarean section may be performed.

Adequate nutrition, good prenatal care, and control of preexisting hypertension during pregnancy decrease the incidence and severity of pre-eclampsia.

Pregnancy is unique in that at no other time in life does the well-being of an individual depend so much on the well-being of another. During pregnancy, the mother and child have an intimate and inseparable relationship. The health of the mother before and during pregnancy has profound effects on the status of her infant in the womb and at birth. Therefore, efforts are directed to the mother to ensure a safe and successful delivery and that her infant will be born well.

Pregnancy or gestation is the period from conception to birth and for human beings, it lasts from 38 to 42 weeks. It is often divided into thirds or trimesters, i.e., first, second, and third trimesters. Pregnancy has three stages namely implantation, organogenesis, and growth.

Implantation is the period in which the fertilized ovum implants itself in the uterus and begins to develop. This usually occurs during the first two weeks of conception. During organogenesis, the embryo undergoes differentiation or rapid cell division that occurs from two to eight weeks after conception. This is a critical period when organs are being formed and most vulnerable to adverse influences. If cell division and the final cell number achieved in an organ are limited during the critical period, it will have irreversible effects on later developmental stage.

For example, malnutrition that occurs at this stage may affect organ development that may not be reversed by subsequent refeeding. The remaining seven months is that last stage characterized primarily by growth in the number of cells and size of the organs until it can support extra- uterine life.

Anatomic and physiologic changes accompany normal pregnancy that affects most functions of the body. Most of these changes are seen in the very early weeks showing that they are not merely a response to physiologic stress but an integral part of the maternal- fetal system to create the most favorable environment possible for the developing fetus. The changes are necessary to regulate maternal metabolism, promote fetal growth, and prepare the mother for labor, birth, and lactation.

Lactation is the period of milk production by the mammary glands. The preparation for lactation starts during adolescence when hormonal changes bring about the development and increase in size of the breast, areola, and nipple. During pregnancy, these anatomical parts are markedly increased, especially in the latter stage of pregnancy, when the lobules of the alveolar system reach maximum size.

The two main hormones responsible for milk production are prolactin and oxytocin. The first milk is a thick, yellowish fluid that comes out on the second to the fifth day after delivery. This is called the colostrums and it is very important that the baby is fed this first milk because it contains antibodies and immune cells. It is richer in protein and lower in carbohydrate and fat, compared to the breast milk in later days, which is more watery and bluish. Colostrum is also a laxative, which initially cleans out the baby’s digestive organs.