Rh incompatibility Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her

womb has Rh-positive blood. Causes During pregnancy, red blood cells from the unborn baby can cross into the mother's bloodstream through the placenta. If the mother is Rh-negative, her immune system treats Rh-positive fetal cells as if they were a foreign substance and makes antibodies against the fetal blood cells. These anti-Rh antibodies may cross back through the placenta into the developing baby and destroy the baby's circulating red blood cells. When red blood cells are broken down, they make bilirubin. This causes an infant to become yellow (jaundiced). The level of bilirubin in the infant's bloodstream may range from mild to dangerously high. Because it takes time for the mother to develop antibodies, firstborn infants are often not affected unless the mother had past miscarriages or abortions that sensitized her immune system. However, all children she has afterwards who are also Rh-positive may be affected. Rh incompatibility develops only when the mother is Rh-negative and the infant is Rh-positive. Thanks to the use of special immune globulins called RhoGHAM, this problem has become uncommon in the United States and other places that provide access to good prenatal care. Symptoms Rh incompatibility can cause symptoms ranging from very mild to deadly. In its mildest form, Rh incompatibility causes the destruction of red blood cells. After birth, the infant may have: Yellowing of the skin and whites of the eyes (jaundice) Low muscle tone (hypotonia) and lethargy Exams and Tests Before delivery, the mother may have an increased amount of amniotic fluid around her unborn baby (polyhydramnios). There may be: A positive direct Coombs test result Higher-than-normal levels of bilirubin in the baby's umbilical cord blood Signs of red blood cell destruction in the infant's blood Treatment Because Rh incompatibility is preventable with the use of RhoGAM, prevention remains the best treatment. Treatment of an infant who is already affected depends on the severity of the condition. Infants with mild Rh incompatibility may be treated with: Feeding and fluids (hydration) Phototherapy using bilirubin lights Outlook (Prognosis) Full recovery is expected for mild Rh incompatibility. Possible Complications Possible complications include: Brain damage due to high levels of bilirubin (kernicterus)

Fluid buildup and swelling in the baby (hydrops fetalis) Problems with mental function, movement, hearing, speech, and seizures When to Contact a Medical Professional Call your health care provider if you think or know you are pregnant and have not yet seen a doctor. Prevention Rh incompatibility is almost completely preventable. Rh-negative mothers should be followed closely by their obstetricians during pregnancy. Special immune globulins, called RhoGAM, are now used to prevent RH incompatibility in mothers who are Rh-negative. If the father of the infant is Rh-positive or if his blood type cannot be confirmed, the mother is given an injection of RhoGAM during the second trimester. If the baby is Rh-negative, the mother will get a second injection within a few days after delivery. These injections prevent the development of antibodies against Rh-positive blood. However, women with Rh-negative blood type must receive injections: During every pregnancy If they have a miscarriage or abortion After prenatal tests such as amniocentesis and chorionic villus biopsy After injury to the abdomen during pregnancy Alternative Names Rh-induced hemolytic disease of the newborn Pregnancy induced hypertension (PIH) is a condition of high blood pressure during pregnancy. Your blood pressure goes up, you retain water, and protein is found in your urine. It is also called toxemia or preeclampsia. The exact cause of PIH is unknown. Who is at risk for Pregnancy Induced Hypertension (PIH)? The following may increase the risk of developing PIH: A first-time mom Women whose sisters and mothers had PIH Women carrying multiple babies; teenage mothers; and women older than age 40 Women who had high blood pressure or kidney disease prior to pregnancy What are the symptoms of Pregnancy Induced Hypertension (PIH)? Mild : high blood pressure, water retention, and protein in the urine. Severe : headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily. Contact your doctor immediately if you experience blurred vision, severe headaches, abdominal pain, and/or urinating very infrequently . How do I know if I have Pregnancy Induced Hypertension (PIH)? At each prenatal checkup your healthcare provider will check your blood pressure, urine levels, and may order blood tests which may show if you have hypertension. Your physician may also perform other tests that include: checking kidney and blood-clotting functions; ultrasound scan to check your baby's

growth; and Doppler scan to measure the efficiency of blood flow to the placenta. How is Pregnancy Induced Hypertension (PIH) treated? Treatment depends on how close you are to your due date. If you are close to your due date, and the baby is developed enough, your health care provider will probably want to deliver your baby as soon as possible. If you have mild hypertension and your baby has not reached full development, your doctor will probably recommend you do the following: Rest, lying on your left side to take the weight of the baby off your major blood vessels. Increase prenatal checkups. Consume less salt. Drink 8 glasses of water a day. If you have severe hypertension, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely. How does Pregnancy Induced Hypertension (PIH) affect my baby? Pregnancy induced hypertension (PIH) can prevent the placenta from getting enough blood. If the placenta doesn't get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women still can deliver a healthy baby if PIH is detected early and treated with regular prenatal care. How can I prevent Pregnancy Induced Hypertension (PIH): Currently, there is no sure way to prevent hypertension. Some contributing factors to high blood pressure can be controlled and some can't. Follow your doctor's instruction about diet and exercise. Use little or no added salt in your meals. Drink 6-8 glasses of water a day. Don't eat a lot of fried foods and junk food. Get enough rest Exercise regularly Elevate your feet several times during the day. Avoid drinking alcohol. Avoid beverages containing caffeine. Your doctor may suggest you take prescribed medicine and additional supplements. Introduction to Preeclampsia What is Preeclampsia? How Common Are High Blood Pressure and Preeclampsia in Pregnancy? Who Is More Likely to Develop Preeclampsia? What Are the Symptoms of Preeclampsia and How Is It Detected? How Can Women with High Blood Pressure Prevent Problems During Pregnancy? Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems? Find a local Obstetrician-Gynecologist in your town Introduction to Preeclampsia Although many pregnant women with high blood pressure have healthy babies without serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-

existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension). The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia-or "toxemia of pregnancy"-which can threaten the lives of both the mother and the fetus. What is preeclampsia? Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia-the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The way to "cure" preeclampsia is to deliver the baby. How Common Are High Blood Pressure and Preeclampsia in Pregnancy? High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S., about 70 percent of which are first-time pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed. Although the proportion of pregnancies with gestational hypertension and eclampsia has remained about the same in the U.S. over the past decade, the rate of preeclampsia has increased by nearly one-third. This increase is due in part to a rise in the numbers of older mothers and of multiple births, where preeclampsia occurs more frequently. For example, in 1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and older were at the highest levels in 3 decades, according to the National Center for Health Statistics. Furthermore, between 1980 and 1998, rates of twin births increased about 50 percent overall and 1,000 percent among women ages 45 to 49; rates of triplet and other higher-order multiple births jumped more than 400 percent overall, and 1,000 percent among women in their 40s. Who Is More Likely to Develop Preeclampsia? Women with chronic hypertension (high blood pressure before becoming pregnant). Women who developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy. Women who are obese prior to pregnancy. Pregnant women under the age of 20 or over the age of 40. Women who are pregnant with more than one baby.

Women with diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. What Are the Symptoms of Preeclampsia and How Is It Detected? Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia include persistent headaches, blurred vision or sensitivity to light, and abdominal pain. All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze blood tests that detect signs of preeclampsia, and to monitor fetal development more closely. How Can Women with High Blood Pressure Prevent Problems During Pregnancy? If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. Taking steps to control your blood pressure before and during pregnancy-and getting regular prenatal care-go a long way toward ensuring your well-being and your baby's health. Before becoming pregnant: Be sure your blood pressure is under control. Lifestyle changes such as limiting your salt intake, participating in regular physical activity, and losing weight if you are overweight can be helpful. Discuss with your doctor how hypertension might affect you and your baby during pregnancy, and what you can do to prevent or lessen problems. If you take medicines for your blood pressure, ask your doctor whether you should change the amount you take or stop taking them during pregnancy. Experts currently recommend avoiding angiotensinconverting enzyme (ACE) inhibitors and Angiotensin II (AII) receptor antagonists during pregnancy; other blood pressure medications may be OK for you to use. Do not, however, stop or change your medicines unless your doctor tells you to do so. While you are pregnant: Obtain regular prenatal medical care. Avoid alcohol and tobacco. Talk to your doctor about any over-thecounter medications you are taking or are thinking about taking Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems? The effects of high blood pressure during pregnancy vary depending on the disorder and other factors. According to the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in general increase a woman's risk for developing chronic hypertension or other heart-related problems. The NHBPEP also reports that in women with normal blood pressure who develop preeclampsia after the 20th week of their first pregnancy, short-term complications-

including increased blood pressure-usually go away within about 6 weeks after delivery. Some women, however, may be more likely to develop high blood pressure or other heart disease later in life. More research is needed to determine the long-term health effects of hypertensive disorders in pregnancy and to develop better methods for identifying, diagnosing, and treating women at risk for these conditions. Even though high blood pressure and related disorders during pregnancy can be serious, most women with high blood pressure and those who develop preeclampsia have successful pregnancies. Obtaining early and regular prenatal care is the most important thing you can do for you and your baby. Featured: Preeclampsia (Pregnancy Induced Hypertension) Main Article Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.

There exist several hypertensive states of pregnancy:

Gestational hypertension = usually defined as a BP over 140/90 without the presence of protein in the urine. Preeclampsia = gestational hypertension (BP > 140/90), and proteinuria (>300 mg of protein in a 24-hour urine sample). Severe preeclampsia involves a BP over 160/110 (with additional signs) Eclampsia = seizures in a preeclamptic patient HELLP syndrome = Hemolytic anemia, elevated liver enzymes and low platelet count Acute fatty liver of pregnancy is sometimes included in the preeclamptic spectrum.

Pre-eclampsia and eclampsia are sometimes treated as components of a common syndrome.[1] [edit] Risk Factors

Family history of preeclampsia Pre-existing hypertension Renal disease Diabetes mellitus Obesity Multiple gestation (twins or triplets, etc.) Age 35 or greater Adolescent pregnancy African-American race