DEAR DR. DONOHUE: My wife and I are expecting our first child. We are quite anxious, because her blood pressure has risen, and the doctor says that if it continues to rise, she will have to go to the hospital. She is only 27 and never had a blood pressure problem. How come she has it now? – W.W.

ANSWER: Around 5 percent of pregnant women develop high blood pressure during pregnancy, and it is known as pre-eclampsia. It’s a pressure of 140/90 or greater. Often, along with the rise in blood pressure comes a loss of protein into the urine and sometimes fluid retention, which can be seen as swollen hands or a swollen face. All of this typically occurs after the 20th week of pregnancy.

Some women have no symptoms when all this takes place. Others develop headaches, blurry vision and pain in the stomach or the upper right side of the abdomen.

If the blood pressure rise is not severe and if the protein loss into the urine is not great, many women can remain home but must be closely monitored by their doctors. If the pressure continues to rise, complications can happen. The kidneys can fail; the number of platelets (the blood-clotting cells) can drop; clots can form in blood vessels; strokes are possible, as is death. Pre-eclampsia can cause fetal death.

Should pressure rise to 160/110 or higher and should the protein loss be great, hospitalization is necessary.

What causes this has not been worked out.

Delivery is the cure for pre-eclampsia. The decision about when to deliver the baby has to be made by balancing the risks to the mother with the risks to the baby from too early a delivery. For mild pre-eclampsia, delivery can usually be safely postponed until the 38th week. For severe pre-eclampsia, delivery is often induced around the 34th week.

Most women pull through a bout of pre-eclampsia healthy and with a healthy baby.

DEAR DR. DONOHUE: My father’s death certificate says he died of “cardiac tamponade and a ruptured myocardium.” Would you explain? He had no doctor, and neither do I. Thank you. – V.B.

ANSWER: A double-layered sac, the pericardium, covers the heart. Should this sac fill with fluid, the fluid can compress the heart and render it unable to pump blood. That is cardiac tamponade.

Cardiac rupture is a split that develops in the heart muscle. The usual cause is a massive heart attack. The split causes blood to gush out of the heart and fill the pericardium. This is what happened to your father. The fluid that led to tamponade of his heart was his own blood.

Both conditions can be medical catastrophes. The likelihood of recovery from a ruptured myocardium with cardiac tamponade is close to zero.

Heart attacks come in many varieties and with consequences that range from mild to life-threatening. The heart attack booklet explains the causes, treatments and outlook for heart attacks.

Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-4675. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Why is it necessary to get a urine test if you’re getting blood tests too? Don’t blood tests give you all the information needed? What more does a urine test do?

I ask the question because I have no medical insurance and am on a fixed income. I have to keep my medical costs to a minimum. – L.K.

ANSWER: Urine tests provide information that blood tests don’t.

Only a urine test can provide proof of a urinary tract infection, and only a urine test can be used to identify the germ that causes such an infection.

A urine test provides valuable information on how well the kidneys function. No protein should appear in urine. If it does, that’s an indication that the kidneys have developed a problem needing investigation.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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