Q: I am 24 years old and first time 38 weeks pregnant. I got hypertension in the 35th week and my doctor started anti-hypertensive drug Alphadopa. It is completely controlled with this. I was in the hospital for 24 hours for PIH monitoring and my BP was measured at 130/90 mmHg (only once) and most of the times it is 120/90 mmHg and the lowest has been 110/70 mmHg. The baby’s heartbeat was varying between 150-125. The rest of the blood and urine tests are normal. After this monitoring, my doctor advised a c-section but I was not in favour of it. I am currently taking Alphadopa 250 once daily and monitoring my BP daily. Please suggest if I should select a c-section or should I wait for normal labour pains?

A:If your blood pressure was on one occasion raised to 130/90 mmHg and otherwise it was between 110-120/70-90 mmHg with normal urine results, I would not even bother advising any antihypertensive. 250 mg of Alpha methyldopa once a day is a very inadequate dose anyway! I do not believe it is doing anything in terms of helping blood pressure profile over a 24-hour period. It would be helpful to do some renal and liver function (blood) tests. It would be further reassuring if they are normal. Based on your history, I do not see any reason for advising caesarean section. You can very well hope to go in spontaneous labour and achieve a nice and normal delivery. If the blood pressure remains under control (as it seems to be) you can wait for at least 10 days over your due date. I would advise to take this approach (of waiting) only if you are sure of dates and preferably if EDD was based on scans from early pregnancy. If you do not go in labour by that time then you may undergo induction of labour (by giving some preparations vaginally you will be made to go in labour).