Pregnancy is an extremely significant period in the life of a woman, during which she fulfills one of her main destinations provided for by nature: she carries a child. But this great time can be overshadowed by unpleasant sensations caused by increased blood pressure.
About 4 – 8% of expectant mothers suffer from the disease. In Soviet times, the diagnosis of hypertension was not usually considered by doctors in the context of pregnancy.
A misconception was widely accepted that high blood pressure (BP) is the prerogative of people no younger than 40 – 45 years old. However, after a few years, when examining the population, it was found that many people aged 17 to 29 years old were affected by high blood pressure – 23,1%.
I am glad that at present medicine has paid attention to pregnancy with hypertension and has taken up clinical studies of this issue.
- Causes of Hypertension in Pregnancy
- Symptoms and signs of hypertension
- Diagnosis of hypertension
- Instrumental studies
- Core research
- Risk Factors
- Treatment of hypertension during pregnancy
- Preeclampsia in Pregnancy
- Eclampsia in pregnant women
- Arterial hypertension in pregnant women
- The consequences and complications after hypertension
- preventive measures
Causes of Hypertension in Pregnancy
In the body of a pregnant woman, a new full-fledged life develops, the body undergoes many hemodynamic changes due to adaptation of the coexistence of the mother and the fetus. During this period, it is quite difficult to distinguish physiological changes from pathologies. The walls of blood vessels expand, the volume of fluid and salt in the body increases, and by the end of the 20th week of pregnancy an additional circle of blood circulation is formed.
During this period, an increase in blood pressure usually manifests itself. Normally, this increase is insignificant and does not pose a danger to the state of health of the mother and baby, since it is characteristic of almost all pregnant women at this time.
If arterial pressure increases by 20 mm. Hg. Art. and higher in comparison with pressure before pregnancy, then we can confidently talk about gestational hypertension. In other words, it is hypertension due to pregnancy.
From scratch, a serious diagnosis cannot arise. Almost all diseases are caused by various reasons, knowing about which in advance, it is easier to avoid the onset of the disease than to treat it later. From the point of view of medicine, hypertension during pregnancy can occur, as a consequence of the following factors:
- High blood pressure of a woman before pregnancy;
- Insufficient increase in vascular volume (decreased clearance of endogenous creatinine, decreased hematocrit and decreased hemoglobin);
- Multiple pregnancy;
- Fetal growth retardation;
- First pregnancy;
- Pregnancy after 30 – 35 years;
- Decreased physical activity during and before pregnancy;
- Constant stress, fear, anxiety and depression;
- The presence of mental or neurogenic disorders;
- Late gestosis (toxicosis).
Usually, one factor is not enough for the development of the disease. It manifests itself and progresses under the condition of a combination of several of these reasons.
In most cases, women learn about hypertension already during the observation of pregnancy. This is due to the fact that in the first stages, an increase in blood pressure does not cause much discomfort and impairment of well-being, but subsequently extremely complicates the diagnosis and treatment.
Symptoms and signs of hypertension
It happens that hypertension is almost asymptomatic, and its symptoms can be lubricated by manifestations of gestosis. The first criterion for hypertension during pregnancy is an increase in blood pressure. Additional symptoms include:
- Headache (usually with an epicenter in the occipital or temporal region, intensifies during stress);
- Tachycardia (increased heart rate);
- Lumbar pain
- Cold feeling in limbs;
- Increased sweating and sensation of heat;
- Constant thirst;
- Nose bleed;
- Sleep disturbances;
- Fast fatiguability;
- Visual impairment (points in front of the eyes);
- The appearance of red spots on the face (sometimes on the chest);
- Increased irritability;
- Unmotivated feeling of anxiety.
Diagnosis of hypertension
Due to the characteristics of the body of a woman expecting a baby, pregnancy and hypertension are often concomitant in the early stages. The main difficulty in diagnosing hypertension during pregnancy lies in the fact that expectant mothers usually do not measure pressure, and do not feel symptoms of the disease or attribute them to the manifestation of toxicosis.
This is due to the need to exclude other diagnoses and dysfunctions of the internal organs, which are characterized by an increase in blood pressure, and which are dangerous for the normal life of the fetus and mother.
A single increase in pressure is recorded in 40 – 50% of women, so a single measurement for diagnosis is not enough. Plus, the syndrome of the so-called “white coat hypertension” is popular in medicine, when the pressure measurement in the medical environment shows much higher numbers than with a similar diagnostic method, but in outpatient (home) conditions. This phenomenon occurs in approximately 20-30% of pregnant women, therefore, in case of suspicion of it, daily monitoring of blood pressure is indicated.
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The main non-invasive method for diagnosing hypertension is auscultation Blood pressure according to N. S. Korotkov. On the recommendation of WHO, the measurement of blood pressure should be carried out in pregnant women in a sitting position (to avoid pressure on the inferior vena cava), strictly after 5, and preferably at least 10 minutes of rest, in turn on both hands and using the appropriate size of the cuff of the tonometer.
If the tonometer gives different numbers, then the real blood pressure is considered to be a larger indicator. It is important that auscultation was performed no earlier than 1,5 to 2 hours after eating. Before measuring blood pressure, it is necessary to exclude the use of coffee, any kind of tea and adrenomimetics.
The main studies for the diagnosis of hypertension include:
- Clinical blood test (for platelets, hematocrit and hemoglobin).
- Extensive biochemical blood test to measure the level of sugar, cholesterol, uric acid and creatinine.
- The study of daily urine for blood, glucose, determining the level of glomerular filtration.
- Functional examinations – ECG, ECHO-KG (allows you to see violations in the “work” of the heart), ultrasound of the kidneys.
Mandatory consultation of a neurologist, ophthalmologist, endocrinologist and other specialized specialists at the discretion of the attending physician.
Hypertension during pregnancy is not only due to any reasons, but, like any disease, is based on certain risk factors, which include:
- The presence of bad habits in a pregnant woman: smoking and drinking alcohol;
- Regular abuse of salty, spicy and smoked foods;
- Dyslipidemia (elevated cholesterol);
- High blood pressure in a previous pregnancy;
- Body mass index> 27 kg / m 2;
- Past diseases of the genitourinary system, especially dysuric disorders (violation of urination);
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Treatment of hypertension during pregnancy
Pregnancy and hypertension, the risks of complications from which are quite serious, are capable, figuratively speaking, go hand in hand until the birth of the baby. The prognosis can be quite favorable provided that the doctor’s recommendations are followed, regular rest and the presence of positive emotions in the future mother. In each individual case, pregnant women with hypertension are shown individual treatment, the main tasks of which are:
- Reducing the risk of complications.
- The normal course of pregnancy.
- Optimization of delivery.
Treatment is carried out on an outpatient or inpatient basis, it depends on the physical condition of the pregnant woman, taking into account the degree of risk. For the low-risk group, characterized by an increase in blood pressure to 140 – 49/90 – 199 mm RT. Art. and normal results of the analysis, there is enough non-drug therapy. The patient is shown:
- Compliance with diet and proper nutrition (it is important to minimize salt intake, not more than 5 g per day; also reduce the consumption of vegetable and animal fats; increase the volume of dairy and grain products, fruits and vegetables);
- Daily stay in the fresh air for several hours (preferably outdoors: in a forest or park);
- Full night sleep and daytime rest;
- Physiotherapy (electrosleep, inductothermy, diathermy);
- Hyperbaric oxygenation;
- Moderate physical activity (swimming, walking, gymnastic exercises, yoga for pregnant women, exercise therapy);
- Daily measurement of blood pressure;
- Elimination of stress, fear, anxiety (may require work with a psychologist);
- Lack of overloads;
- Strong abstinence from bad habits.
Excellent results are given by relaxation exercises, moderate yoga classes, autogenic training. It is imperative that the pregnant woman learns to abstract from the stresses of life, does not take everyday troubles to heart. If there is such an opportunity, then it is advisable to take a break from work, especially if it is associated with stress, to spend time in a relaxed atmosphere.
It is important for them to learn how to protect a pregnant woman from problems of any nature, provide her with constant moral support, deliver only positive emotions. Usually, with a low risk of the disease, this is enough for a normal pregnancy.
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If arterial pressure continues to rise and reaches 160-100 mmHg. and higher, the degree of risk is high, and antihypertensive therapy must be included. Many women are afraid to take medicine during pregnancy, thinking that this will certainly harm the fetus, which is fundamentally wrong.
Medicine does not stand still, and those medicines that a doctor prescribes will only bring benefits to the mother and child. The absolute harmlessness of medicines is not guaranteed, but their minimal effect on the fetus has been scientifically proven.
Typically, in case of hypertension in pregnant women, methyldopa (dopegit, aldomet), nifedipine, pindolol, atenolol, oxprenolol, nifedipine SR, isradipine, diltiazem are prescribed. The choice of the drug remains with the doctor, it is strictly forbidden to take medicine alone or on the recommendation of friends.
Self-medication, refusal to take medications or their irregular use are very dangerous for the development of the unborn child: the fetus receives little oxygen, there is a high probability of placental abruption. But the most serious complications are the conditions of preeclampsia and eclampsia. They are life-threatening to both the mother and the fetus.
Preeclampsia in Pregnancy
A serious question is how the second pregnancy goes with hypertension. If hypertension was first diagnosed, then preeclampsia is likely to occur.
Preeclampsia is a dangerous condition of a pregnant woman in the late stages (at the end of the second – third trimester), a severe degree of gestosis, which is characterized by a significant increase in pressure and the appearance of edema. Preeclampsia is divided into three stages: mild, moderate and severe. Severe can flow into eclampsia, which will be discussed later.
With a mild stage of preeclampsia (blood pressure rises to 150/90 mm Hg), the patient may not experience any particular discomfort. Small swelling of the legs is possible, the protein level in the urine is not more than 1 g.
With moderate (high blood pressure up to 170/110 mm Hg. Art.) And severe stage (pressure above 170/110 mm Hg. Art.), Additional symptoms are associated with increased blood pressure and gestosis:
- Visual impairment (decreased severity, flies in front of the eyes);
- Headache and pain in the upper part of the peritoneum;
- Fluid retention in the body and as a result: weight gain – more than 2,5 – 3 kg per week, severe swelling of the face, arms, legs, nasal mucosa and anterior abdominal wall;
- Nausea and vomiting;
- Proteinuria (protein in the urine);
- Oliguria (decreased urine output);
- Disorders in the central nervous system (CNS) – sleep disturbances (drowsiness or insomnia), apathy, memory loss, irritability or lethargy;
- Disorders in the liver – jaundice, darkening of the color of urine, yellowing of the skin;
- Thrombocytopenia (a decrease in the number of platelets in the blood) – poor blood clotting.
If at the first stage of the condition a woman can still stay at home and strictly follow the doctor’s recommendations (walk less, refuse to play sports), then for other stages hospitalization, bed rest and drug therapy are mandatory.
If the diagnosis is made up to 34 weeks, then the pregnant woman is prescribed corticosteroids – medicines designed to accelerate lung development. This is due to the safety of the fetus in case it is necessary to carry out stimulation of labor. In the severe stage of preeclampsia diagnosed after 37 weeks, in most cases, labor induction is immediately prescribed.
Since the exact cause of preeclampsia is still not clear, this condition of the pregnant woman is considered as a genetically determined pathology. In addition to hypertension, risk factors include:
- First birth;
- Pregnant age after 40 years;
- The interval between births is more than 10 years;
- A similar disease in the first pregnancy;
- Multiple pregnancy;
- Bubble drift;
- Dropsy of the fetus;
- Systemic lupus erythematosus;
Eclampsia in pregnant women
Eclampsia is the last stage of preeclampsia, which poses a serious threat to the life of the mother and fetus. It is characterized by a critical increase in blood pressure, acute impaired renal function and central nervous system, convulsive seizures.
The state of eclampsia manifests itself in the form of loss of consciousness and the instant development of one or more convulsive seizures, one after the other, and then the patient falls into a coma. One seizure lasts from 40 seconds to 1 to 2 minutes, accompanied by loss of tongue, foam from the mouth, dilated pupils, cyanosis.
Physical and nervous tension, pain, external irritants (bright light, loud noise) can provoke an attack. A seizure can begin during childbirth with insufficient pain relief of labor, with excessively fast labor or stimulation, with difficult delivery.
Eclampsia develops in 1,5% of cases of all gestosis of pregnancy. There are 3 clinical forms of eclampsia:
- Typical – the symptoms include serious edema of the epithelium of the internal organs and subcutaneous tissue, albuminuria, severe hypertension. It is characteristic of women of the hypersthenic type.
- Atypical – usually manifests itself in pregnant women with a labile nervous system. This form is characterized by cerebral edema, increased intracranial pressure and hypertension.
- Uremic – based on pre-pregnancy or nephritis that appeared during it. More often, women with an asthenic physique suffer. Severe violations in the liver (jaundice, necrosis, hemorrhage), depression of the central nervous system, severe hypertension are observed.
When symptoms appear, the actions of doctors are aimed at compensating and restoring the most important functions of the body, and preventing new seizures. Delivery is shown careful, in the majority of cases with the help of cesarean section.
Arterial hypertension in pregnant women
Some sources indicate that hypertension is a diagnosis, and hypertension is a symptom of a disease, that is, a persistent increase in blood pressure. From the point of view of medicine, arterial hypertension includes several conditions, each of which has been discussed above. These painful conditions are characteristic of pregnant women with high blood pressure:
- Severe hypertension.
The consequences and complications after hypertension
The negative effects of hypertension depend on the degree of risk of pregnancy and childbirth (according to Shekhman):
- First, minimal – only 20% of women experience minor complications of pregnancy.
- The second, more pronounced – causes gestosis, premature birth, spontaneous abortion, fetal malnutrition, perinatal mortality, and the incidence of hypertensive crisis increases.
- The third, maximum – the birth of a premature baby, a danger to the life of a woman and a fetus.
Severe consequences are caused by preeclampsia and eclampsia. In the second condition, there is a risk of circulatory disorders of the woman and the fetus, the pregnant woman falls into a coma, which usually leads to death. The most dangerous consequences of these conditions:
- Cerebral hemorrhage;
- Cardiac arrest;
- Pulmonary edema;
- Infection (the body becomes extremely susceptible to them);
- Croupous pneumonia;
- Intrauterine growth retardation;
- Fetoplacental insufficiency;
- Septic postpartum processes.
With uremic eclampsia, the likelihood of complications and the fact that the functions of vital organs (retinitis, nephritis) after childbirth do not recover or partially recover, is extremely high.
For her, the absence of a convulsive stage with the rapid development of paralysis is characteristic. This form in most cases gives severe relapses in the following pregnancies.
The prognosis is most favorable with typical eclampsia, the work of internal organs is usually normalized. An exception may be a disease that began in the early stages of pregnancy or after childbirth.
Many of the risk factors are easily eliminated by thinking about your own and the health of the unborn baby before pregnancy. Preventive measures aimed at avoiding hypertension during pregnancy include, first of all: