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GB in pregnant women treatment. Treatment of complications of gestation by trimester. Causes of hypertension during pregnancy

Pregnancy in combination with hypertension occurs in 3-4% of cases ("hyper" means higher or higher, over). Most pregnant women develop before pregnancy, but can occur during pregnancy as well.

Recently, hypertension has become common among young people. Nevertheless, an increase in the incidence of essential hypertension is observed in parallel with an increase in age. Thus, among women over 30 years of age, the frequency of hypertension is 3-4%, over 35 years old - 5-8%, and over 40 years old - 13.5%.

It is believed that normal blood pressure is 110-140 mm. rt. Art. - systolic (or upper); 70-90 mm. rt. Art. -.

The presence of arterial hypertension is evidenced by an increase in blood pressure above 140/90 mm Hg. Art.

In hypertension, several degrees of severity of the disease are noted, on which the prognosis of the outcome of pregnancy and childbirth for a woman depends.

For Stage I(it is also called functional) is characterized by unstable hypertension, that is, an increase in blood pressure is replaced by periods of normal pressure. For stages IIA and IIB there is a persistent increase in blood pressure, and Stage III hypertension is already characterized by damage to organs and tissues (brain, heart, kidneys, blood vessels).

Only with mild degree (I degree) of hypertension, when the increase in blood pressure is mild and unstable, in the absence of changes in the heart, pregnancy and childbirth can proceed normally. With a persistent and significant increase in blood pressure, pregnancy worsens the course of hypertension. In patients with stage III of hypertension, the ability to conceive is sharply reduced, and if pregnancy does occur, then, as a rule, it ends in miscarriage or intrauterine fetal death.

Other serious complications during pregnancy can also occur. The most serious complication is encephalopathy, which can lead to cerebral hemorrhage (stroke), coma, and even death. Therefore, carrying a pregnancy at this stage of the disease is contraindicated.

In many patients in the initial stages of the disease at the 15-16th week of pregnancy, blood pressure decreases (often to normal values), which is explained by endocrine changes in the body during pregnancy, in particular, an increase in the synthesis of progesterone by the placenta, which reduces vascular tone. At stages II-III, such a decrease is not observed. After 24 weeks, blood pressure rises in all patients, regardless of the stage of the disease. Against this background, such complication of pregnancy as gestosis (32-55%), which has an unfavorable course, is often added.

Due to the spasm of the uteroplacental vessels, the delivery of nutrients and oxygen to the fetus is disrupted, which leads to oxygen starvation (hypoxia) and fetal growth retardation... Placental insufficiency develops, there is a threat of termination of pregnancy.

In 20-25% of cases, a child is born with a reduced body weight (malnutrition). Premature births often occur, in 4% intrauterine fetal death may occur.

When planning pregnancy and carrying out preventive treatment, as well as with timely registration at the antenatal clinic and monitoring the course of pregnancy by a therapist, constant monitoring of blood pressure and timely prevention and treatment of complications of pregnancy, it is possible to achieve a significant reduction in the adverse outcome of pregnancy and childbirth.

Everything should only be taken as directed by a doctor. because many of the pressure-lowering drugs are contraindicated in pregnancy and can adversely affect the baby's body.

Of non-medicinal products with high blood pressure, beet juice with honey, a mixture of vegetable juices, which have a beneficial effect on blood pressure, and also replenish the body with the necessary vitamins and minerals during pregnancy, help. In addition, beetroot and other vegetable juices help relieve constipation, so common during pregnancy.

As in the case of hypertension, one should limit fluid intake to 1 liter, and salt to 1-3 g per day.

Hypertension - high blood pressure in pregnant women


For citation: Shibai B.M. Arterial hypertension in pregnant women // BC. 1999. No. 18. P. 890

Arterial hypertension (AH) is the most frequent complication of pregnancy and the cause of maternal and perinatal morbidity and mortality worldwide. During normal pregnancy, systolic pressure changes slightly; however, diastolic in the early stages (13-20 weeks) decreases by an average of 10 mm Hg. Art., and in the third trimester again returns to those values ​​that were before pregnancy. The term "pregnancy hypertension" encompasses a wide range of conditions in which blood pressure varies widely. A study of the literature reveals that the classification of hypertension in pregnant women is associated with a number of problems, including, for example, the question of which Korotkoff tone (phase IV or V) should be used to measure diastolic pressure. All modern definitions and classifications, when applied for diagnosis and treatment, reveal certain disadvantages. However, the latest report from the Working Group on High Blood Pressure in Pregnancy recommends the classification system proposed by the American College of Obstetrics and Gynecology in 1972. We divided hypertensive disorders in pregnant women into three categories: chronic hypertension, gestational hypertension and preeclampsia (Table 1).

Chronic hypertension

Prevalence chronic hypertension in pregnant women it is 1-5%. This indicator rises with age, it is also higher in obese women. The diagnosis is based on anamnestic data (pressure level before pregnancy) or an increase in pressure up to 140/90 mm Hg. and more until the 20th week of pregnancy.

It is very difficult to diagnose chronic hypertension in pregnant women if the pressure before pregnancy is not known. In such cases, the diagnosis is usually based on the presence of hypertension before the 20th week of pregnancy. However, in some women, hypertension during these periods may be the first manifestation of preeclampsia. Moreover, due to the physiological decrease in blood pressure during the second trimester, many women with chronic hypertension have normal blood pressure before the 20th week of pregnancy.

Hypertension is often classified as mild, moderate, severe, and very severe based on the level of systolic or diastolic pressure. Chronic hypertension during pregnancy can be considered mild or severe . Although there is no unambiguous definition of mild hypertension, it is generally accepted that a diastolic pressure level of 110 mm Hg and above (according to Korotkoff's V tone) indicates severe hypertension.

Newborns from women with chronic hypertension have a serious prognosis, mainly due to preeclampsia.

Neither exacerbation of hypertension nor edema are reliable indicators of developing preeclampsia. The best indicator of preeclampsia is the occurrence of proteinuria (at least 300 mg in 24 hours) in the absence of kidney disease.

Risk to mother and fetus

Pregnant women with chronic hypertension are at increased risk of developing preeclampsia and placental abruption, and their babies have increased perinatal morbidity and mortality. The likelihood of these complications is especially high in women who have been suffering from severe hypertension for a long time or who have cardiovascular and renal pathology. Moreover, maternal and child morbidity and mortality increase if a pregnant woman has a diastolic pressure of 110 mm Hg or more during the first trimester. In contrast, outcomes in women with mild, uncomplicated chronic hypertension during pregnancy and in their children are similar to those in healthy pregnant women.

Treatment

Results from retrospective studies involving pregnant women indicate that antihypertensive therapy reduces the incidence of strokes and cardiovascular complications in pregnant women with diastolic blood pressure above 110 mmHg. There is general agreement that pregnant women with severe hypertension should receive drug therapy, but it is unclear whether such therapy is warranted for mild essential hypertension.

The advantages of long-term therapy aimed at lowering blood pressure in non-pregnant, middle-aged and elderly people with a diastolic pressure of less than 110 mm Hg are well known (mild hypertension). These benefits are most pronounced after 4-6 years of treatment in men over 50 years of age and with risk factors for cardiovascular disease or stroke. However, the majority of pregnant women with mild chronic hypertension are younger than 40 years of age and have an uncomplicated course of hypertension. So treatment of mild chronic hypertension in pregnant women is not justified .

It is necessary that antihypertensive therapy in pregnant women with mild hypertension reduced the risk of preeclampsia, placental abruption, premature birth and perinatal mortality. There is currently uncertainty about the advisability of treating pregnant women with mild chronic hypertension.

Antihypertensive drugs can have harmful effects on the mother, fetus, or newborn moreover, some effects appear after the neonatal period. Antihypertensive drugs can have both an indirect effect on the fetus, reducing uteroplacental blood flow, and direct, by affecting the umbilical or cardiovascular circulation of the fetus.

Most commonly used for the treatment of chronic hypertension in pregnant women methyldopa . Short-term (average 24 days) methyldopa therapy during the third trimester does not affect uteroplacental blood flow and fetal hemodynamics. In addition, after prolonged use of methyldopa in pregnant women, there was no immediate or delayed effect on the fetus and newborn. Atenolol , against, has a pronounced effect on uteroplacental blood flow and fetal hemodynamics , as well as on the growth of the fetus. There are conflicting data on the side effects of other b-blockers when used during pregnancy. Moreover, there have been no studies on the delayed effects of these drugs in children.

A meta-analysis of 9 randomized trials comparing diuretic therapy versus no treatment in 7,000 normal blood pressure pregnant women found no difference in the prevalence of side effects between the two groups. The effect of diuretics on fetal growth has not been analyzed. Therapy diuretics of pregnant women with mild chronic hypertension leads to a decrease in plasma volume, which can be extremely unfavorable for fetal growth.

The use of angiotensin-converting enzyme inhibitors during pregnancy is contraindicated as these drugs cause fetal growth retardation, oligohydramnios, congenital malformations, neonatal renal failure, and neonatal death.

Women with chronic hypertension should be evaluated prior to conception. , so that drugs that may be harmful to the fetus (angiotensin-converting enzyme inhibitors and atenolol) are replaced by other drugs such as methyldopa and labetalol. Many women with chronic hypertension receive diuretics; Opinions differ on whether such therapy should be continued during pregnancy.

When deciding whether to initiate drug therapy in women with chronic hypertension, the severity of hypertension, the potential risk of target organ damage, and the presence or absence of preexisting pathology of the cardiovascular system must be considered. The first line is methyldopa ... If there are contraindications to its use (such as drug damage to the liver) and if it is ineffective or intolerant, it can be prescribed labetalol .

Gestational hypertension

Gestational hypertension is defined as the occurrence of high blood pressure without other symptoms of preeclampsia after the 20th week of pregnancy in women. ,who previously had normal blood pressure. In some women, gestational hypertension may be an early manifestation of preeclampsia, while in others it may be a sign of unrecognized chronic hypertension. Generally, pregnancy outcome with gestational hypertension is good without drug therapy... Preeclampsia

Traditionally under preeclampsia is understood as the appearance of hypertension, edema and proteinuria after the 20th week of pregnancy with previously normal blood pressure. The differences between preeclampsia and gestational hypertension are summarized in Table 1. In general, preeclampsia is defined as hypertension plus hyperuricemia or proteinuria ; it is classified as mild or severe depending on the degree of increase in blood pressure, the severity of proteinuria, or both. There is currently no agreement on the definition of mild hypertension, severe hypertension, or severe proteinuria. However, an emphasis on hypertension or proteinuria may minimize the clinical significance of other organ disorders. For instance, some women with hemolysis syndrome, increased liver enzyme activity and low platelet count (HELLP syndrome) have life-threatening complications (pulmonary edema, acute renal failure, or liver rupture), but there is little or no hypertension with minimal proteinuria. Moreover, among women with preeclampsia who develop seizures (eclampsia), diastolic blood pressure is below 90 mmHg in 20% of cases, and proteinuria is absent. Some women with preeclampsia have signs and symptoms that are mistaken for other disorders (Table 2).

Etiology and pathogenesis

One of the earliest abnormalities found in women who later develop preeclampsia is lack of penetration of trophoblast cilia into the spiral arteries of the uterus ... This defect in placentation leads to impaired cardiovascular adaptation (increased plasma volume and decreased systemic vascular resistance) characteristic of normal pregnancy. In preeclampsia, both cardiac output and plasma volume are reduced, while systemic vascular resistance increases. These changes lead to a decrease in perfusion of the placenta, kidneys, liver and brain. Endothelial dysfunction, manifested by vasospasm, changes in vascular permeability and activation of the coagulation system, can explain many clinical manifestations in women with preeclampsia. Indeed, many of the pathological manifestations described in these women are associated with a decrease in perfusion rather than a damaging effect of hypertension.

Complications

The main dangers to women associated with preeclampsia are - convulsions, cerebral hemorrhage, placental abruption with disseminated intravascular coagulation, pulmonary edema, renal failure. For the fetus, the greatest danger is expressed by growth retardation, hypoxemia, acidosis. The frequency of these complications depends on the timing of pregnancy at the time of onset of preeclampsia, the presence or absence of associated complications, the severity of preeclampsia, and the quality of care. In women with mild preeclampsia, under close supervision, the risk of developing seizures is 0.2%, placental abruption is 1%, fetal death or neonatal death is less than 1%. The incidence of fetal growth retardation ranges from 5 to 13%, premature births - from 13 to 54%, depending on the timing of pregnancy at the time of onset and the presence or absence of proteinuria. In contrast, maternal and child morbidity and mortality are significant among women with eclampsia and those with preeclampsia before 34 weeks of gestation.

Treatment

Early diagnosis, close medical supervision and timely delivery are cardinal requirements in the treatment of preeclampsia; To the final cure is childbirth ... When establishing a diagnosis, further tactics are determined by the results of a study of the state of the mother and fetus. Based on these results, a decision is made on the need for hospitalization, expectant tactics or delivery. In this case, factors such as the severity of the pathological process, the condition of the mother and fetus, and the duration of pregnancy are taken into account. Regardless of the chosen treatment strategy, the main goal should be, firstly, mother's safety and secondly birth of a viable child that will not need long-term intensive care.

Light degree. Women with preeclampsia need close observation , since a sudden deterioration of the condition is possible. Symptoms (such as headache, epigastric pain, and blurred vision) and proteinuria increase the risk of eclampsia and placental abruption ; for women with these symptoms, hospital observation is indicated. Outpatient observation is possible with strict adherence to recommendations, mild hypertension and normal fetal health. Observation calls for monitoring maternal blood pressure, weight, urinary protein excretion, platelet count, and fetal health. In addition, the woman should be informed about the symptoms of an increase in preeclampsia. With the progression of the disease, hospitalization is indicated.

It is generally accepted that women with mild preeclampsia who have reached the term of labor need to induce delivery to avoid complications for the mother and fetus. On the contrary, there is no consensus on the tactics for mild preeclampsia at an earlier stage of pregnancy. Most of the disagreement concerns the need for bed rest, prolonged hospitalization, antihypertensive therapy and prevention of seizures.

Women with mild preeclampsia are generally advised to adherence to bed rest at home, or in a hospital. It is believed to help reduce edema, improve fetal growth, prevent severe preeclampsia, and improve pregnancy outcomes.

Severe degree. Severe preeclampsia can progress rapidly, resulting in a sudden deterioration in both the mother and the fetus; at the same time, immediate delivery is shown, regardless of the gestational age. Urgent delivery is clearly indicated in case of threat of eclampsia, multiple organ dysfunction, abnormal fetal condition, or the development of severe preeclampsia after 34 weeks. However, early pregnancy can be continued under close supervision to improve neonatal survival and reduce neonatal morbidity. Three recent studies show that conservative treatment of women with more severe preeclampsia who have not reached the term of delivery leads to a decrease in neonatal morbidity and mortality. However, due to the fact that in these studies only 116 women received conservative therapy, and such therapy may pose a certain danger to the mother and fetus, conservative treatment should be carried out in perinatal centers and involve very careful monitoring of the mother and fetus.

The main goal of treating women with severe hypertension and preeclampsia is to prevent cerebral complications such as encephalopathy and stroke. The indication for drug treatment is the level of diastolic pressure 110 mm Hg. and higher. Some experts recommend starting treatment with a diastolic pressure of 105 mmHg. and even less, while others consider the mean arterial pressure value exceeding 125 mm Hg as an indication for starting treatment.

The goal of treatment is to keep the mean arterial pressure below 126 mm Hg. (but at the same time it should not be lower than 105 mm Hg) and diastolic pressure - not higher than 105 mm Hg. (but not lower than 90 mm Hg) . The first-line drug for women with severe perinatal hypertension is hydralazine administered intravenously at a dose of 5 mg. If necessary, the administration can be repeated every 20 minutes until a total dose of 20 mg is reached. If the indicated dose of hydralazine does not achieve the desired result, or if the mother develops adverse reactions such as tachycardia, headache, nausea, you can use labetalol (With 20 mg intravenously) if labetalol is ineffective, then administration is indicated nifedipine at a dose of 10 mg / day. Because hydralazine can worsen the fetus, some researchers recommend other drugs for the treatment of severe preeclampsia (dihydralazine, diazoxide) .

Women with preeclampsia have an increased risk of developing seizures... The degree of risk depends on the severity of preeclampsia and on the characteristics of the woman's body. For many years, experts in the United States have recommended the prophylactic use of magnesium sulfate during labor and the postpartum period for all women with preeclampsia. In contrast, experts in other countries considered lowering maternal blood pressure to be an adequate preventive measure. This controversy is not surprising because the prevalence of eclampsia in women with preeclampsia is very low and differs to a large extent in different groups of women.

Two randomized trials have investigated the effectiveness of magnesium sulfate prophylaxis in women with preeclampsia. In one of them, 112 women with severe preeclampsia received an antihypertensive drug in combination with magnesium sulfate, and an antihypertensive drug as monotherapy was used in 116 patients. There was one case of eclampsia in the group of women receiving magnesium sulfate, and no case in the other group. Another study compared magnesium sulfate and phenytoin for the prevention of eclampsia in 2,137 women with mild preeclampsia. There were 10 cases of eclampsia (1%) in the phenytoin group and no cases in the group of women receiving magnesium sulfate.

In a recent large study, magnesium sulfate was more effective than phenytoin and diazepam in treating and preventing seizures in women with eclampsia. Therefore, all women with eclampsia should receive magnesium sulfate during labor and for at least 24 hours after birth.

Prophylaxis

For many years, salt restriction and diuretic drugs have been used to prevent preeclampsia. It is currently known that dietary sodium restriction during pregnancy reduces blood volume without reducing the incidence of hypertension ... The results of epidemiological studies indicate that normal calcium intake during pregnancy effectively reduces the risk of hypertension however, the effect of this factor on preeclampsia (defined as hypertension + proteinuria) was negligible.

Conclusion

When monitoring pregnant women with hypertension, it is very important to distinguish between chronic hypertension, gestational hypertension and preeclampsia. Antihypertensive therapy allows these women to fully carry the pregnancy. Careful medical supervision and timely delivery are key to the management of hypertension in pregnant women.






Blood pressure (BP) in the body forces blood to move through the vessels and supply organs and tissues with nutrients. The force of pressure on the vessels is measured in millimeters of mercury (mm Hg). Upper, or systolic, pressure is a condition in which the heart muscle is absolutely compressed for further pumping of blood through the vessels. The lower pressure, diastolic, is an indicator when the heart muscle is completely relaxed. Indicators of upper pressure from 90 to 120 mm Hg are recognized as normal. Art. AD is allowed up to 130 / 80-60. But during pregnancy, these norms sometimes deviate. Arterial hypertension in pregnant women, as well as diagnosed hypertension in pregnant women, occurs for several reasons at once.

During pregnancy, hormonal changes occur, with the growth of the fetus, one or more additional circles of blood circulation in the placenta are formed with multiple pregnancies. This is necessary to provide food for the unborn child. The load on the heart muscle increases sharply, as the heart works hard. During this period, the likelihood of arterial hypertension is high. If the difference between the normal working blood pressure does not exceed 10%, the health of the woman and the unborn child is not in danger. But indicators exceeding the norm above 15-20% indicate the occurrence of gestational hypertension, and in the case of persistent excess pressure, hypertension in a pregnant woman is suspected.

Hypertension during pregnancy occurs for the same reasons as everyone else, although there are specific factors that can attract the attention of the attending physician, namely:

  1. Heredity. The doctor finds out if any of the relatives suffer from hypertension, the level of pressure before pregnancy.
  2. The age of the woman. After 30-35 years, there is a greater chance that hypertension may develop during pregnancy.
  3. The sequence of pregnancy. The doctor analyzes the features of the course of previous pregnancies in order to form an overall picture.
  4. The interval between births. The optimal interval is considered to be from two years. If the body did not have time to rest from a previous pregnancy, the likelihood that a woman will develop gestational hypertension or hypertension increases many times over.
  5. Multiple pregnancies. Hypertension in pregnant women with multiple pregnancy occurs almost always, but usually disappears immediately after childbirth. Exception: if a woman previously suffered from hypertension.

  1. The presence of mental, neurogenic disorders, depression.
  2. Physical activity, lifestyle, bad habits.
  3. Toxicosis.

Hypertension in pregnant women is often provoked by concomitant diseases:

  • diabetes mellitus;
  • anemia;
  • hypothyroidism;
  • obesity;
  • cardiovascular disease;
  • renal failure.

Classifications of hypertension in pregnancy

Arterial hypertension during pregnancy is classified into the following types:


  • Light: BP up to 150/90 mm Hg. Art. Swelling of the legs is observed, protein appears in the urine (up to 1 g).
  • Average: BP up to 170/110 mm Hg. Art.
  • Severe: BP is above 180/120 mm Hg. Art.

In moderate-severe forms of a pregnant patient, hospitalization or bed rest, drug treatment in order to preserve the fetus is indicated.

This form is also called late toxicosis. The most dangerous is the combination of preeclampsia with chronic hypertension. The exact cause of preeclampsia has not been identified. It is believed that this is a genetically determined pathology.

If the diagnosis is diagnosed before 34 weeks, the patient is prescribed corticosteroids to accelerate the laying of the lungs in the fetus, followed by premature delivery.

  1. Gestosis is an excess of blood pressure in the second or third trimesters of pregnancy. It is a complication as a result of the persistence of high blood pressure during pregnancy, characterized by the appearance of edema, protein in the urine. In the future, renal failure, brain damage, seizures like epilepsy appear. Doctors call the main cause of preeclampsia a large weight gain in pregnant women. This is why doctors regularly weigh expectant mothers during appointments. The danger is that the vessels of the placenta during gestosis are damaged due to the accumulation of excess fluid and edema, and the fetus does not receive oxygen and nutrition, the condition develops into the following form.
  2. Eclampsia. This form is extremely dangerous and is the leading cause of death among pregnant women. A woman "in position" has convulsions as in epilepsy, she loses consciousness.

Symptoms of hypertension in pregnant women

The symptoms of high blood pressure in pregnant women are in many ways similar to the general manifestations of arterial hypertension, these are:

  • severe pain in the head, upper peritoneum, dizziness;
  • visual impairment, fear of light, tinnitus;
  • sudden nausea that turns into vomiting;
  • increased heart rate - tachycardia;
  • weight gain due to fluid retention;
  • shortness of breath, weakness;
  • nosebleeds;
  • liver dysfunction, resulting in dark feces, yellowness of the skin;
  • redness of the face due to flushing;
  • a decrease in the level of platelets in the blood due to its poor coagulability. Seen from a blood test;
  • mental disorders: the appearance of fear of death, anxiety.

Impaired vision or hearing with simultaneous headaches indicate the onset of cerebral edema and a preconvulsive state. Shortness of breath sometimes occurs not only due to increased pressure, but also due to the growth of the abdomen.

With a deep breath, the chest rises slightly, and with a strong exhalation, it narrows. In a pregnant woman, a growing belly does not allow the chest to contract normally, this causes an increase in blood pressure. The heart muscle has to work harder to deliver oxygen to all organs, including the placenta.

If at least one of the listed signs appears, you should immediately consult a doctor, such late complications in pregnant women as preeclampsia and eclampsia are difficult to correct. The risk of developing complications due to an increase in blood pressure is that the fetus, due to a violation of the blood supply in the placenta, experiences oxygen starvation, or hypoxia. As a result, intrauterine development is delayed or premature exfoliation of the placenta occurs, leading to the death of the fetus.

Diagnosis of pregnant women with high blood pressure

For a complete examination, pregnant women with arterial hypertension are prescribed:

  • general examination with measurement of pulse, heart rate;
  • Ultrasound of the heart, or echocardioscopy;
  • identification of concomitant diseases;

  • examination by an ophthalmologist of the fundus;
  • examination by an endocrinologist;
  • biochemical and general blood test;
  • examination of urine for protein, the presence of blood in it, the level of glomerular filtration.

Treatment and contraindications

Drug treatment in pregnant women is reduced to the correction of antihypertensive therapy. Pregnant women should not take the usual drugs that lower blood pressure, so they are not prescribed ATP inhibitors: "Captopril", "Enalapril".

Also, during pregnancy, one should not take blockers of receptors for angiotensin II: "Valsartan", "Losartan", since their teratogenic property causes pathology, fetal deformities. For the same reason, due to the teratogenic effect, the drug "Diltiazem" is contraindicated.

"Reserpine" inhibits the nervous system, circulates in the blood for a long time and is also not used in treatment during pregnancy.

"Spironolactone" due to its antiandrogenic effect - a decrease in the level of male hormones - and the associated risk of developing anomalies of the genitourinary system in the fetus, is also not used in the treatment of pregnant and lactating patients.

Medical treatment of pregnant women in the event of an ambulance with blood pressure values ​​of 140/90 mm Hg. Art .:

  1. "Nifedipine" (10 mg): under the tongue, one tablet at a time. It is recommended to take up to three pieces during the day. During the intake, it is required to be in a supine position due to possible dizziness after taking the medication.
  2. "Magnesia", or magnesium sulfate, - intravenously, sometimes after a rapid infusion, a drip is placed in a vein. Anticonvulsant with hypotensive action. The dosage is prescribed only by the doctor.
  3. "Nitroglycerin" - intravenously, with a dropper, slow infusion. It is rarely used if other medicines do not help. Strong vasodilator with antihypertensive effect.

Non-drug treatment of pregnant women is reduced to early registration: up to 12 weeks. By this time, the issue of maintaining or terminating pregnancy is usually resolved. With late calls, the interruption issue becomes problematic. Subsequently, the patient is measured the pressure on both hands at each visit to the antenatal clinic. With arterial hypertension of a pregnant woman, it is recommended to keep a daily diary, where you need to record blood pressure, pulse in the morning and in the evening. When taking the medicine, it is necessary to count the number of daily urinations.

If there is a need for planned hospitalization of the patient, it is carried out in three stages.

Stage I hospitalization: for up to 12 weeks. The patient is placed in the cardiology department and it is decided whether the pregnancy can be left without a threat to the mother. In the presence of grade I hypertension (blood pressure up to 140/90 mm Hg), there are no contraindications to pregnancy.

With hypertension II degree (up to 160/95 mm Hg. Art.), Pregnancy is left under the close supervision of a specialist. But this is possible if there are no concomitant diseases: diabetes, heart rhythm disturbances, kidney diseases.

If II degree of hypertension cannot be corrected or III degree develops, this is the reason for termination of pregnancy.

The second stage of hospitalization is carried out for a period of 28-32 weeks. The pregnant woman is admitted to the cardiology department to assess compensatory cardiac activity. At this time, the vascular bed is maximally loaded with fluid, with an unstable state of the cardiovascular system, the issue of premature birth is resolved.

The third stage of hospitalization takes place approximately two weeks before delivery. At this time, the question of the method of obstetrics is being decided, the risks for the mother and the baby are assessed.

Unscheduled hospitalizations are carried out at any time according to indications.

Preventive actions

Pregnancy and concomitant hypertension is a serious test for a woman's body. It is irresponsible to ignore the symptoms and hope that "everything will go away".

As with any disease, with arterial hypertension or hypertension, preventive measures must be followed:

  1. Eat right, excluding fatty, salty, canned foods. Keep track of your own weight: the increase is no more than 15 kg for the entire pregnancy. It is useful to take at least one glass of cranberry juice, birch juice, ¼ glass of beet juice before meals to lower blood pressure every day.
  2. Give up smoking and alcohol.
  3. Anti-infective and anti-inflammatory therapies are especially important before pregnancy.
  4. Moderate physical activity, walking outside.
  5. Avoid stressful situations, overload, observe the regime of work and rest, get enough sleep. Psychological support from loved ones helps the pregnant woman.
  6. Measure blood pressure regularly.

It is important to remember that self-medication of pregnant women with arterial hypertension, hypertension is categorically contraindicated. Improper use of drugs leads to the development of complications: eclampsia, preeclampsia, which is the leading cause of death in pregnant women.

When carrying a fetus, hypertension is one of the most common complications that can significantly aggravate the condition of the expectant mother and cause the death of the embryo. To exclude a dangerous relapse, it is necessary to take timely care of preventive measures, consult with an obstetrician-gynecologist, and start conservative therapy on time. Pregnancy and hypertension is a dangerous combination that can result in a hypertensive crisis, urgent hospitalization of a woman.

What is hypertension in pregnant women

This is one of the diseases of the cardiovascular system, in which the indicator of systolic blood pressure exceeds 140 mm. rt. Art., and diastolic - 90 mm. rt. Art. If the patient does not take hypertensive drugs, the symptoms become more complicated and may negatively affect the intrauterine development of the fetus. Arterial hypertension is a chronic ailment, and recurs during pregnancy against the background of an increase in systemic blood flow, under the influence of stagnant blood. The reasons may be different, but there is still a real threat to the fetus.

Classification of arterial hypertension in pregnant women

The disease progresses unexpectedly during gestation or is diagnosed in a woman's body even before successful conception. In both clinical cases, sharp jumps in blood pressure negatively affect the general condition and vital activity of the fetus. To understand the danger of relapse and not to hesitate with the diagnosis, it is recommended to study the following classification:

  1. Gestational hypertension in pregnant women progresses at the beginning of the second trimester, while blood pressure normalizes only after childbirth (after 7 to 8 weeks).
  2. Preeclampsia. A dangerous attack reminds of itself after 20 obstetric weeks with manifestation and proteinuria (protein content in urine from 300 mg).
  3. Eclampsia. The attack is accompanied by visible edema with a pronounced convulsive state, proteinuria and abnormalities in laboratory parameters of biological fluids.
  4. HELLP syndrome. Hemolytic anemia progresses, associated with increased activity of liver enzymes with a low platelet count.

Having determined which arterial hypertension during pregnancy prevails in a specific clinical picture, the attending physician individually selects the optimal set of therapeutic measures, which, in addition to taking oral pills, includes nutritional correction, rejection of bad habits and walking in the fresh air. It is important to restore the general well-being of the expectant mother, to exclude intrauterine fetal death.

The causes of hypertension in pregnant women

When carrying a fetus, the patient may face manifestations of gestational hypertension, which often progresses in the second trimester. The first attack is associated with double blood flow against the background of the birth and development of a new person. As a result of increased blood circulation, the internal organs cannot cope with the increased load, and the vascular walls lose their previous permeability, vascular permeability is impaired, and the blood pressure index rises. To exclude a hypertensive crisis in pregnant women, it is important to know the causes of the disease:

  • compression against the background of increased pressure of the growing uterus on the diaphragm;
  • limited vascular volumes, not suitable for double blood flow;
  • changes in the position of the heart in the chest;
  • hormonal imbalance in the female body;
  • signs of late gestosis.

Risk factors for the development of hypertension

Since hypertension is a chronic cardiovascular disease, acute attacks are followed by long periods of remission. To increase the duration of the latter, it is important to know about the so-called "risk factors" for pregnant women. This:

  • emotional, mental exhaustion;
  • physical overload;
  • impaired patency of the placenta vessels;
  • increased blood cholesterol levels;
  • first pregnancy;
  • chronic kidney disease;
  • diabetes;
  • excessive weight gain;
  • intrauterine growth retardation;
  • multiple pregnancy;
  • bad habits (alcohol, smoking);
  • genetic factor.

Pregnant women in the presence of symptoms of arterial hypertension should monitor their condition and avoid an increase in relapse, otherwise premature birth in the 2nd and early 3rd trimester, miscarriage in early pregnancy are possible. To eliminate the high risk of developing arterial hypertension, women should take care of preventive measures even when planning an "interesting position".

Symptoms of hypertension during pregnancy

The first symptoms of hypertension are more frequent migraine attacks. At first, a pregnant woman does not understand the origin of the pain syndrome, but when measuring blood pressure, she finds pathologically high values ​​on the tonometer screen. To prevent the development of a neglected degree of hypertension and exclude dangerous consequences for the health of the mother and child, it is important to know the main symptoms of the disease:

  • flies before the eyes with loss of clarity of vision;
  • tinnitus, dizziness;
  • excessive sweating;
  • recurrent convulsions;
  • increased frequency of nosebleeds;
  • recurrent chest pain;
  • tachycardia (heart palpitations), other symptoms of cardiovascular disease;
  • increased nausea with periodic bouts of vomiting;
  • hyperemia of the skin on the face;
  • nervous tension, increased excitability;
  • constant feeling of thirst, dryness of the mucous membranes;
  • panic attacks (inner fear, unexplained anxiety).

Risk to mother and fetus

If hypertension develops in pregnant women, the patient urgently needs to consult a gynecologist and cardiologist. Otherwise, a real threat to the health of not only the mother, but also the unborn child prevails. The main task of specialists is to regularly monitor the well-being of a pregnant woman, to extend the remission interval using a medication or an alternative method. During an attack, complications can be as follows:

  • premature birth (early miscarriage);
  • congenital diseases of newborns;
  • progressive fetal hypoxia;
  • intrauterine growth retardation of 2-3 degrees;
  • sudden infant death syndrome (first days - weeks of life).

Arterial hypertension harms the expectant mother, and here are some potential pathologies we are talking about:

  • the risk of placental abruption;
  • hypertensive crisis;
  • bleeding due to disseminated intravascular coagulation;
  • stroke, myocardial infarction;
  • preeclampsia, eclampsia;
  • heart failure;
  • detachment of the retina.

Treatment of hypertension in pregnant women

The first step is to undergo a full diagnosis and clinically determine reliably what could provoke a relapse and eliminate the main provoking factor. Next, the patient needs to change her habitual lifestyle, determine a balanced diet, realize all the harmfulness of bad habits, undergo a full course of medication on the recommendation of the attending physician. General instructions of the specialist:

  1. It is necessary to reduce the consumption of table salt and use natural, herbal diuretics to quickly remove excess fluid from the body of a pregnant woman, stabilize blood pressure.
  2. Medication intake is strictly limited, since synthetic components in the chemical composition can cause fetal mutations, extensive intrauterine pathologies.
  3. In the family, the expectant mother needs to ensure complete comfort and peace of mind, eliminate stress, prolonged emotional stress, dangerous shock conditions.
  4. It is recommended to do breathing exercises, be outdoors more often and walk more. This is a good way to combat toxicosis and the ability to prevent the development of late gestosis.
  5. Control weight gain during pregnancy, avoid overeating and obesity. If the weight gain is noticeable, the doctor suggests that the pregnant woman arrange a fasting day once a week.
  6. It is important to ensure the prevention of vitamin deficiency, regularly monitor the concentration of iron in the blood. If laboratory tests show low hemoglobin, it can be replenished with a therapeutic diet and conservative methods, taking vitamins.

Diet

Food for hypertension should be fortified and balanced, it is important to completely abandon spicy, salty, fatty, fried and smoked foods. Such food ingredients only delay the passage of fluid and maintain the blood pressure above normal for a long time. It will be useful to reduce the consumption of vegetable and animal fats. Restrictions apply to strong coffee and carbonated drinks, alcohol, energy drinks. The daily diet of a pregnant woman needs to be enriched with such food ingredients as:

  • fresh fruits and vegetables;
  • seafood, fish products;
  • low-fat dairy products;
  • lean meats, chicken, rabbit;
  • chicken and vegetable soups;
  • natural juices, fruit drinks;
  • herbal teas.

Drug therapy

AH in pregnant women (arterial hypertension) occurs and progresses even at a young age of 20 - 27 years. In the relapse stage, headache can be eliminated and pressure reduced by conservative methods with the participation of such pharmacological groups:

  • beta-blockers: Atenolol, Nebivolol, Labetalol, Urapidil;
  • calcium channel blockers (slow): Nifedipine, Pindolol, Oxprenolol;
  • direct vasodilators: Hydralazine;
  • diuretics for excretion of fluid and salt ions: Furosemide, Lasix;
  • antispasmodics for relieving an attack of pain: Dibazol, Magnesium sulfate, Euphyllin;
  • Clonidine preparations for lowering blood pressure: Clonidine, Katapresan, Gemiton;
  • saluretics to stabilize blood pressure: Brinaldix, Hypothiazide, Hygroton;
  • drugs based on methyldopa to increase vascular tone: Dopegit, Aldomed.

As a resuscitation measure in the acute stage of arterial hypertension, it is required to put a Nifedipine tablet (10 mg) under the tongue of a pregnant woman and dissolve it until it is completely dissolved. In case of insufficient effect, it is allowed to use 3 tablets in three approaches with an interval of several hours. Side effects include dizziness.

Prevention of arterial hypertension in pregnant women

A woman of childbearing age should approach future motherhood with special responsibility and prepare her own body in a timely manner for a successful conception. To do this, it does not hurt to consult with a local gynecologist, undergo a comprehensive examination. Well-chosen prophylaxis helps to successfully conceive, bear and give birth to a healthy child without complications for the mother and the newborn.

The prescribed preventive measures exclude oral medication (this rule can only be violated in the relapse stage), but they force the expectant mother to look a little differently at her daily lifestyle and taste preferences. Here are some preventive measures for every day we are talking about:

  1. Create a balanced menu, remove food ingredients that are harmful to pregnant women.
  2. Reduce daily portions of table salt and regularly monitor the body's water balance.
  3. More often to be in the fresh air, to arrange slow walks on foot in ecologically clean areas.
  4. Give up coffee, nicotine and alcoholic beverages, since such bad habits only increase the frequency of high blood pressure attacks.
  5. Treat all chronic diseases of the cardiovascular system even during pregnancy planning, thereby reducing the frequency of attacks.
  6. It is imperative, on the recommendation of the attending physician, to take multivitamin complexes for pregnant women with a full course, to use natural vitamins.
  7. With obvious symptoms of hypertension, it is required to lie down in order to exclude complications for the health of the mother and child.

Video

Pregnancy is a huge burden on the female body. Nowadays, bearing a child is rarely not accompanied by any disruptions in the body. Among all diseases during pregnancy, a pathological increase in blood pressure is one fourth. Hypertensive conditions can be of three types, subdivided according to the reasons and timing of development in pregnant women:

  • Primary arterial hypertension - 7%.
  • Hypertensive states with gestosis - 70%.
  • Secondary hypertension - 23%.

Arterial hypertension is a disease that is based on a persistent increase in blood pressure. An increase in pressure in the vessels occurs due to their spasm under the influence of signals from the autonomic nervous system and hormones. In the early stages, the increased pressure is not felt by the woman and she continues to carry out her usual load. At this time, all organ systems suffer due to insufficient supply of blood with oxygen. Lack of oxygen provokes the growth of connective tissue where it should not be. It has been proven that highly specialized cells of the body (for example, nerve, endocrine) stop working under conditions of hypoxia.

Hypertensive crises are a serious complication of chronic arterial hypertension during pregnancy. The course of crises can be divided into several types:

  • Neurovegetative. Abrupt onset, causeless fear, profuse sweating, pale skin.
  • Hydropic. The gradual onset of a crisis, weakness, drowsiness, deterioration in orientation in space, apathy. Swelling of the legs and face appears.
  • Convulsive. Fainting, convulsive contractions of the body. Dangerous by the rapid development of cerebral edema with a fatal outcome.

The optimal blood pressure for pregnant women is 110/70 mm Hg. Art.

During pregnancy, an abnormal increase in blood pressure occurs for the following reasons:

  • The presence of chronic hypertension and before conception.
  • The presence of diseases accompanied by concomitant hypertension (kidney disease, endocrine diseases).
  • Mental or neurological failures that provoke a rise in pressure.

The course of hypertension in pregnant women

In order to see the dangerous symptom of increased blood pressure in time for pregnant women, blood pressure is regularly measured in the antenatal clinic. Hypertension in the initial stages of development can proceed without any symptoms. However, more often women complain:

  • headache;
  • interruptions in the heart, palpitations;
  • insomnia or drowsiness;
  • swelling of the face, legs;
  • weight gain of about 2 kg per week;
  • flickering sparks before the eyes;
  • deterioration of vision;
  • weakness;
  • frequent nosebleeds.

One of the features of the course of hypertension during pregnancy is that blood pressure decreases during the initial gestational period. Gestosis (pregnancy complication) can mask hypertension.

If hypertension proceeds unnoticed by a woman and a doctor, then its neglected form develops, in which the kidneys, heart, and brain suffer. Hypertensive crises, constant headaches, shortness of breath develop regularly. When examining the retina, an ophthalmologist may notice changes in its vessels. Against the background of high pressure, these altered vessels can burst and blood is poured into the eye cavity. Hypertrophic changes in the left half of the heart develop.

In addition to the negative effect on the woman's body, hypertension adversely affects the development of the fetus. Against the background of high pressure, the placental circulation and the placenta itself suffer, this leads to a lack of oxygen and nutritional components in the child.

With chronic arterial hypertension, the process of delivery is disrupted. Labor activity either slows down or develops rapidly. Both situations are dangerous for the child: you can injure the newborn or develop hypoxia.

Complications in pregnant women, possible with chronic arterial hypertension:

  • placental insufficiency;
  • placental abruption;
  • bleeding;
  • premature delivery;
  • fetal growth retardation or death.

Therapy for hypertension in pregnant women

As soon as a pregnant woman is diagnosed with hypertension, treatment should be started immediately. This is necessary to maintain a favorable environment for the development of the fetus. Pregnancy management:

  • Maintaining the conditions for a calm existence of a woman, avoiding stress and anxiety. A pregnant woman needs good sleep, daytime rest. Physical activity should be avoided.
  • Compliance with a diet. Exclusion of salty, smoked, spicy and fried foods. An increase in the diet of a pregnant woman, vegetables, fruits. Weight gain should be avoided. You can take a multivitamin.
  • Daily outdoor walks are essential.
  • Recommendations for sudden mood swings, increased excitability: attending auto-training sessions, at home you can use relaxation techniques. Good reviews about acupuncture. You can attend yoga classes.
  • If a woman used antihypertensive drugs before pregnancy, then it must be remembered that not all pills can be taken while carrying a child. Treatment is prescribed by a doctor, taking into account the pregnancy.
  • During pregnancy with chronic arterial hypertension, a woman is usually hospitalized three times: up to 12 weeks, at 30 weeks and two weeks before delivery. The tactics of delivery and the need for taking painkillers are determined individually. Often, childbirth takes place on its own, operational management of childbirth is carried out according to the usual indications.

The possibility of carrying a child is determined by a direct dependence on the severity of hypertension. The first stage (BP up to 159/99 mm Hg) is favorable, provided that all clinical guidelines are followed and adequately managed by a doctor. It is possible to preserve pregnancy in the second stage (blood pressure up to 179/109 mm Hg) with mild lesions of internal organs. In the third stage, pregnancy is contraindicated (BP is more than 179/110 mm Hg).

  • Drugs based on angiotensin receptor antagonists are contraindicated due to teratogenic effects.
  • For gestational periods up to three months, angiotensin-converting enzyme inhibitor tablets should not be taken due to teratogenic effects.
  • At a gestational age of more than two months, it is contraindicated to take drugs that have a toxic effect on the embryo (some insulin-substituting tablets, antibacterial agents, anti-inflammatory, anticoagulants).

During pregnancy, it is important to find a safe drug for the treatment of hypertension:

  • One of the first doctors to prescribe tablets based on the alpha-adrenergic agonist methyldopa. These pills are completely safe for the mother as well as the baby. Often, methyldopa must be taken in conjunction with a diuretic.
  • Preparations of selective beta-blockers (tablets Atenolol, Metoprolol).
  • Calcium channel blockers. The dosage of the pill is determined by the doctor.

Chronic arterial hypertension is not a sentence for a pregnant woman. Timely treatment and proper management of pregnancy, in accordance with all recommendations, will help women to transfer it well and give birth to a healthy baby.