Arterial hypertension and pregnancy. The pathogenesis of complications of gestation. Methods of laboratory diagnostics

Hypertonic disease

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

Recently, hypertension has become a frequent occurrence in young people. However, an increase in the incidence of hypertension is observed in parallel with the increase in age. Thus, in women over 30 years of age, the incidence of hypertension is 3-4%, over 35 years - 5-8%, and over 40 years - 13.5%.

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

About availability arterial hypertension indicates an increase in blood pressure above 140/90 mm Hg. Art.

With 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 intermittent hypertension, that is, an increase in blood pressure is replaced by periods of normal pressure. For the stages of PA and IV, a persistent increase in blood pressure is observed, and stage III of hypertension is already characterized by damage to organs and tissues (brain, heart, kidneys, blood vessels).

Only with a mild degree (I degree) 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 hypertension, the ability to conceive is sharply reduced, and if pregnancy does occur, it usually ends in miscarriage or intrauterine fetal death.

Other severe complications may occur during pregnancy.

The most severe 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.

The course of hypertension during pregnancy has its own characteristics.

In many patients in the initial stages of the disease at the 15-16th week of pregnancy, blood pressure decreases (often to normal levels), 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 II-III stages no such decrease has been observed. After 24 weeks, blood pressure rises in all patients, regardless of the stage of the disease. Against this background, such a complication of pregnancy as gestosis (32-55%), which has an unfavorable course, often joins.

Due to 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 abortion.

In 20-25% of cases, a child is born with reduced body weight (hypotrophy). Occur often premature birth, in 4% intrauterine fetal death may occur.

When planning pregnancy and conducting preventive treatment, as well as timely registering with a antenatal clinic and monitoring the course of pregnancy by a therapist, constant monitoring of blood pressure and timely prevention and treatment of pregnancy complications, a significant reduction in the adverse outcome of pregnancy and childbirth can be achieved.

All medicines should only be taken with a doctor's prescription, as many of the blood pressure-lowering drugs are contraindicated during pregnancy and can adversely affect the baby's body.

From non-drugs with increased pressure, beet juice with honey helps, a mixture of vegetable juices, which have a beneficial effect on blood pressure, and also replenish the body during pregnancy essential vitamins and minerals. In addition, beetroot and other vegetable juices help with constipation, which is so common during pregnancy.

As with heart defects, with hypertension, fluid intake should be limited to 1 liter, and salt to 1-3 g per day.

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Pregnancy and hypertension, high blood pressure during pregnancy, hypertension in pregnant women

Currently the most common and fairly common disease of cardio-vascular system at a young age is hypertension.

In the structure of diseases of pregnant women, arterial hypertension is 15-20%. Among these 20%, primary hypertension makes up a third, hypertension with preeclampsia - about 70% and secondary hypertension due to other diseases - 25%. Arterial hypertension - serious illness, which imperceptibly undermines the strength of the body from the inside. The essence of the disease: vasoconstriction occurs under the influence of nerve impulses and certain hormones. At first, arterial hypertension does not manifest itself. The woman does not feel the increase in pressure and performs the same load. However internal organs suffer because little blood flows through the narrowed vessels, there is not enough oxygen (hypoxia), connective tissue begins to grow in the organs (its cells can grow with a lack of oxygen). Specialized cells of organs do not live without oxygen, and the organ loses its function. That's when women complain. They can be different: dizziness, headaches, flies before the eyes.

In severe forms of hypertension, there may be a sharp rise in blood pressure - a hypertensive crisis (a complication of hypertension). There is the following classification of hypertensive crises: neurovegetative form, edematous form, convulsive form. During a crisis, the woman's health deteriorates sharply: a sudden onset, arousal, fear, sweating, pallor of the skin appear (neurovegetative form). Another form of crisis is edematous: the development is gradual, the woman has drowsiness, lethargy, there is a decrease in activity and poor orientation in space, swelling and puffiness of the face and whole body increase. With a sudden loss of consciousness, the appearance of convulsions, a convulsive form develops, threatening sudden death as a result of cerebral edema. First aid for hypertensive crisis in pregnant women should be carried out only by doctors of the "Ambulance". When a pregnant woman complains of feeling unwell, an ambulance is immediately called. Arterial hypertension has its own classification, which is based on the levels of pressure increase: the optimal pressure is 120 to 80 mm Hg. Art. in pregnant women, it is desirable 100-110 and 60-70 mm Hg. Art.

I degree - 140-159 and 90-99 mm Hg. Art.

II degree - 160-179 and 100-109 mm Hg. Art.

III degree - 160-179 and more 110 mm Hg. Art.

Causes of hypertension during pregnancy

Arterial hypertension during pregnancy often occurs if:

the woman had hypertension before pregnancy;
a woman suffers from kidney diseases (pyelonephritis, glomerulonephritis, kidney infarction, diabetic nephropathy, etc.) and (or) diseases of the endocrine system (hypothyroidism, hypercortisolism, etc.), which can contribute to the development of hypertension during pregnancy;
there are mental and (or) neurogenic disorders, which can also serve as triggers for increasing blood pressure.

Symptoms and signs of hypertension during pregnancy

The main symptom of hypertension is an increase in blood pressure. An increase in blood pressure may be asymptomatic, but often a woman may experience the following unpleasant symptoms.

headache;
heartbeat;
sleep disorders;
fatigue;
visual impairment;
noise in ears;
nosebleeds, etc.

The main difficulty in diagnosing arterial hypertension in pregnant women is as follows: young women do not measure their pressure, and if there is hypertension, they do not feel it. Due to the peculiarities of pregnancy at its beginning, blood pressure decreases in all expectant mothers. In addition, the presence of preeclampsia, which is also manifested by an increase in pressure, masks hypertension. It is possible to make a diagnosis of "arterial hypertension" only under certain criteria: the presence of a disease in the next of kin and an increase in pressure in a woman at least once in her life, in comparison with blood pressure levels during previous pregnancies, if any, complaints of a pregnant woman about frequent headaches, nasal bleeding or pain in the heart, etc. Naturally, the main criterion for hypertension is the fact of increased blood pressure. At the first stage of hypertension, a pregnant woman does not experience any inconvenience. May complain of recurrent headaches (often after a stressful situation), tinnitus, or nosebleeds. At the same time, there are no changes in other organs; the kidneys, the brain and the fundus of the eye are the first to suffer in hypertension. In the second stage of arterial hypertension, there are constant headaches, limitation of physical activity and stress due to shortness of breath. Here hypertensive crises can appear. There are changes in the fundus when examined by an ophthalmologist, the wall of the left ventricle of the heart thickens (hypertrophy). With hypertension of the third degree, pregnancy and the ability to conceive a child are unlikely due to adverse conditions. When diagnosing hypertension in a pregnant woman, it is necessary to begin immediate treatment to create conditions for normal growth and maturation of the fetus. First you need to create a calm environment for a pregnant woman, protect her from stress and worries, provide her with sufficient good sleep and rest, and a balanced diet. With excessive excitability, sessions of auto-training and hypnosis, acupuncture can help well. The expectant mother should be under the constant supervision of a general practitioner, who must prescribe certain drugs to reduce pressure. Women should remember: many drugs that they took before pregnancy to reduce pressure are not suitable during pregnancy, as they negatively affect the child. Arterial hypertension has an adverse effect on the course of pregnancy, woman and child. The child suffers the most. Against the background of hypertension, preeclampsia develops, accompanied by insufficiency of all organs. The placenta, which nourishes and protects the fetus, uteroplacental blood flow suffers. These manifestations lead to a lack of oxygen, nutrients, and the fetus dies. generic activity with arterial hypertension is also perverted: childbirth either lasts slowly or very quickly, which threatens the child with injury or hypoxia. It is important for pregnant women with hypertension to be hospitalized for less than 12 weeks. The clinic specifies the severity of the disease, its complications, the possibility of bearing a child. At the first stage of hypertension, the prognosis for expectant mothers is favorable: with all the recommendations and supervision of a doctor, pregnancy is possible and the child will be born healthy. In the second stage, the possibility of maintaining pregnancy is decided on an individual basis and depends on the severity of complications from other organs. The third stage is a contraindication for pregnancy. The second time, the expectant mother is hospitalized at 28-32 weeks to prevent excessive stress on the heart and blood vessels. The third hospitalization - two to three weeks before childbirth to prepare for childbirth, determine the tactics of childbirth and the necessary methods of anesthesia. Often women give birth to a child themselves, a caesarean section is needed only for certain indications. The basis for the course of pregnancy in a woman with arterial hypertension is the correct daily routine, lack of stress, proper nutrition, regular medication and observation by specialists.

Arterial hypertension is dangerous for its complications during pregnancy, as it can cause:

placental insufficiency;
massive bleeding;
premature birth,
intrauterine fetal death;
premature detachment of the placenta, etc.

During pregnancy, the internal organs and vital systems of the child are laid. A lot depends on the woman's health. What if the expectant mother has hypertension?

Of course, the situation should not be dramatized, although it would be unwise to completely ignore the risk.

Arterial hypertension in our time is very common in people of the most different ages. Therefore, it is difficult to surprise anyone with increased pressure. Most people know from their own experience what it is, so they do not believe that a pregnant woman with hypertension needs special care. This is an erroneous opinion. After all, it is relatives and friends who, first of all, should be interested in her well-being and the successful course of pregnancy.

The vast majority of women with hypertension tolerate pregnancy well and give birth healthy babies. But problems, of course, can arise and often do. The modern level of development of medicine allows us to cope with them. However, there is severe stage III hypertension. At this stage of the disease, pregnancy is deadly to a woman's life. Fortunately, stage III is extremely rare, and stages I and II of arterial hypertension are not a contraindication to pregnancy.

Usually a woman suffering from hypertension knows about it before pregnancy. Most likely, she already has a certain understanding of the disease, regularly or periodically takes some medications and is observed by a cardiologist.

At the very beginning of pregnancy, a woman who has been diagnosed with hypertension should definitely consult a cardiologist, and later, throughout the entire pregnancy, regularly undergo examinations, including blood pressure measurement, urine tests (to determine protein), and an electrocardiogram (ECG). It is very important that the specialist regularly monitors the development of the fetus. Not all medicines can be taken during pregnancy. That is why the independent choice of medications is unacceptable. Only a doctor prescribes drugs that do not have a teratogenic effect, that is, they will not harm the unborn child. When choosing drugs, it is very important individual characteristics body of a woman, as well as the presence of concomitant diseases.

In addition to the appointment of drug treatment, the doctor must give the necessary recommendations that relate to the lifestyle of a woman suffering from hypertension. During pregnancy, such patients will have to reconsider their lifestyle, pay special attention to their diet, and refuse some foods. Moderate physical activity is very important.

It often happens that in the early stages of pregnancy, the pressure decreases even in those women who had high blood pressure before pregnancy. In some cases, on the contrary, there is a sharp increase in blood pressure. Sometimes it is during pregnancy that a woman learns about a new diagnosis for herself - arterial hypertension.

The consequence of hypertension in pregnant women can be late toxicosis, which occurs in severe form.

At the same time, a woman has severe headaches, sometimes even vision is impaired.

Very dangerous complications of hypertension during pregnancy can be cerebral hemorrhage and retinal detachment. That is why, throughout the entire period of pregnancy, a woman should regularly undergo medical examinations, follow all the doctor's instructions, be sure to measure blood pressure, do an ECG, and take a urine test to determine the protein content. Consultations of the oculist are not less necessary.

During pregnancy, patients with arterial hypertension should visit the antenatal clinic once every 14 days and do a urinalysis. After 30 weeks of pregnancy, a urine test should be taken every week.

If the level of diastolic pressure rises above 90 mm Hg. Art. in a sitting position, a pregnant woman needs antihypertensive therapy.

If, despite following all the recommendations, a hypertensive crisis occurs during pregnancy, signs of late toxicosis appear, or a woman feels a noticeable deterioration in her condition, it is better for her not to refuse hospitalization.

At least 2 weeks before the expected birth, even with a favorable course of pregnancy, experts still recommend that the woman go to the hospital. This is associated with the risk of unexpected complications in the expectant mother or child. When complications occur, a woman is prescribed a special therapy aimed at lowering blood pressure. At the same time, doctors carefully monitor the condition of the fetus. Sometimes a woman is given a caesarean section. In some cases, they cause premature birth.

High blood pressure during pregnancy can cause fetal death and prematurity, placental abruption, and several other problems. Therefore, timely assistance of a specialist is necessary.

Diagnostics and treatment of arterial hypertension in pregnant women

During each examination, the doctor necessarily measures the blood pressure of a pregnant woman and writes down its indicators in the card. This is necessary to monitor the dynamics of blood pressure on different terms pregnancy.

Often you can meet with a situation where blood pressure rises as a reaction to the "white coat".

For example, in a healthy woman, during an appointment with a doctor, pressure can noticeably “jump”, while this does not happen at home and the expectant mother feels good. If you know this feature behind you, if you are afraid of doctors and react to them in this way, warn your doctor in advance about the possibility of receiving incorrect blood pressure numbers at the appointment.

Most often, in this case, the doctor prescribes home monitoring of blood pressure. It is good if you begin to measure and record blood pressure data three times a day for a long time, so that the doctor is convinced of your "sensitivity to the medical staff." In this case, you will have to independently control blood pressure at home throughout the pregnancy.

Treatment of the expectant mother is aimed at stabilizing pressure and eliminating complications for the baby (if any have begun). Quite often, a pregnant woman is required to be hospitalized for examination and normalization of her condition.

With hypertension expectant mother shown:

consultation with a psychologist in order to eliminate psycho-emotional negative manifestations (stress, fears, anxiety, etc.);
dieting;
daily leisurely walks fresh air, preferably in nature (park or forest area);
day rest;
limiting weight gain (avoid being overweight);
daily measurement of blood pressure at home;
physiotherapy.

Antihypertensive drugs prescribed and controlled by a doctor should be taken constantly, since missed medications can cause sudden pressure surges, which is dangerous for blood vessels.

In the second semester of pregnancy, but sometimes even in the first, blood pressure often decreases. In the third semester, blood pressure becomes the same as usual. In some cases, it exceeds the normal rate. If, when examining a pregnant woman, the doctor notes high blood pressure, he will definitely recommend a thorough examination in order to clarify the nature of hypertension, find out the presence of concomitant diseases, and also determine the need for antihypertensive treatment.

Treatment is carried out depending on the degree of risk. If the patient has normal ECG and echocardiography, no protein in the urine, and blood pressure levels are 140-149/90-199 mmHg. Art. she is in the low risk group. If the patient has severe arterial hypertension, poor obstetric history, concomitant diseases are present (collagenoses are especially dangerous, diabetes, kidney disease) and changes in internal organs, then it is at high risk.

Regardless of the degree of risk for each individual patient, there are general recommendations. They relate to the correct mode, the absence of overload, the obligatory 8-9-hour sleep. During pregnancy, a woman in the diet should limit the amount of fats and carbohydrates. The diet should contain as little salt as possible, no more than 5 g. This rule is common for people suffering from arterial hypertension, but during pregnancy it is especially important.

If the patient is in a low-risk group, she is often not prescribed special drugs. It is enough to use non-drug therapy, which consists in eliminating excessive stress, dieting, exercise, taking care of your emotional state. Every day she must necessarily walk as long as possible. It is advisable to take walks not along gassed city streets, but in a forest or park. Good results are given by autogenic training, relaxation. In this difficult, but very important for the health of the baby, period, the expectant mother must learn not to take all anxieties and troubles to heart. It is very important that relatives provide a woman with psychological support and do not cause trouble.

However, despite the various non-pharmacological means, blood pressure may rise. If blood pressure rises to 160/100 mm Hg. Art. and above, the patient must be prescribed antihypertensive drugs. Medicines make it possible to control the level of blood pressure. But, I must say, even taking medications is not always reliable protection from the onset of preeclampsia. That is why, even if a pregnant woman belongs to a low-risk group, she should undergo an examination in a timely manner.

In some cases, in patients with I degree of arterial hypertension, the pressure decreases to a normal level. Then there is no need to take medication. But you still need to control your blood pressure. If a pregnant woman is at high risk, she is usually advised to start antihypertensive therapy immediately. Timely treatment will make it possible to avoid a number of complications. If the blood pressure level is 140/90 mm Hg. Art. then the uteroplacental circulation is disturbed, which entails various pathologies of fetal development. The child does not have enough oxygen, since it is the blood that carries it. Due to high pressure, premature detachment of the placenta can begin. There is also a risk of slowing down the development of the fetus.

Treatment of arterial hypertension in pregnant women is complicated by the fact that not all drugs are harmless to the child. But modern medicine is at a very high level.

Despite the clear need for treatment, some pregnant women themselves try not to take medication, as they are worried about the harmful effects on the fetus. With severe arterial hypertension, this is unacceptable. Lack of treatment will do much more harm.

There are some general rules for pregnant women regarding taking medications.

Most experts believe that angiotensin receptor antagonists (for example, valsartan, ibesartan, etc.) should not be used during pregnancy, because they have a teratogenic effect.
In the first trimester of pregnancy, it is better not to take angiotensin-converting enzyme inhibitors that have a teratogenic effect (for example, quinapril, enalopril).
After the eighth week of pregnancy, some drugs can have an embryotoxic effect (in particular, a number of antibiotics, antidiabetic, anti-inflammatory drugs). Therefore, it is undesirable to use a drug that worsens the hemodynamics of the mother, because it also worsens the blood supply to the fetus. A drug that reduces blood clotting in the mother, therefore, reduces blood clotting in the fetus.

A number of drugs do not have a harmful effect on either the expectant mother or the unborn child. The first-line drug for the treatment of arterial hypertension during pregnancy is methyldopa (dopegyt, aldomet). Many years of research and observation of children born have allowed scientists to assert that methyldopa is absolutely safe. Usually it is prescribed in 3-4 doses of 0.75-4 g per day. Taking the drug can lead to the fact that some people experience fluid retention in the body. Therefore, if long-term use of the drug is required, it is combined in small doses with diuretics. If the patient has impaired renal or hepatic function, the drug should be taken with caution, the patient should be constantly under the supervision of the attending physician.

Calcium channel blockers are also used to treat hypertension during pregnancy. Nifedipine, a dihydropyridine group drug, is often used. Doses are set by the doctor. The drug is able to quickly stop the impending hypertensive crisis.

The undoubted advantages of beta-blockers include a gradual effect on blood pressure. Also, drugs stabilize the function of platelets. It is very important that beta-blockers do not adversely affect plasma volume. Examples of beta-blockers include pindolol, atenolol, metoprolol, oxprenolol, and some others.

It is important to remember that the choice of the necessary medicines remains with the doctor, because it is the specialist who must take into account the individual health status of the patient and other factors that affect the course of pregnancy.

The most severe complications of pregnancy with arterial hypertension are preeclampsia and eclampsia. Such complications are very dangerous for the life of a woman and a child.

Preeclampsia during pregnancy

Preeclampsia is a condition that occurs late in pregnancy. In this condition, a woman has high blood pressure. Protein is found in the urine. The woman's legs and arms are swollen. The woman feels a headache, vomiting, visual disturbances are observed. There are also signs of nephropathy.

There is a risk of preeclampsia progressing to the last and most severe phase. In this case, there is a threat of coma or death of both the mother and the child during or after childbirth, if the necessary treatment is not carried out. Severe forms of preeclampsia and eclampsia lead to dysfunction of vital organs, that is, the brain, lungs, kidneys, liver, and heart. The consequences of preeclampsia and eclampsia can affect the rest of your life if you do not carry out appropriate treatment in time. This applies to both mother and child. According to the World Health Organization, preeclampsia is responsible for 15-40% of maternal and 38% of perinatal deaths worldwide.

Preeclampsia is most common during the first pregnancy. At risk are the youngest girls and women who are over 35 years old.

Risk factors are:

arterial hypertension, which was diagnosed before pregnancy;
obesity;
multiple pregnancy;
diabetes;
rheumatoid arthritis;
systemic lupus erythematosus;
cases of preeclampsia that have already been observed in the past in the patient herself;
cases of preeclampsia in the sister or mother of the patient.

Preeclampsia leads to the fact that the blood flow through the placenta is disturbed, that is, the child may be born underdeveloped. In some cases, preeclampsia also causes preterm labor. A newborn may have pathologies such as impaired vision and hearing, cerebral palsy, epilepsy.

Some doctors tend to underestimate the dangers of preeclampsia. A simplified view of it is based on the fact that the main problem is high blood pressure, edema and proteinuria (protein excretion in the urine). But such symptoms are only superficial manifestations of the syndrome of multiple organ and polysystemic failure. These signs make it possible to make the diagnosis of preeclampsia itself, but are not the cause of the disease.

If we talk about swelling of the hands, feet and face, then such symptoms often accompany normal pregnancy. Also, a clear correlation has not been established between the fact that one or another degree of arterial hypertension is observed and edema is present at the same time.

Often, edema can occur in those women whose blood pressure is normal. The presence of protein in the urine is a later sign of preeclampsia. Approximately 5-10% of pregnant women with preeclampsia first have seizures, and then proteinuria, that is, protein in the urine, appears. Based on this, it was concluded that if the patient developed preeclampsia, then there are morphological damage to the kidneys, such as pyelonephritis, glumerulonephritis, nephrosclerosis. Before protein appears in the urine, other symptoms occur: the concentration of urea and creatinine in the blood plasma increases.

Preeclampsia also manifests itself in early term pregnancy, up to 20 weeks. In this case, the cause may be a disease of the fetal egg in a pregnant woman, which is characterized by the growth of the surface layer of the villous membrane (chorion) and swelling of the substance of the villi (vesical skid).

There are several types of preeclampsia.

Type I - there is low pressure in the pulmonary artery system, low cardiac output. The total peripheral vascular resistance is high.
Type II - there is high pressure in the pulmonary artery system, high cardiac output. The overall vascular resistance is high.
Type III - there is normal pressure in the pulmonary artery system, high cardiac output. The total peripheral resistance is low.
Type IV - high pressure appears in the pulmonary artery system, a high cardiac output occurs. Plasma volume is normal or increased.

Specialists often use the term "mild preeclampsia". In this case, the outcome is favorable, because the pregnant woman has only a single increase in blood pressure. There are no other symptoms associated with preeclampsia. With a mild degree of preeclampsia, special measures are usually not taken. A woman should only limit activity, take care of her health.

If there is a risk of preterm birth, then with preeclampsia, special treatment is carried out, which must be prescribed by the attending physician. Sometimes it is better for a woman to be in a hospital in order to be constantly monitored. At a long gestational age, childbirth can be forced.

If a pregnant woman manifests gestosis (late toxicosis of pregnant women, nephropathy is a complication accompanied by impaired function of the placenta and the condition of the fetus), this means that there are signs of a critical condition, expressed to varying degrees.

These signs include:

hypovolemia - a decrease in the volume of blood circulating in the body (it may be associated with restriction of fluid intake or its loss);
hypoxemia - reduction of gas exchange in goblin, hemoglobin content in the blood;
circulatory disorders in the kidneys, brain, liver.

Similar signs are associated with the fact that the properties of the blood are deteriorating, microthrombosis is present. Probable insufficiency of the function of the kidneys, lungs, myocardium. The severity of the patient's condition exacerbates vascular spasm, violation of all types of metabolism, and especially water-salt.

Severe forms of preeclampsia are very dangerous for a woman during pregnancy. Lack of special treatment can lead to her death. In some cases, other methods of treatment are prescribed, for example, magnesium sulfate (magnesia) is used. It helps prevent seizures and lower blood pressure. It is also possible to use various drugs that lower blood pressure. Fluid control is important. An extreme measure is the immediate induction of childbirth, regardless of the gestational age.

If a pregnant woman with manifestations of preeclampsia is observed in a hospital, eclampsia develops very rarely in her. This is due to the fact that the patient is under the constant supervision of specialists; a variety of intensive therapy methods are used to improve her condition. Due to this, the development of the convulsive stage is prevented.

Eclampsia in pregnancy

The term "eclampsia" comes from the Greek. the words "eklampsis", which means "flash". The main symptom of eclampsia is muscle spasms of the whole body and loss of consciousness.

For specialists, a very important, but at the same time complex problem is the ability to predict eclampsia, despite the suddenness of its onset. There are certain criteria that allow one or another patient to be considered at risk.

In eclampsia, great importance is given to the study of hereditary factors. This is very important because eclampsia most often develops during the first pregnancy. If the patient's mother had eclampsia, her daughter has a 49% chance of developing it. If the patient's sister had eclampsia, then the patient's risk of developing eclampsia increases to 58%. At multiple pregnancy the likelihood of developing eclampsia increases. The risk of this condition is also high in pregnant women under the age of 25 and in women after 35 years.

Eclampsia leads to a spasm of the respiratory muscles, while breathing is disturbed, the tongue sinks, hypoxia (oxygen starvation) and hypercapnia occur.

As a result of hypercapnia, the secretion of the glands increases, an increased separation of saliva, bronchial secretions, gastric and intestinal juice begins. There is no cough reflex during loss of consciousness. There is an accumulation of bronchial secretions and saliva, the airways narrow. Their lumen can completely close, which leads to disruption of gas exchange.

With hypercapnia, the excitability of the respiratory center decreases, and the violation of gas exchange is aggravated. The vasomotor center and sinoaortic receptors are irritated, as a result of which blood pressure rises.

Vasospasm progresses, excess blood enters the circulatory bed from spasmodic muscles. As a result, the load on the heart increases significantly. This load is exacerbated by hypoxia and hypercapnia. Therefore, with eclampsia, there is a violation of the heart rhythm. (These changes are clearly diagnosed on the ECG.)

The increased load on the heart leads to tachycardia and expansion of the cardiac cavity. Circulatory insufficiency occurs, it only exacerbates hypoxia and hypercapnia.

Violation of cardiac function in eclampsia is often accompanied by pulmonary edema. As a result, hypoxia and hypercapnia are aggravated.

There are severe bouts of eclampsia. With them, a very strong hypercapnia develops, which affects the peripheral vessels and the vasomotor center. In this case, in addition to the central circulatory insufficiency, there is also a peripheral one.

More than 70% of patients with eclampsia have liver failure, and impaired renal function is also manifested. Various changes in kidney function lead to the fact that the filtration of the body is disturbed. Due to impaired renal function, compensation occurs only as a result of increased ventilation if there is free patency of the respiratory center and there is no brain damage. Otherwise, a mixed form of acidosis may develop and hypoxia and hypercapnia may worsen. At the same time, intracranial pressure increases and seizures become more frequent.

It happens that it is not possible to stop what is happening. Then there is a risk of cerebral hemorrhage, paralysis of the respiratory center, cardiac arrest. The lungs swell, or respiratory and metabolic acidosis occurs. Death may not occur immediately, but after a few days. In this way, main reason death in eclampsia is (in 70%) cerebral hemorrhage, followed by respiratory failure with pulmonary edema, acute renal failure, postpartum hemorrhage, placental abruption, liver rupture, septic shock. If the patient has had eclampsia and survived, in the future she may experience a number of complications. In particular, disorders of the central nervous system, such as paralysis, autonomic disorders, headache, memory disorders, psychosis. Pathologies of other vital organs and systems of the body may also appear.

The development of eclampsia is considered a syndrome of multiple organ failure, because in this condition there is a failure of a number of systems and organs: respiratory, cardiac, renal, hepatic. There are also pronounced disorders in the distribution of blood flow, rheological properties of blood, various kinds metabolism.

Complications of severe eclampsia may include:

disseminated intravascular coagulation with uncontrolled bleeding;
capillary leak syndrome;
intrahepatic bleeding;
heart attacks;
acute renal failure.

Arterial hypertension associated with the presence of late taxicosis can cause premature placental abruption, miscarriage, hypoxia, developmental delays and even death.

Against the background of multiple organ failure, convulsive seizures develop. These seizures are not associated with a violation cerebral circulation. Convulsive seizures are rare. But a whole series of seizures can occur, which follow one after another. This phenomenon is called "eclamptic status". After a seizure, a woman sometimes loses consciousness, that is, an eclamptic coma develops. (Sudden loss of consciousness may occur without an attack of convulsions.)

Before convulsions appear, the head begins to hurt sharply, insomnia occurs, and pressure rises. The woman feels intense anxiety. The seizure lasts 1 to 2 minutes.

A convulsive seizure consists of several stages.

Preconvulsive period. It lasts approximately 30 s. The muscles of the face twitch, the corners of the mouth drop, the eyelids close.
Period of tonic convulsions. It also lasts about 30 seconds. The muscles of the whole body are reduced, the torso is tensed. The face turns blue, breathing stops.
period of clonic convulsions. Continues 30 s. There is twitching of the facial muscles, muscles of the whole body and limbs. Convulsions become weaker. Breathing becomes hoarse, there is foam from the mouth with blood.
Consciousness gradually returns. The woman does not remember anything that happened to her just a few minutes ago.

The excitability of the central nervous system during eclampsia increases markedly. A new attack can occur from a variety of stimuli, such as light and noise.

Magnesium sulfate is often used in the treatment of eclampsia. This drug is also used for preeclampsia. Magnesium sulfate is administered slowly intravenously or intramuscularly. At the same time, tendon reflexes and respiratory rate are necessarily controlled. But if the patient is taking calcium channel blockers, magnesium sulfate is not prescribed, because there is a danger of a sharp drop in blood pressure.

With eclampsia, chlorpromazine or diazoxide is sometimes administered intravenously. It is also possible intravenous, then drip administration of diazepam (seduxen).

Long-term rehabilitation therapy is of great importance. It is necessary for women who have suffered preeclampsia and eclampsia. Rehabilitation therapy can lower blood pressure, improve microcirculation and hemodynamics of the brain.

During the period of rehabilitation therapy, patients are advised to take mildronate 1 tablet (125 mg) three times a day in the period after childbirth. Mildronate affects the redistribution of blood flow in the brain, helps to eliminate functional disorders of the nervous system, improves blood supply to the brain.

If the patient has had eclampsia or preeclampsia, then even after discharge she should be under the supervision of a cardiologist, urologist, internist and neuropathologist. Timely treatment and further monitoring can avoid serious consequences that can lead to disability.

Arterial hypertension in pregnant women

The concept of "arterial hypertension in pregnancy" is used to refer to various painful conditions.

First of all, we mean the following diseases:

Hypertension in pregnancy. Pregnant hypertension is said to be when a pregnant woman's blood pressure is greater than 140/90 mm PC and rises for the first time after the 20th week.
Severe hypertension in pregnancy. If blood pressure readings exceed 160/110 mm PC.
Preeclampsia. The diagnosis is made when, along with high blood pressure, protein in the urine is observed in an amount of more than 300 mg per day. Clinical manifestations such as headaches, double vision and ripples in the eyes, pain in the upper part of the eye can also indicate preeclampsia.
Eclampsia. The most severe form of preeclampsia, accompanied by convulsive seizures.

Measurement of blood pressure. Important conditions are a wide cuff and rest, otherwise the indicators may be unreliable.

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Symptoms of the disease and measurement of pressure

Quite often, the symptoms of arterial hypertension do not manifest themselves in any way, but it also happens that it can manifest itself in full. The main signs of the presence of the disease are:

Headache (occipital region), more pronounced after sleep.
Dizziness.
Nausea.
Violation of vision.
Heartache.
Cardiopalmus.
Dyspnea.
Intermittent lameness.
Rigor of limbs.

In order to fully control your condition, it is recommended to regularly measure blood pressure using a special device. It is very important to measure correctly. So, half an hour before the measurement, you should stop all physical activities, you should also not eat, drink coffee or alcohol and, of course, smoke. The pressure is measured within 5 minutes after a short rest. It is very important to choose the right pose, the main points of which are:

The straight back is leaning against the back of the chair.
Legs in normal position (not crossed).
Feet lie completely on the floor.
Hands need emphasis.
The bladder must be emptied.
Clothing should not tighten the shoulder.
The measurement is carried out only on the bare hand.

When measuring pressure, it should be remembered that it should be measured twice on one arm, and the record should be kept on average. At the same time, pressure should be measured initially on both hands, not forgetting a 5-minute break. The secondary measurement should be taken on the arm with the higher results. You should know that the excess of the difference in pressure between one and the other hand in 5 mm Hg. Art. symbolizes vascular diseases.

Arterial hypertension of the 1st degree

It is clear that the 1st degree of arterial hypertension is a mild form of the disease, which is characterized by arbitrary rises in pressure and its return to normal levels. However, the mild stage is accompanied by not the most pleasant symptoms. So, during a pressure surge, a person begins to suffer from a headache in the back of the head, and often this pain is supplemented by tinnitus and darkening of the eyes. The heart of a person begins to beat loudly and rapidly, a feeling of nausea appears. All of the above reasons can lead to the development of 1 degree of arterial hypertension. Of course, it is much easier to cure a mild form of hypertension than an already running one. Stage 1 is characterized by non-drug treatment. The main emphasis is on normalizing a person's lifestyle, changing nutrition and giving up bad habits. First of all, a person is advised to reset excess weight, if any. After that, you should abandon harmful, fried and fatty foods, reduce the level of salt intake to 5 grams per day. It is very important for a person to stop smoking and reduce alcohol consumption to a minimum. Patients with arterial hypertension are advised to increase the intake of dairy products, fruits, dried fruits and grains. In addition, a person may be prescribed non-traditional therapy, for example, a visit to a psychologist or reflexology. Highly nice results brings physiotherapy and herbal medicine. Only in the absence of positive results of such treatment, patients are prescribed medication. Speaking about predictions, you should know that 1 degree of arterial hypertension of 1 risk indicates a 15% chance of getting complications over the next 10 years. The most dangerous is risk 4, which increases the percentage to 30.

Arterial hypertension of the 3rd degree

Most often, the development of the 3rd degree of the disease occurs under the watchful eye of a doctor who tirelessly monitors the dynamics of the disease. To talk about the 3rd degree of arterial hypertension can be the detection of damage to organs (targets) and the occurrence of associated conditions. If the patient can control the level of pressure with the help of drugs, then the developing complications require professional intervention. You should know that at such a severe stage, the patient's physical condition can be considered satisfactory, but his physical performance is rapidly declining, the body is depleted. Among the reasons for the development of grade 3, the main ones should be distinguished - untimely treatment of hypertension, as well as the lack of treatment of concomitant and existing diseases of the internal organs. In addition to the standard symptoms of hypertension, patients with grade 3 experience other, more severe symptoms, such as:

Damage to the central nervous system;
Kidney damage, development of pathologies;
The likelihood of myocardial infarction;
Damage to the retina, decreased vision.

Like other degrees, degree 3 has its own risk levels, among which 4 is considered the most terrible. Quite often there are patients with 3 degrees of arterial hypertension of 3 risk, which indicates an extremely serious condition of the patient. You should not reach this state, treatment should be started in the initial stages of hypertension in order to avoid serious complications. In the case of arterial hypertension of the 3rd degree of risk, treatment can be carried out by several methods, in most cases, combined with each other, making up a complex treatment. Of course, the basis is the normalization of the lifestyle, where the patient needs to lead healthy lifestyle life. However, it is important to strike a balance between stress and rest. Also, the patient is prescribed a diet that is designed to normalize nutrition. And, of course, medication is prescribed, carried out exclusively under the supervision of the attending physician. In the most difficult cases, surgery may be prescribed.

hypertension stage 2 stage 2

Hypertension of the 2nd degree is characterized by high sustained hypertension of the 2nd degree of the 2nd stage. Hypertension stage 2. would allow postvit diagnosis of the degree of hypertension?.

Hypertension 2 degrees: Clinicians say that stage two A is unstable, stage two B. With hypertension, degrees 2 or 3 are affected: Already in the early stages of hypertension, my husband’s blood supply is stage 4 bowel cancer, stage 2 hypertension is the same as with stage I hypertension.

Hypertension and pregnancy

In the life of every person there are moments for which you can prepare and which you can remember all your life. These are milestones dividing our life path into “time before” and “time after”. There is no doubt that for almost every woman such a milestone is the birth of a desired child. I want him to be born healthy and strong, to grow up happy, to live a long, long time. If a woman is healthy, then nothing prevents her from realizing beautiful dreams. But what if a woman dreaming of a child is sick hypertension. Undoubtedly hypertension and pregnancy is not the best combination. But still, let's try to figure it out, because forewarned means forearmed.

Of course, any stage of hypertension may affect the course of pregnancy. Therefore, a pregnant woman should immediately contact not only a gynecologist, but also a cardiologist and visit him regularly. Cardiac examination pregnant woman with hypertension includes regular measurement of blood pressure, conducting an ECG study. done every two weeks urine tests with the definition of protein.

In addition to the examination of the expectant mother, of course, a regular examination of the fetus is carried out, which includes serial Ultrasound examinations fetal growth and prenatal assessment of its condition. The cardiologist will discuss with the pregnant woman suffering from hypertension the main points related to changing her lifestyle, diet, physical activity, etc. In addition, the doctor will be able to determine which medications from those that the patient with hypertension took before pregnancy are necessary for her at a new stage in her life, and which ones need to be replaced in order to avoid a harmful effect on the fetus. It should also be taken into account here that in the early stages of pregnancy in patients hypertension blood pressure decreases on its own. Although it happens the other way around: pregnancy, which is a stressful situation for a woman, especially who has not given birth before, can provoke an increase in pressure. Sometimes even the diagnosis of hypertension is first made to a woman during pregnancy.

With hypertension in 60% of cases, pregnancy is complicated late toxicosis with severe leakage. pregnant woman suffering from headache. she may have visual impairment. The most formidable complications arterial hypertension during pregnancy are cerebral hemorrhage and retinal detachment. However, it is possible to prevent the development of complications of hypertension during pregnancy with constant and careful monitoring. cardiologist and obstetrician-gynecologist. leading pregnancy. With an increase in blood pressure, the occurrence of hypertensive crises, signs of late toxicosis, a persistent deterioration in well-being, a pregnant woman with hypertension should be immediately referred for treatment.

Even with a favorable course of pregnancy, a patient with hypertension must be taken to the maternity ward 2-3 weeks before the expected date of delivery. Childbirth with hypertension is often complicated by both the mother and the child. In the first case, antihypertensive therapy for a woman is carried out during childbirth, and in the second, constant monitoring of the fetus. In some cases it is shown C-section. sometimes childbirth has to be induced prematurely.

However, as already mentioned, a mild form of hypertension is not an obstacle to pregnancy, and it is in the power of the woman herself to do a lot for her health and the health of the unborn baby. The general recommendations are the same: complete or almost complete exclusion of table salt from the diet, full and light nutrition with natural products, regular walks, moderate physical activity, good rest and sleep, a favorable environment at home. I must say that among the above there is not a single item that would not be included in the list of tips for perfectly healthy expectant mothers. And one more thing, no less important for everyone. A pregnant woman should always remember that she can give birth to a healthy child. And be sure that she will do it, no matter what. There were times when it was the confidence of the mother that kept the baby both life and health.

However, we should not forget that after childbirth, the life of the baby is just beginning. A mother suffering from hypertension passes hereditary predisposition to it to her child. Therefore, from an early age, it is necessary to take preventive measures to prevent future development of hypertension.

Pregnancy is an important and exciting event in the life of every woman. Throughout pregnancy, various changes occur, to which the body of each woman reacts individually. However, in all cases, during pregnancy, a strong load is placed on the woman's body.

Arterial hypertension is a fairly common disease. AT Soviet times during pregnancy, they did not even think about such a disease, since, according to statistics, it appeared in people over 45 years old. Now the disease is getting younger and can appear even at the age of 20.

Hypertension of pregnant women does not bypass. Hypertension and pregnancy are quite dangerous things. You need to know how to act when arterial hypertension appears during pregnancy, so as not to harm the pregnant woman and the child. Classify arterial hypertension in pregnant women as well as in ordinary people.

Contributing factors

During pregnancy, any woman's blood pressure rises. However, a normal increase is considered if the pressure increases by no more than 20 mm Hg. Art. compared to pre-pregnancy levels. If the indicators are increased by 20 mm Hg. Art. and more, then this is gestational hypertension during pregnancy.

All diseases appear for some reason. Sometimes it is easier to prevent the effects of the causes than to treat the disease. According to doctors, hypertension during pregnancy appears when exposed to the following factors:

arterial hypertension diagnosed before pregnancy;
small volume of vessels;
multiple pregnancy;
first pregnancy;
pregnancy in women over 30;
insufficient physical activity during pregnancy and before it;
chronic stress, depression, depressed mood;
mental disorders;
late toxicosis.

One factor is enough for the disease to begin to develop. In some women, the disease is detected after the conception of a child. This is due to the fact that at the beginning of pregnancy and before it, with slight rises, blood pressure does not bring discomfort and discomfort to a woman. With the progression of the disease, this complicates its treatment.

Important! For a pregnant woman, increased blood pressure is considered to be 140/90. With severe hypertension.

Clinical picture

Hypertension in pregnant women often occurs without manifestations, which makes it difficult to diagnose the disease. Also, the clinical picture is sometimes blurred. The main symptom is an increase in blood pressure when it is measured. There are other manifestations of the disease:

dizziness;
back pain;
pain in the region of the heart, increased heart rate;
weakness, severe fatigue dyspnea;
coldness in limbs;
increased sweating and feeling hot;
strong thirst;
nausea, vomiting;
loss of visual fields, flickering of "flies";
red spots on the face and chest;
fear, anxiety.

Important! visual impairment symptoms are very dangerous. They are a signal of brain damage.

Effect of hypertension on pregnancy

Hypertension creates an increased load on the blood vessels, and when carrying a child, the load in pregnant women increases even more.

During pregnancy, BCC becomes much larger. If the fetus is one, then it increases to 50%, and with multiple pregnancy - up to 70%. The blood is more fluid in consistency, which ensures a normal blood supply to the fetus. Therefore, the load on the vessels of the expectant mother increases. The flow of blood to the lungs also increases. With concomitant pathologies, shortness of breath may occur.
The development and growth of the fetus contribute to excessive stress.
When the uterus enlarges and the fetus grows, the excursion of the lungs decreases. In the average person, the chest cavity grows and shrinks. In pregnant women, there is practically no room for this, which also becomes a provocateur of shortness of breath.

Such features contribute to an increase in blood pressure, which aggravates the situation of a pregnant woman.

Preparing for pregnancy

For women with chronic diseases, pregnancy should be considered before it occurs, as sometimes there are irreversible consequences. Hypertension and pregnancy is no exception. If the pregnancy was not planned, then this does not exclude the woman's chances of giving birth to a healthy child. Important as possible before a woman register with a gynecologist for examination and possible treatment.

In preparation, the woman should do the following:

Get checked out by a doctor and cardiologist. The therapist listens to heart sounds and determines. Blood pressure is also measured. An ECG is also performed with the appointment of a doctor ultrasound of the heart. This allows you to identify defects and other pathologies in a pregnant woman.
Treat comorbidities. Before giving birth to a child, a woman needs to be examined for the presence of diseases. Even at a young age, women are overweight, have diabetes or hypothyroidism. This complicates the course of pregnancy, and also increases the risk of complications.
Consult an optometrist. He will examine the woman's fundus to rule out complications during pregnancy. If there are violations, then therapeutic measures should be carried out before the conception of the child. At the time of childbirth, there is a strong load on the eyes, which sometimes provokes loss of vision.
Correction of antihypertensive therapy. During pregnancy, a woman is prohibited from using many drugs. Therefore, the doctor must adjust the therapy and prescribe drugs that will not harm the child.

These activities should be carried out so that during pregnancy you do not run into trouble.

Management of pregnancy

With arterial hypertension during pregnancy, a woman should carefully monitor her health.

Observation at the gynecologist

Any pregnant woman is observed and examined by a gynecologist. Pregnant women will have to undergo a number of additional studies. When pregnancy occurs, do the following:

Register with a gynecologist up to 12 weeks. A woman should consult a specialist as early as possible, since abortion is possible only up to 12 weeks. This is necessary to identify violations and a threat to the fetus from the mother's condition.
At the appointment, the gynecologist should measure the woman's blood pressure.
If desired, a woman should also conduct a pulse. At each measurement, indicators should be recorded there, and deterioration in well-being should also be noted in it.
It is necessary to study the woman and the fetus. A pregnant woman is examined according to the standard scheme and, in addition, Echo-KS and pulse are prescribed. For the fetus, 3 ultrasound screenings are performed and other studies in the form of ultrasound may be prescribed.

During pregnancy, 3 planned hospitalizations are carried out.

First: carried out until the 12th week of pregnancy in the cardiology department. A decision is made whether the woman can continue bearing the fetus. Pregnancy with hypertension is not always contraindicated. With, as well as with correction of treatment - bearing a fetus is not prohibited. If there is arterial hypertension in pregnant women of the second degree without adjusting treatment or, then the woman is recommended to terminate the pregnancy.

Consideration of the situation and the decision on the birth of a child is made by a council of doctors. In case of danger, explain to the patient possible dangers threatening her and the baby. Doctors will advise optimal choice, but still the final decision is made by the pregnant woman.

Second: at 28-32 weeks to the cardiology department. It was then that the strongest load on all the vessels and organs of a woman occurs. During hospitalization, the work of the cardiovascular system is evaluated. Therapy is adjusted if necessary. In this period of time, the option of inducing childbirth can be considered if the vessels are in poor condition and there are factors that threaten the life of the woman and the child.

Third: held 2 weeks before the due date of delivery. Doctors monitor the condition of the woman and choose the best method of childbirth.

Hospitalization not according to the plan is carried out at any time according to the indications of the doctor.

Diagnostic methods

The diagnosis is complicated by the fact that during pregnancy, women do not monitor blood pressure. Hypertension during pregnancy often does not worsen well-being. Even if some signs appear, women often attribute this to toxicosis.

If a woman's blood pressure rises for the first time, then there is a need to conduct a complete study. This will exclude the presence of other diseases that appear as an increase in blood pressure. Some of them are dangerous, as they can disrupt the normal development of the fetus.

A single increase in blood pressure is diagnosed in 50% of pregnant women. Here one measurement will not be enough. In addition, there is such a phenomenon as "". In a normal setting, a woman's blood pressure may be normal, but surrounded by doctors, it increases significantly. If there is a suspicion of such a phenomenon, then daily monitoring of blood pressure should be carried out.

Instrumental Research

The most common method is to measure blood pressure with a tonometer. Pregnant women should be measured after 10 minutes of rest in a sitting position. So there will be no impact on the inferior vena cava, which will help to obtain reliable indicators. According to the rules, if the tonometer does not show the same indicators, then the largest is considered to be reliable. The measurement should be taken at least 2 hours after eating. Before the procedure, a woman should refrain from taking coffee, tea and adrenomimetics.

Basic Research

The necessary studies to detect hypertension during pregnancy are:

General and biochemical analysis of blood.
Urinalysis according to Nechiporenko.
, ECHO-KG, ultrasound of the kidneys.

On the advice of a doctor, a pregnant woman may need to consult narrow specialists.

Accompanying illnesses

Hypertension can be caused by other diseases and provoking factors. The examination should take into account the presence of other pathologies. Factors that provoke hypertension include:

smoking, drinking alcohol;
high consumption of spicy, salty and smoked foods;
diabetes;
high cholesterol;
increased blood pressure in other pregnancies;
excess weight;
pathology of the urinary system (with impaired urination);
kidney disease;
taking some medicines;
endocrine diseases;
head and abdomen injuries;
burdened heredity, predisposition to the disease.

These factors and diseases should be taken into account at the time of diagnosis, as they play an important role.

Treatment Methods

Hypertension during pregnancy can pass without complications if you follow the doctor's prescription and do not ignore the treatment. Treatment of hypertension in pregnant women is prescribed individually, but in all cases the same goals:

Minimize the risk of complications.
Ensure the normal course of pregnancy.
Optimize delivery.

Treatment can be at home or in a hospital. With an increase in blood pressure to mm Hg. Art. manage without medication. In such a situation, a pregnant woman needs:

follow a diet;
regular walks;
good sleep and rest;
small physical activity;
daily monitoring of blood pressure;
avoiding stressful situations;
rejection of bad habits.

It is necessary that a pregnant woman learn to be distracted from the daily hustle and bustle. You should learn not to pay attention to trifles. If possible, you need to take a break from work, especially if it brings a lot of stress.

Diet

Diet plays an important role, as it is sometimes possible to avoid medication by adjusting the diet.

It is allowed to use low-fat dairy products and cheese, fresh fruits, vegetables, herbs from the garden, legumes, seeds, dried fruits. Such products will help saturate the body with calcium, potassium and magnesium.

You should refrain from products such as rich bakery products, fatty meats and fish. It is also worth excluding spicy, smoked, fried foods, spices and marinades from the diet. Salt intake is recommended to be limited to 5 g per day, and the amount of fluid consumed, if necessary, should be no more than 1.5 liters.

Conservative treatment

If blood pressure continues to increase and has reached 160/100 mm Hg. Art., then the doctor prescribes medication. Most pregnant women believe that taking any medication can harm the unborn baby. However, this opinion is incorrect.

Usually, pregnant women are prescribed Nifedipine, Pindolol, Oxprenolol and others. Medicines must be prescribed by a doctor. Do not self-medicate or use drugs on the advice of friends. This can cause serious harm to the fetus.

Important! The doctor selects drugs that do not harm the fetus and the woman throughout the course of therapy.

Urgent care

If blood pressure rises to high levels, then emergency intervention is required. When rendering emergency care pregnant woman, the following drugs are used:

Nifedipine. 1 tablet under the tongue. You can take no more than three tablets per day. It is better to take the medicine lying down, as there is a risk of dizziness;
Magnesium sulfate. Sometimes it starts with a jet intravenous injection, and then continues with a drip;
Nitrates (nitroglycerin and others). They are prescribed in situations where other drugs do not help. They greatly dilate the blood vessels, so blood pressure drops sharply. Introduced by drip and very slowly. With rapid introduction there is a risk of collapse.

Possible complications for the mother

If you refuse treatment, there is a risk of complications:

hypertensive crisis;
heart failure;
violation of the heart rhythm;
detachment of the placenta or retina.

These complications are quite serious and can cause irreversible consequences.

Possible complications in the fetus

Many are interested in the question: is hypertension during pregnancy dangerous for a child? The risk of complications is not only for the mother, but also for the fetus itself. Chronic hypoxia often occurs, leading to serious impairment. This may be a miscarriage, premature birth, fetal developmental disorders, or even its death.

childbirth process

Hypertension during pregnancy suggests that childbirth can be either spontaneous or operative. If during the observation there are no deviations and there is no risk of complications, then independent childbirth is allowed.

At independent childbirth the woman's condition is carefully monitored. To prevent complications at the time of contractions, a woman is injected with an anesthetic to relieve pain. If necessary, it can be re-introduced through the catheter after 2-3 hours. Before the introduction, the pulse and blood pressure are monitored, as well as a study by an obstetrician. If the uterus is fully open and the woman is ready for attempts, then the anesthetic is stopped. With the introduction of anesthesia with full disclosure of the uterus, there is a risk that the woman will stop following the process and disrupt the normal expulsion of the fetus.

Indications for caesarean section in emergency situations:

hypertensive crisis in pregnant women;
placental abruption;
development of preeclampsia and eclampsia;
anomalies of labor activity;
violation of intrauterine development of the fetus.

Indications for a planned operation:

changes in the fundus of a woman;
a scar from a previous operation on the uterus in combination with hypertension.

The attending physician chooses the optimal variant for delivery.

Newborn examination

At birth, the child's condition is first assessed using the Apgar scale. He is monitored by neonatologists and if there are wheezing in the lungs or other symptoms, additional studies may be prescribed. With fetal hypoxia in the womb, neurological symptoms are noted at birth. This requires a consultation with a neurologist.

If during pregnancy a woman fulfilled all the doctor's prescriptions and took care of her health, then the child is born healthy and develops on a par with other children.

Forecast

Sometimes pregnancy-induced hypertension may go away on its own after delivery. Subject to all the recommendations of the doctor in almost all cases, the prognosis of a woman and her child is favorable. If there is arterial hypertension during pregnancy without correction of treatment or its severe forms, then the prognosis is possible unfavorable. This will entail serious and sometimes irreversible consequences. Pregnancy hypertension makes a woman think about her health.

If a pregnant hypertensive patient knows about her diagnosis, but is determined to bear a healthy child, then everything is in her hands. An important role is played by the lifestyle of the mother, so proper nutrition and a healthy lifestyle greatly help in correcting the disease. Regular visits to the doctor and the implementation of his appointments can ensure the birth of a healthy child for a woman.

Pregnancy in combination with hypertension occurs in 3-4% of cases ("hyper" means higher or higher, over). In most pregnant women, it develops before pregnancy, but it can also occur during it.

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.

With 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 I stage(it is also called functional) is characterized by intermittent 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 III stage hypertension is already characterized by damage to organs and tissues (brain, heart, kidneys, blood vessels).

Only with a 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 hypertension, the ability to conceive is sharply reduced, and if pregnancy does occur, it usually ends in miscarriage or intrauterine fetal death.

There may be other severe complications during pregnancy. The most severe 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 levels), 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 II-III stages, 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 a complication of pregnancy as gestosis (32-55%), which has an unfavorable course, often joins.

Due to 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 abortion.

In 20-25% of cases, a child is born with reduced body weight (hypotrophy). Often there are premature births, in 4% intrauterine death of the fetus may occur.

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

From non-drugs 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 during pregnancy with essential vitamins and minerals, helps. In addition, beetroot and other vegetable juices help with constipation, which is so common during pregnancy.

As with hypertension, fluid intake should be limited to 1 liter, and salt to 1-3 g per day.

Hypertension - high blood pressure in pregnancy

Arterial hypertension (AH) occurs in 4-8% of pregnant women. Hypertension includes a whole range of different clinical and pathogenetic conditions: hypertension, symptomatic hypertension (renal, endocrine), preeclampsia. According to WHO, hypertensive syndrome is the second cause of maternal death after embolism, accounting for 20-30% of cases in the structure of maternal mortality. Rates of perinatal mortality (30-100 0/00) and preterm birth (10-12%) in pregnant women with chronic hypertension are significantly higher than those in pregnant women without hypertension. Hypertension increases the risk of abruption of a normally located placenta, may be the cause of cerebrovascular accident, retinal detachment, eclampsia, massive coagulopathic bleeding as a result of placental abruption.

Until recently, hypertension was thought to be relatively rare in people younger than 30 years of age. However, in recent years, population surveys have revealed elevated blood pressure (BP) numbers in 23.1% of people aged 17-29 years. At the same time, the early appearance of AH is one of the factors that determine the unfavorable prognosis of the disease in the future. It is important that the frequency of detection of patients with hypertension in terms of negotiability is significantly lower than in mass surveys of the population. This is due to the fact that a significant proportion of people, mostly with early stages of the disease, feel well and do not visit a doctor. This, apparently, also explains to a certain extent the fact that many women find out that they have high blood pressure only during pregnancy, which greatly complicates the diagnosis and treatment of such patients.

The physiological characteristics of the cardiovascular system, depending on the developing pregnancy, sometimes create a situation where it is difficult to distinguish physiological changes from pathological ones.

Hemodynamic changes during physiological pregnancy are an adaptation to the coexistence of mother and fetus, they are reversible and due to the following reasons:

strengthening of metabolic processes aimed at ensuring the normal functioning of the fetus;
an increase in the volume of circulating blood (BCC);
the appearance of an additional placental circulatory system;
gradual increase in body weight of a pregnant woman;
an increase in the size of the uterus and limitation of the mobility of the diaphragm;
increased intra-abdominal pressure;
change in the position of the heart in the chest;
increase in blood levels of estrogen, progesterone, prostaglandins E.

Physiological hypervolemia is one of the main mechanisms that ensure the maintenance of optimal microcirculation (oxygen transport) in the placenta and such vital organs of the mother as the heart, brain and kidneys. In addition, hypervolemia allows some pregnant women to lose up to 30-35% of blood volume during childbirth without developing severe hypotension. The volume of blood plasma in pregnant women increases from about the 10th week, then increases rapidly (until about the 34th week), after which the increase continues, but more slowly. The volume of erythrocytes increases in the same terms, but to a lesser extent than the volume of plasma. Since the percentage increase in plasma volume exceeds the increase in erythrocyte volume, so-called physiological anemia of pregnancy occurs, on the one hand, and hypervolemic dilution, leading to a decrease in blood viscosity, on the other.

By the time of birth, blood viscosity reaches a normal level.

Systemic BP healthy women changes slightly. In a normal pregnancy, systolic blood pressure (SBP) and diastolic blood pressure (DBP), as a rule, decrease in the II trimester by 5-15 mm Hg. Art. The reasons for these changes are the formation of placental circulation during these periods of pregnancy and the vasodilating effect of a number of hormones, including progesterone and prostaglandins E, causing a drop in total peripheral vascular resistance (OPSS).

During pregnancy, physiological tachycardia is observed. The heart rate (HR) reaches a maximum in the third trimester of pregnancy, when it is 15-20 beats / min higher than the heart rate in a non-pregnant woman. Thus, in the normal heart rate in late dates pregnancy is 80-95 beats / min, and it is the same for both sleeping and awake women.

It is now known that cardiac output (MOV) increases by about 1-1.5 liters per minute mainly during the first 10 weeks of pregnancy and reaches an average of 6-7 liters per minute by the end of the 20th week. By the end of pregnancy, MOS begins to decline.

With a physiologically proceeding pregnancy, there is a significant decrease in OPSS, which is associated with the formation of a uterine circulation with low resistance, as well as with the vasodilating effect of estrogens and progesterone. A decrease in peripheral vascular resistance, as well as a decrease in blood viscosity, facilitates hemocirculation and reduces afterload on the heart.

Thus, the individual level of blood pressure in pregnant women is determined by the interaction of the main factors:

a decrease in peripheral vascular resistance and blood viscosity, aimed at reducing blood pressure;
an increase in BCC and MOS, aimed at increasing blood pressure.

In the event of an imbalance between these groups of factors, blood pressure in pregnant women ceases to be stably normal.

Classification of hypertension

AH in pregnant women is a heterogeneous concept that combines various clinical and pathogenetic forms of hypertensive conditions in pregnant women.

Currently, the classification is the subject of discussion, since there are no uniform criteria and classification signs of hypertension during pregnancy, there is no single terminology base (for example, the term preeclampsia is used to refer to the same process in Russia and in many European countries, in the USA and UK - preeclampsia, Japan - toxemia).

More than 100 classifications of hypertensive conditions during pregnancy have been proposed. In particular, the International Classification of Diseases of the 10th revision (ICD-10) combines all such manifestations associated with pregnancy in the 2nd obstetric block. In Russia, all diseases are encrypted in accordance with this classification, although due to different terminology, encryption in accordance with ICD-10 causes controversy among specialists.

Working Group on High Blood Pressure in Pregnancy in 2000 developed a more concise classification of hypertensive conditions during pregnancy, which includes the following forms:

chronic hypertension;
preeclampsia - eclampsia;
preeclampsia superimposed on chronic hypertension;
gestational hypertension: a) transient hypertension in pregnancy (no preeclampsia by the time of delivery and the pressure returns to normal by the 12th week after birth (retrospective diagnosis)); b) chronic hypertension (the rise in pressure after childbirth persists (retrospective diagnosis)).

Chronic hypertension refers to hypertension present before pregnancy or diagnosed before the 20th week of gestation. Hypertension is defined as a condition with SBP equal to or greater than 140 mm Hg. Art. and DBP - 90 mm Hg. Art. Hypertension diagnosed for the first time during pregnancy but not resolved after delivery is also classified as chronic.

The pregnancy-specific gestosis syndrome usually occurs after the 20th week of gestation. It is determined by the increased level of blood pressure (gestational rise in blood pressure), accompanied by proteinuria. Gestational increase in blood pressure determine SBP above 140 mm Hg. Art. and DBP above 90 mm Hg. Art. in women who had normal blood pressure before the 20th week. At the same time, proteinuria is considered to be a concentration of protein in the urine of 0.3 g per day and higher when analyzing a daily urine sample. The test strip method can be used to diagnose proteinuria. In the case of its use, it is necessary to obtain two urine samples with a difference of 4 hours or more. For analysis, an average portion of urine or urine obtained through a catheter is used. The sample is considered positive if the amount of albumin in both samples reaches 1 g/L.

Previously, the rise in SBP by 30 and DBP by 15 mm Hg. Art. it was recommended to consider it as a diagnostic criterion, even if the absolute values of blood pressure are below 140/90 mm Hg. Art. Some authors do not consider this a sufficient criterion, since the available data show that there is no increase in the number of adverse outcomes in women in this group. Nevertheless, most experts call for special attention to women in this group who have a rise in SBP by 30 and DBP by 15 mm Hg. Art., especially in the presence of concomitant proteinuria and hyperuricemia.

Diagnostics

The most common errors in measuring blood pressure include: a single blood pressure measurement without prior rest, using the wrong cuff size (“cuff” hyper- or hypotension) and rounding numbers. The measurement must be taken on both hands. The SBP value is determined by the first of two consecutive auscultatory tones. In the presence of an auscultatory failure, there may be an underestimation of blood pressure numbers. The DBP value is determined by the fifth phase of the Korotkoff sounds. Measurement of blood pressure should be made with an accuracy of 2 mm Hg. Art., which is achieved by slowly releasing air from the cuff of the tonometer. At different values, the greater is considered true blood pressure. Measurements in pregnant women are preferably performed in a sitting position. In the supine position, due to compression of the inferior vena cava, blood pressure values \u200b\u200bcan be distorted.

Single increase in blood pressure ≥ 140/90 mm Hg. Art. registered in approximately 40-50% of women. It is obvious that a random single measurement of blood pressure for the diagnosis of hypertension in pregnant women is clearly not enough. In addition, the phenomenon of so-called “white-coat hypertension”, i.e., high blood pressure when measured in a medical environment (office blood pressure) compared to ambulatory (home) measurement, is widely known. Approximately 30% of pregnant women with hypertension registered at the doctor's appointment during the daily monitoring of blood pressure (ABPM) had a normal average daily blood pressure. Until now, the question of the prognostic value of the phenomenon of "white coat hypertension" has not been finally resolved. Currently, most researchers believe that it reflects an increased reactivity of the vascular wall, which in turn potentially increases the risk of cardiovascular disease. The role of ABPM in pregnant women is also not fully defined. In addition to diagnosing "white coat hypertension", evaluating the effectiveness of therapy in established hypertension, this method can be used to predict the development of preeclampsia. Blood pressure usually decreases at night in patients with mild preeclampsia and chronic hypertension, but in severe preeclampsia, the circadian rhythm of blood pressure can be perverted, with a peak in blood pressure at 2 am.

However, given the complexity of the technique, the high cost of equipment, and the existence of other alternative methods for predicting preeclampsia, we can assume that ABPM is not included in the group of mandatory (screening) methods for examining pregnant women with high blood pressure. However, it can be successfully applied according to individual indications.

Antihypertensive therapy for hypertension in pregnant women

The long-term use of antihypertensive drugs in pregnant women with chronic hypertension is a matter of controversy. A decrease in blood pressure can impair uteroplacental blood flow and compromise fetal development. Over the past 30 years, there have been seven international studies comparing groups of women with mild chronic gestational hypertension when using various schemes management (with the appointment of antihypertensive therapy and without pharmacological correction of hypertension). Treatment did not reduce the incidence of superimposed preeclampsia, preterm birth, placental abruption, or perinatal mortality compared to no treatment groups.

Some centers in the United States currently keep women with chronic hypertension who have stopped taking antihypertensive drugs under close observation. In women with hypertension that has developed over several years, with damage to target organs, taking large doses of antihypertensive drugs, therapy should be continued. Reports on the experience of monitoring patients with severe chronic hypertension without adequate antihypertensive therapy in the first trimester describe fetal loss in 50% of cases and significant maternal mortality.

The experts of the Working Group on High Blood Pressure in Pregnancy, 2000, consider the following criteria for prescribing treatment: SBP - from 150 to 160 mm Hg. Art., DBP - from 100 to 110 mm Hg. Art. or the presence of target organ damage such as left ventricular hypertrophy or renal failure. There are other provisions on the criteria for starting antihypertensive therapy: with blood pressure over 170/110 mm Hg. Art. (with higher blood pressure, the risk of placental abruption increases, regardless of the genesis of hypertension). There is an opinion that the treatment of hypertension at lower values of the initial blood pressure “removes” such a significant marker of preeclampsia as elevated blood pressure. At the same time, normal numbers of arterial hypertension give a picture of false well-being. European guidelines for the diagnosis and treatment of pregnant women with hypertension suggest the following tactics for managing pregnant women with various options AG.

Pre-pregnancy hypertension without target organ damage - non-drug therapy for BP 140-149 / 90-95 mm Hg. Art.
Gestational hypertension that developed after 28 weeks of gestation - drug therapy for blood pressure 150/95 mm Hg. Art.
Pre-pregnancy hypertension with target organ damage, pre-pregnancy hypertension with superimposed pre-eclampsia, pre-eclampsia, gestational hypertension that developed before the 28th week of pregnancy - drug therapy for BP 140/90 mm Hg. Art.

Basic principles of drug therapy in pregnant women: proven efficacy and proven safety.

In Russia, there is no classification of drugs according to safety criteria for the fetus. It is possible to use the criteria of the American classification of drugs and food products Food and Drug Administration (FDA-2002).

FDA Fetal Safety Classification Criteria (2002):

A - studies in pregnant women did not reveal a risk to the fetus;

B - a risk to the fetus is found in animals, but not in humans, or there is no risk in the experiment, but there are not enough studies in humans;

C - found in animals side effects but people don't have enough research. The expected therapeutic effect of the drug may justify its appointment, despite the potential risk to the fetus;

D - in humans, the risk to the fetus has been proven, but the expected benefit from its use for the expectant mother may exceed the potential risk to the fetus;

X is a drug that is dangerous to the fetus, and the negative effects of this drug on the fetus outweigh the potential benefits to the expectant mother.

Despite the fact that the range of drugs used in the treatment of hypertension in pregnant women is quite wide (methyldopa, beta-blockers, alpha-blockers, calcium antagonists, myotropic antispasmodics, diuretics, clonidine), the choice of drug therapy for a pregnant woman is very responsible and difficult. a case that requires strict consideration of all the pros and cons of this treatment.

Methyldopa

This drug belongs to class B according to the FDA classification. It is preferred as a first line treatment by many clinicians based on reports of stability in uteroplacental blood flow and fetal hemodynamics, as well as 7.5 years of follow-up with a limited number of children without any delayed developmental adverse effects following methyldopa administration during pregnancy. their mothers.

Benefits of methyldopa:

does not impair uteroplacental blood flow and fetal hemodynamics;
does not give delayed adverse effects on the development of children after administration during pregnancy to their mothers;
reduces perinatal mortality;
safe for mother and fetus.

Disadvantages of methyldopa:

it is not recommended to use at the 16-20th week (possible effect on the content of dopamine in nervous system fetus);
intolerance: 22% have depression, sedation, orthostatic hypotension.

Adequate and strictly controlled studies on other groups of antihypertensive drugs during pregnancy have not been conducted. Even when the results of studies are combined into a meta-analysis, there is no clear evidence of the efficacy and safety of antihypertensive drugs in pregnancy.

β-blockers

Most of the published material on antihypertensive therapy in pregnancy comes from studies on the effects of adrenoblockers, including β-blockers and the α-β-blocker labetalol. There is an opinion that β-blockers given in early pregnancy, in particular atenolol, can cause fetal growth retardation. However, none of these drugs gave serious side effects; although long-term follow-up is not enough to state this with complete certainty.

The advantage of β-blockers is the gradual onset of hypotensive action, characterized by a decrease in the frequency of proteinuria, no effect on BCC, no postural hypotension, and a decrease in the frequency of respiratory distress syndrome in the newborn.

The disadvantages of β-blockers are to reduce the weight of the newborn and placenta due to increased vascular resistance when administered in early pregnancy.

In accordance with the FDA classification, atenolol, metoprolol, timolol, oxprenolol, propranolol, labetolol belong to class C, pindolol, acebutolol belong to class B.

Dadelszen in 2000 conducted a "fresh" meta-analysis of clinical trials on β-blockers and made some very interesting findings. The intrauterine growth retardation is not due to the effect of β-blockers, but to a decrease in blood pressure as a result of antihypertensive therapy with any drug. All antihypertensive drugs equally reduced the risk of developing severe hypertension by 2 times compared with placebo. When comparing various antihypertensive drugs with each other, no advantages were found regarding the effect on endpoints (development of severe hypertension, maternal and perinatal mortality).

α-blockers are used in the treatment of hypertension in pregnant women, but adequate and strictly controlled studies has not been carried out in humans. With limited uncontrolled use of prazosin and a β-blocker, 44 pregnant women showed no adverse effects. The use of prazosin in the III trimester in 8 women with hypertension did not reveal clinical complications after 6-30 months, the children developed normally.

The advantages of this group of drugs are as follows:

effective reduction of blood pressure (used in combination with β-blockers);
do not affect the BCC;
no adverse effects (according to the results of clinical studies in a small number of women).

Flaws:

a sharp decrease in blood pressure;
possible orthostatic reactions;
lack of adequate and well-controlled studies in humans.

In accordance with the FDA classification, prazosin, terazosin belong to class C, doxazosin belongs to class B. In our country, according to the instructions of the Pharmaceutical Committee of the Russian Federation, α-blockers are not used for hypertension in pregnant women.

calcium antagonists. Experience with the use of calcium antagonists is limited to their appointment mainly in the third trimester of pregnancy. However, a multicentre prospective cohort study on the use of these drugs in the first trimester of pregnancy did not reveal teratogenicity. A recent multicenter, randomized trial with slow-release nifedipine in the second trimester showed neither positive nor negative effects of the drug when compared with the control group that did not receive treatment.

Benefits of calcium antagonists:

fetal weight in women taking nifedipine is higher than in women taking hydralazine;
early use reduces the incidence of severe preeclampsia and other complications in the mother and fetus (however, in a number of studies using nifedipine in the II trimester, neither positive nor negative effects of the drug were found when compared with the control group that received no treatment);
the absence (according to the results of clinical studies) of embryotoxicity in humans;
antiplatelet effect;
when used in the first trimester of pregnancy, the absence of teratogenic effects (not found in studies).

Disadvantages of calcium antagonists:

embryotoxicity of calcium antagonists in animals;
a rapid decrease in blood pressure can lead to a deterioration in uteroplacental blood flow (therefore, nifedipine for the relief of a hypertensive crisis in pregnant women is better taken orally than sublingually);
side effects: swelling of the legs, nausea, heaviness in the epigastrium, allergic reactions.

According to the FDA classification, nifedipine, amlodipine, felodipine, nifedipine SR, isradipine, diltiazem are class C.

Diuretics(hypothiazid 25-100 mg/day). Opinions about the use of diuretics during pregnancy are controversial. Medical concerns are largely understandable. It is known that preeclampsia is associated with a decrease in plasma volume and the prognosis for the fetus is worse in women with chronic hypertension who have not experienced an increase in BCC. Dehydration can impair uteroplacental circulation.

Against the background of treatment, electrolyte disturbances, an increase in the level of uric acid may develop (which means that this indicator cannot be used to determine the severity of preeclampsia). In women taking diuretics, from the beginning of pregnancy, there is no increase in BCC to normal values. For this reason, due to theoretical concerns, diuretics are not usually given in the first place. A meta-analysis of nine randomized trials involving more than 7000 subjects treated with diuretics showed a trend towards a decrease in the development of edema and / or hypertension with a confirmed absence of an increase in adverse fetal outcomes. At the same time, if their use is justified, they prove to be safe and effective means, which can significantly potentiate the action of other antihypertensive drugs, and are not contraindicated in pregnancy, except in cases of a decrease in uteroplacental blood flow (preeclampsia and intrauterine growth retardation). A number of experts believe that pregnancy is not a contraindication to the use of diuretics in women with essential hypertension that preceded conception or manifested before mid-pregnancy. However, data on the use of diuretics to lower blood pressure in pregnant women with hypertension are insufficient.

In accordance with the FDA classification, hypothiazide belongs to class B. However, the instructions of the pharmaceutical committee of the Russian Federation state that hypothiazide is contraindicated in the first trimester of pregnancy, and is prescribed in the II and III trimesters according to strict indications.

Clonidine- the central α 2 -agonist has limitations for use during pregnancy, and when taken in the postpartum period, one should refrain from breastfeeding. The drug has no advantages over β-blockers. Sleep disorders have been identified in children whose mothers received clonidine during pregnancy. When used in early pregnancy, embryotoxicity was detected.

Myotropic antispasmodics currently not used for planned therapy. They are prescribed only in emergency situations - with a hypertensive crisis. Hydralazine (apressin) with prolonged use can cause: headache, tachycardia, fluid retention, lupus-like syndrome. Diazoxide (hyperstat) with long-term treatment can cause sodium and water retention in the mother, hypoxia, hyperglycemia, hyperbilirubinemia, thrombocytopenia in the fetus. Sodium nitroprusside can cause cyanide intoxication after many hours of use.

Angiotensin-converting enzyme inhibitors(ACE) are contraindicated in pregnancy due to the high risk of intrauterine growth retardation, the development of bone dysplasia with impaired ossification of the cranial vault, shortening of the limbs, oligohydramnios (oligohydramnios), neonatal renal failure (kidney dysgenesis, acute renal failure in the fetus or newborn), death fetus.

Although no data have been accumulated regarding the use of angiotensin II receptor antagonists, their adverse effects are likely to be similar to those of ACE inhibitors, so these drugs should also be avoided.

Treatment of acute severe hypertension in pregnant women

Some experts raise DBP to 105 mm Hg. Art. or higher is considered as an indication for starting antihypertensive therapy, others consider it possible to refrain from antihypertensive therapy up to 110 mm Hg. Art. . There is evidence that if the initial diastolic blood pressure did not exceed 75 mm Hg. Art., treatment should begin already when it rises to 100 mm Hg. Art. .

The spectrum of drugs used in the treatment of acute severe hypertension in pregnancy includes hydralazine (start with 5 mg IV or 10 mg IM). If not effective, repeat after 20 minutes (5 to 10 mg depending on response; if desired blood pressure is achieved, repeat as needed (usually after 3 hours); if no effect from a total dose of 20 mg intravenously or 30 mg intramuscularly, use another agent ); labetalol (start with a dose of 20 mg IV; if the effect is insufficient, give 40 mg 10 minutes later and 80 mg every 10 minutes 2 more times, the maximum dose is 220 mg; if the desired result is not achieved, prescribe another drug; do not use in women with asthma and heart failure); nifedipine (start with 10 mg per os and repeat after 30 minutes if necessary); sodium nitroprusside (rarely used when no effect of the above agents and/or signs of hypertensive encephalopathy; start at 0.25 mg/kg/min up to a maximum of 5 mg/kg/min; cyanide poisoning of the fetus may occur with therapy lasting more than 4 hours).

Sudden and severe hypotension may occur with any of these drugs, especially the short-acting nifedipine. The ultimate goal of lowering blood pressure in emergency situations should be its gradual normalization.

In the treatment of acute hypertension, the intravenous route is safer than the oral or intramuscular route, as it is easier to prevent accidental hypotension by stopping intravenous infusion than to stop intestinal or intramuscular absorption of drugs.

Of the above drugs for the relief of hypertensive crisis in pregnant women, only nifedipine is currently registered with the Pharmaceutical Committee of the Russian Federation. However, pregnancy is indicated in the instructions for this drug as a contraindication to its use.

Thus, the problem of arterial hypertension in pregnant women is still far from being resolved and requires the combined efforts of obstetricians, clinical pharmacologists and cardiologists.

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A. L. Vertkin,
O. N. Tkacheva, doctor of medical sciences, professor
L. E. Murashko, doctor of medical sciences, professor
I. V. Tumbaev
I. E. Mishina
MGMSU, TsAGiP, IvGMA, Moscow, Ivanovo

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 preventive measures, consult with an obstetrician-gynecologist, and start conservative therapy in time. Pregnancy and hypertension is a dangerous combination that can result in a hypertensive crisis, urgent hospitalization of a woman.

What is hypertension in pregnancy

This is one of the diseases of the cardiovascular system, in which the 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 adversely affect the intrauterine development of the fetus. Arterial hypertension is a chronic disease, and recurs during pregnancy against the background of an increase in systemic blood flow, under the influence of blood congestion. The reasons may be different, but the real threat to the fetus still exists.

Classification of arterial hypertension in pregnant women

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

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).
Preeclampsia. A dangerous attack reminds of itself after 20 obstetric week with manifestation and proteinuria (protein content in urine from 300 mg).
Eclampsia. The attack is accompanied by visible swelling with a pronounced convulsive state, proteinuria and violations of laboratory parameters of biological fluids.
HELLP syndrome. Hemolytic anemia progresses, associated with increased activity of liver enzymes with a low platelet count.

Having determined which arterial hypertension during pregnancy predominates in a particular clinical picture, the attending physician individually selects the optimal set of therapeutic measures, which, in addition to oral pills, includes nutrition correction, giving up 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.

Causes of arterial hypertension in pregnant women

When carrying a fetus, the patient may experience manifestations of gestational hypertension, which often progresses in the second trimester. The first attack is associated with a 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 patency is impaired, and blood pressure 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 volumes of vessels 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 developing hypertension

Since arterial 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 be aware of the so-called "risk factors" for pregnant women. It:

emotional, mental exhaustion;
physical overload;
impaired patency of the vessels of the placenta;
elevated 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 with symptoms of arterial hypertension should monitor their condition and avoid an increase in relapses, otherwise premature births in the 2nd and early 3rd trimesters, miscarriage in early pregnancy are possible. To exclude a high risk of developing arterial hypertension, women should take care of preventive measures even when planning an “interesting situation”.

Symptoms of hypertension during pregnancy

The first symptoms of hypertension are 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 an advanced 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;
intermittent seizures;
increased nosebleeds;
recurrent chest pain;
tachycardia (rapid heartbeat), other symptoms of cardiovascular disease;
increased nausea with occasional bouts of vomiting;
hyperemia of the skin on the face;
nervous tension, increased excitability;
constant feeling of thirst, dry mucous membranes;
panic attacks (internal fear, unexplained anxiety).

Risk to mother and fetus

If hypertension develops in pregnant women, the patient should urgently contact a gynecologist and a 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 carry out regular monitoring of the well-being of a pregnant woman, to extend the remission interval already by medication or an alternative method. During an attack, complications can be:

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

Arterial hypertension harms the expectant mother, and here are the potential pathologies in question:

risk of placental abruption;
hypertensive crisis;
bleeding due to DIC;
stroke, myocardial infarction;
preeclampsia, eclampsia;
heart failure;
retinal detachment.

Treatment of arterial hypertension in pregnant women

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

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.
The intake of medicines is strictly limited, since the synthetic components in chemical composition can cause a mutation of the fetus, extensive intrauterine pathologies.
In the family, the expectant mother needs to ensure complete comfort and spiritual harmony, eliminate stress, prolonged emotional overstrain, and dangerous shock states.
It is recommended to perform breathing exercises, to be outdoors more often and to walk more. This is a good way to deal with toxicosis and the ability to prevent the development of late preeclampsia.
Control weight gain during pregnancy, avoid overeating and obesity. If weight gain is noticeable, the doctor suggests that the pregnant woman arrange a fasting day once a week.
It is important to ensure the prevention of beriberi, 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

Nutrition for arterial 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 discharge of fluid and long time maintain blood pressure above normal. It would be useful to reduce the consumption of vegetable and animal fats. Restrictions apply to strong coffee and carbonated drinks, alcohol, and 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;
skimmed dairy products;
lean meats, chicken, rabbit;
chicken and vegetable soups;
natural juices, fruit drinks;
herbal teas.

Medical therapy

AH in pregnant women (arterial hypertension) occurs and progresses even at a young age of 20-27 years. In the stage of relapse, headaches can be eliminated and pressure can be 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 removing fluid and salt ions: Furosemide, Lasix;
antispasmodics for relief of an attack of pain: Dibazol, Magnesium sulfate, Eufillin;
Clonidine drugs to lower blood pressure: Clonidine, Katapresan, Gemiton;
saluretics to stabilize blood pressure: Brinaldix, Hypothiazid, Hygroton;
drugs based on methyldopa to increase vascular tone: Dopegyt, 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 completely dissolved. With insufficient effect, the use of 3 tablets in three approaches with an interval of several hours is allowed. 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 for a successful conception in a timely manner. To do this, it does not hurt to consult with a local gynecologist, to undergo a comprehensive examination. Properly selected prevention helps to successfully conceive, bear and give birth to a healthy child without complications for the mother and newborn.

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

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

Arterial hypertension and pregnancy. The pathogenesis of complications of gestation. Methods of laboratory diagnostics

Pregnancy and hypertension, high blood pressure during pregnancy, hypertension in pregnant women

Causes of hypertension during pregnancy

Symptoms and signs of hypertension during pregnancy

Diagnostics and treatment of arterial hypertension in pregnant women

Preeclampsia during pregnancy

Eclampsia in pregnancy

Arterial hypertension in pregnant women

Symptoms of the disease and measurement of pressure

Arterial hypertension of the 1st degree

Arterial hypertension of the 3rd degree

hypertension stage 2 stage 2

Hypertension and pregnancy

Contributing factors

Clinical picture

Effect of hypertension on pregnancy

Preparing for pregnancy

Management of pregnancy

Observation at the gynecologist

Diagnostic methods

Instrumental Research

Basic Research

Accompanying illnesses

Treatment Methods

Diet

Conservative treatment

Urgent care

Possible complications for the mother

Possible complications in the fetus

childbirth process

Newborn examination

Forecast

Hypertension - high blood pressure in pregnancy

Classification of hypertension

Diagnostics

Antihypertensive therapy for hypertension in pregnant women

Methyldopa

β-blockers

Treatment of acute severe hypertension in pregnant women

Literature

What is hypertension in pregnancy

Classification of arterial hypertension in pregnant women

Causes of arterial hypertension in pregnant women

Risk factors for developing hypertension

Symptoms of hypertension during pregnancy

Risk to mother and fetus

Treatment of arterial hypertension in pregnant women

Diet

Medical therapy

Prevention of arterial hypertension in pregnant women

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