Arterial hypertension of pregnant women
Author Ольга Кияница
Arterial pressure (BP) - a biological indicator that allows you to determine the blood pressure exerted on the walls of arterial vessels. A certain amount of pressure is necessary to ensure that the blood moves throughout the body, but when it rises, serious problems can arise.
During pregnancy, the body, even under normal pressure, experiences a significant load, while too high blood pressure can provoke preeclampsia and eclampsia.
Some women had hypertension before the onset of pregnancy. Despite this, with a stable condition of a woman and a well-controlled disease, pregnancy is not contraindicated. In addition, even with high blood pressure, pregnancy can proceed normally and be resolved naturally, but if necessary, a doctor prescribes a course of drug therapy.
Video: Hypertension during Pregnancy. Chronic, Gestational, Preeclampsia
Description of blood pressure
The calculation of blood pressure is carried out in millimeters of mercury (mm Hg) and has two pressure indicators: upper (systolic) and lower (diastolic). At the upper pressure, the heart is compressed to expel a portion of blood from the ventricles into large vessels, while at the bottom it is in a relaxed state and filled with blood.
Traditionally, the normal BP is 120/80 mm Hg. st., but with arterial hypertension, both the upper and lower index may rise or both.
High blood pressure in the medical language is called "hypertension" or arterial hypertension (AH). With this pathology, blood pressure can rise to 140/90, and in the worst case up to 160/110 and above. With such indicators, serious disorders can occur in the body of the mother and child.
The risk of hypertension in pregnant women is as follows:
- Decreased placental circulation . With this pathology, the fetus receives less oxygen and nutrients, which often leads to violations of intrauterine development.
- Detachment of the placenta . Severe complication, accompanied by the separation of the placenta from the walls of the uterus even before the onset of labor. There is a partial and complete detachment of the placenta, in any case this condition is considered dangerous for the life of the mother and child.
- Injury of other organs . Poorly controlled hypertension can cause trauma to the brain, heart, lungs, kidneys, liver and other major organs. The severe course of the disease can threaten life.
- Premature birth . If the blood pressure is too high, then there is a risk of premature birth, because of which the child may have problems with breathing, infection and other complications. In any case, if there is a threat of development of pre-eclampsia, then an antenatal permit is mandatory.
Types and degrees of hypertension in pregnant women
There are four variants of the course of hypertension in pregnant women, distinguished by the severity of complications and the time of occurrence (before pregnancy, up to 20 weeks or later).
Types of hypertension in pregnant women:
- Gestational hypertension . Women with this type of hypertension have high blood pressure, which develops after 20 weeks of pregnancy. When analyzed in urine, the protein is not detected, and there are no other signs of organ damage.After childbirth, this form of hypertension, as a rule, no longer occurs.
- Chronic hypertension . Elevated blood pressure is determined even before the onset of pregnancy or during the first trimester of fetal development (up to 20 weeks). Symptoms with this type of pathology are often absent, so there are difficulties with diagnosis. For today the chronic form of a hypertension is defined at 5% of pregnant women.
- Chronic hypertension in combination with preeclampsia . In such cases, high blood pressure is determined before the onset of pregnancy, also in the urine protein is detected, there may be various complications of hypertension.
- Preeclampsia . Symptoms of the disease are determined after 20 weeks of pregnancy, in addition, symptoms of disorders of other organs (kidneys, liver, lungs, brain) may occur. Severe cases are complicated by eclampsia, manifested by convulsive attacks.
Previously, the diagnosis of "pre-eclampsia" was exhibited only when determining the pregnant woman's high blood pressure and protein in the urine. Today, experts concluded that pre-eclampsia can develop without protein in the urine.
Degrees of AH in pregnant women:
- High blood pressure . It is a systolic pressure in the range from 120 to 129 mm Hg. Art. and the diastolic pressure is below 80 mm Hg. Art. Elevated blood pressure tends to deteriorate over time, especially if steps are not taken to control blood pressure.
- Hypertension 1 st degree is a systolic pressure in the range of 130 to 139 mm Hg. Art. or diastolic pressure in the range of 80 to 89 mm Hg. Art.
- Hypertension of the 2nd degree . There is severe hypertension when the systolic pressure rises to 140 mm Hg. Art.and higher or diastolic pressure is determined from 90 mm Hg. Art.
After 20 weeks of pregnancy, blood pressure greater than 140/90 mm Hg. Art. and fixed in two or more cases, not less than four hours each and without any other organ damage, is considered gestational hypertension.
Symptoms and risk factors
High blood pressure may not be accompanied by severe symptoms, so it is often not immediately possible to learn about the violation, especially if blood pressure is often not measured. High blood pressure can sometimes be manifested by the following symptoms:
- Severe headaches
- Hesitating Breath
- Strong alarm
The main signs of preeclampsia
In addition to high blood pressure, there are other manifestations of pre-eclampsia, including:
- Excess protein in the urine (proteinuria) or additional signs of kidney problems
- Severe pain in the head
- Changes in vision, including temporary loss, clouding or increased photosensitivity
- Painful sensations in the upper abdomen, usually under the ribs on the right side
- Nausea or vomiting
- Dyspnoea caused by fluid in the lungs
- Unexpected weight gain and swelling, especially on the face and hands, which often accompany preeclampsia. Such signs are not specific for preeclampsia, as they can occur during normal pregnancy.
According to laboratory tests, a decrease in the level of platelets in the blood (thrombocytopenia) can be determined. An ultrasound can confirm a liver function disorder.
In addition, the doctor necessarily assesses the condition of the child. For this, cardiac rhythm of the fetus is monitored with a cardiotocograph within 20-40 minutes (or, if necessary, longer). Also, an ultrasound can be performed to assess the development of the baby, how well the placenta works and whether enough fluid surrounds the baby.
Risk factors that complicate the course of chronic arterial hypertension include:
- Age (the older the woman, the higher the risk)
- Family predisposition to high blood pressure
- African American
- Presence of diabetes or kidney disease
- Pre-eclampsia in a previous pregnancy
- Passive lifestyle
- Drinking too much salt
- Use more than two servings of alcoholic beverages per day
- Poor nutrition, being on a diet that lacks fruits and vegetables
Some risk factors can not be changed, for example, genetic or the presence of certain diseases. But at the same time, it is possible to reduce the level of exposure to other risk factors, and this is especially true during pregnancy.
Diagnosis of pre-eclampsia is based on the following criteria: high blood pressure and the appearance of one or more of the following complications after the 20th week of pregnancy:
- Protein in urine (proteinuria)
- Low amount of platelets
- Impaired liver function
- Symptoms of kidney problems other than protein in the urine
- Fluid in the lungs (pulmonary edema)
- Headaches or visual disturbances
Indications of arterial pressure, exceeding 140/90 mm Hg. are abnormal for pregnant women. However, one measurement of high blood pressure does not mean that there is preeclampsia. If the elevated blood pressure is determined once, then the doctor will closely monitor the indicators in the future.
Tests that may be required in the diagnosis of AH pregnant:
- Blood test . Checking the function of the liver, kidneys, also measured platelets - cells that help the blood to fold.
- Urinalysis . It is based on urine collected for 24 hours to measure the amount of protein in it.
- Ultrasonic examination of the fetus . The child's growth is carefully monitored. Images of the child created during an ultrasound examination allow the doctor to estimate the weight of the fetus and the amount of fluid in the uterus (amniotic fluid).
- Biophysical profile . A no-load test is a simple procedure that tests how the child's heart rate reacts when it moves.The method is based on the use of ultrasound to measure the child's breathing, muscle tone, movement and volume of the amniotic fluid in the uterus.
Gestational and chronic hypertension most often does not require specific medication. If the medications are still indicated, then they are used strictly according to medical recommendations.
Not all drugs are suitable for use by pregnant women, so if there is chronic hypertension and you have to take medications, then at the planning stage of pregnancy you may need to switch to alternative treatment.
Video: Effective treatment of hypertension in pregnant women
Preeclampsia affects about 1 in 100 pregnant women and their children. If pre-eclampsia was defined prior to conception of the child or there is a family history of pre-eclampsia, diabetic or multiple pregnancy, then the risk of developing pre-eclampsia increases with the current pregnancy. Despite these factors, any pregnant woman is able to develop pre-eclampsia.
In the early stages of the disease, women often feel great, and only when their condition worsens, there may be symptoms.
Treatment of preeclampsia
It is carried out in the hospital regardless of the subjective state of health of the pregnant woman. This is due to the fact that pre-eclampsia can quickly switch to eclampsia, so it is very important that the woman's condition is under the control of the doctor and midwife.
Without treatment, preeclampsia rarely progresses to eclampsia. This condition is life-threatening, because there may be seizures similar to epilepsy.
When determining preeclampsia, it may be necessary to administer medications that lower blood pressure through an intravenous drip, especially if the blood pressure is very high.
The only and most effective cure for pre-eclampsia is the birth of a child and the placenta. Fortunately, most women who develop pre-eclampsia remain pregnant up to 36 weeks or more, therefore, either stimulate childbirth or make a cesarean section, which makes it possible to give birth to a healthy, full-fledged child.
Some women develop pre-eclampsia before their child fully ripens. In such cases, doctors carefully balance the need for the child to grow up and mature, especially his lungs, enough for delivery. The best incubator for a baby is his mother's uterus, but pre-eclampsia can limit the flow of oxygen and nutrients through the placenta, which will not allow the fetus to develop normally.
In extreme cases, doctors recommend an early delivery. Before this, hormonal injections are made, which makes it possible to prepare the baby's lungs for breathing. Also, the pregnant woman is housed in a specialized department of the maternity hospital, where all methods of providing extended care to a premature baby are available.
The decision on the need for an early delivery is based on the following data:
- Pregnancy Periods
- How well the blood pressure is controlled
- The results of blood tests, which allow you to assess the function of the liver and kidneys, the ability to clot blood
- Parameters of child development
- Presence of signs of placental abruption
During labor, epidural anesthesia is often recommended, provided that the blood coagulates properly, because this method of anesthesia can lower blood pressure. Most infants are born naturally, but in rare cases, the doctor may offer a cesarean section.
Frequently asked Questions
- Is it safe to take medicines for blood pressure during pregnancy?
Some drugs for treating hypertension are considered safe for pregnant women, but angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and renin inhibitors are usually not recommended to women in the position.
However, treatment with AH is very important. High blood pressure puts a woman at risk for heart attack, stroke and other serious complications. It can also be dangerous for the child.
If you need a drug to control blood pressure during pregnancy, the doctor chooses the safest drug in the most appropriate dose. Take the medicine in accordance with the prescriptions. Do not stop taking the drug or adjust the dose yourself.
- What should I do to prepare for pregnancy with hypertension?
If a woman before the onset of pregnancy determines high blood pressure, you need to first consult with your doctor. A meeting with doctors of another specialization, family doctor or cardiologist is also held. With their help, an assessment is made of how well the blood pressure is controlled.
Changes in treatment that may be required before pregnancy are also considered.
If a woman is overweight, the doctor may recommend you lose weight before trying to get pregnant.
- What can be expected during prenatal visits?
During pregnancy, it is often necessary to visit a doctor from your treating obstetrician-gynecologist. At each visit, the doctor will carefully measure the weight and blood pressure, and blood and urine tests will often be required.
To monitor the child's condition, it may be necessary to perform frequent ultrasound examinations. It is important to monitor the heart rhythm of the fetus, which is used to assess the baby's health. In addition, the doctor can recommend daily fixation of the child's movements.
- What can be done to reduce the risk of complications?
The best way to take care of your child is to take care of yourself. For this you should follow the following recommendations:
- During the entire pregnancy, you need to visit the observing obstetrician-gynecologist on time.
- If necessary, take prescribed medicines at the dose indicated by the doctor.
- It is important to stay in active form. To do this, follow the physician's recommended physical exercises.
- You need to eat healthy and fully. If you need more help, you can talk with a nutritionist.
- It is necessary to abandon all bad habits, even if this irritation is over trifles, not to mention smoking or drinking alcohol
Researchers continue to study ways of preventing preeclampsia, but no clear strategies have been developed so far. If during the previous pregnancy there was hypertensive disorder, then the doctor may recommend taking low-dose aspirin daily (81 milligrams), beginning at the end of the first trimester.
- Can I breastfeed my baby?
Breastfeeding is recommended for most women with high blood pressure, even those who take medication. To ensure the safety of the baby, it is necessary to discuss a possible adjustment of medications that the doctor can prescribe even before the birth of the child. Sometimes an alternative drug to reduce blood pressure is recommended.
Video: Pregnancy and blood pressure