Clinical guidelines for the treatment of hypertension in pregnancy

Pressure is an important factor in the state of health of mother and child, the control of its indicators is under the constant supervision of specialists throughout pregnancy.

Hypertension is diagnosed in 10% of pregnant women.

In the presence of such a pathology, specialists draw up clinical recommendations and a treatment regimen that is aimed at stabilizing pressure indicators. Patients with hypertension should follow a certain diet, work and rest, and undergo clinical trials in a timely manner.

Ignoring hypertension and lack of medical control can cause the development of complications: placental abruption, preeclampsia, fetal developmental disorders.

Diagnosis of hypertension during pregnancy

So, hypertension can cause many complications during pregnancy. For its treatment, drug, non-drug and folk methods of treatment are used.

Diagnosis of the disease involves the collection of a complete history, which includes the following information:

• data on predisposition to hypertension before pregnancy;
• the presence of bad habits;
• Lifestyle;
• the presence of cases of diagnosis of hypertension in the family;
• age;
• transferred diseases of the kidneys, liver, cardiovascular system.

When choosing treatment methods, the specifics of the disease are taken into account.

Its features are established on the basis of studies that can be grouped into three groups:

• primary examination (physical examination) is the collection of information about the symptoms and the time of their manifestation, the measurement of body parameters (mass, weight, height of the mother and fetus), the degree of muscle development;
• laboratory tests help to identify the cause of the disease. For this purpose, a general analysis of blood, urine, feces, ECG is carried out. Additional studies may be prescribed after determining the diagnosis that provokes hypertension;
• instrumental research is a measurement of pressure and pulse indicators.

During pregnancy, women with arterial hypertension are hospitalized three times. In the early stages of pregnancy (up to 12 weeks), the cause of high blood pressure is clarified and a prognosis for the development of pregnancy is made.

The second hospitalization occurs during the period of the highest hemodynamic load - at 26-30 weeks. During this period, adjustment of therapy and a change in treatment methods may be required.

A few weeks before the birth, pregnant women are hospitalized for prenatal preparation.

If gestosis develops during pregnancy, an unscheduled hospitalization is carried out.

Drug treatment: features and indications

In some countries, this method is unacceptable due to the high risks of endangering the health of the fetus, and only non-drug methods are used for treatment. In Russia, when choosing a treatment regimen, doctors assess the possible risk to the child and mother. In severe forms of arterial hypertension, refusal of drug therapy can have tragic consequences.

The use of pharmacological drugs for the treatment of hypertension is indicated in such cases:

• if the systolic pressure is more than 30 mm Hg. Art. above the norm;
• if the standard blood pressure exceeds 130/90 mm Hg. Art.;
• if the diagnosis confirms the presence of gestosis - complications during pregnancy, in which the functioning of the kidneys and cerebral vessels deteriorates.

Drug treatment is aimed at reducing pressure and normalizing the woman's condition.

Depending on the form of the disease and its causes, one of the forms of drug therapy is prescribed:

• monotherapy is the use of one type of drug in minimal dosages. Such treatment is indicated for mild and moderate forms of the disease;
• Combination therapy is the use of several types of drugs to achieve greater effectiveness.

The second form is more effective, but the combination of drugs should be based on a number of clinical studies. Combine vitamin preparations with small dosages of antihypertensives.

New drugs in this treatment are introduced gradually in this order:

1. Magnesium supplements are safe for both mother and child. They have an antihypertensive effect.
2. Sedatives improve the state of the nervous system, relieve stress, which causes hypertension in 30% of pregnant women in the first trimester.
3. Means that improve blood microcirculation are indicated for antiphospholipid syndrome and preeclampsia.
4. Myotropic antispasmodics are prescribed before the use of antihypertensive drugs if their benefits outweigh the possible risks.
5. Preparations containing calcium improve the condition of the nervous system. They are prescribed from the 16th week of pregnancy.
6. Antihypertensive drugs are prescribed for severe forms of the course of the disease.

When prescribing drugs from the latter group, the possibility of treatment with other drugs is first excluded. None of this type of medicine is completely safe for mother and baby. All drugs are classified according to health safety criteria into 5 groups.

The effect of funds on the body of the mother and fetus during treatment

The dosage of drugs is determined by the doctor, taking into account the physiological parameters of the mother and child, the specifics of the disease and the reasons that provoked its development.

Non-Drug Therapy: Recommendations for Adjusting Lifestyle and Nutrition

Non-drug therapy is indicated in such cases:

• if the pressure does not exceed 150/100 mm Hg. Art. and there are no additional symptoms;
• if hypertension did not occur as a result of concomitant diseases of the kidneys, liver and fetoplacental system;
• this type of treatment is used as maintenance therapy when using drugs.

It involves a lifestyle adjustment that includes the following changes:

• control of diet and dietary changes;
• establishing a sleep and rest regimen, the introduction of daytime sleep;
• the introduction of moderate physical activity;
• control of the nervous and emotional state, avoidance of stress;
• daily outdoor walks.

An important aspect of non-drug therapy is dietary adjustment.

Nutrition in pregnant women with hypertension should meet the following requirements:

• salt intake should be limited, reducing the daily intake to 5 g;
• refuse fatty, cholesterol-rich foods to avoid the risk of obesity;
• every day to eat fresh fruits, vegetables, berries;
• increase the consumption of grains and cereal products;
• exclude from the diet foods that irritate the nervous and cardiovascular system: spicy foods, spices (red, black pepper, ginger), fatty fish, alcohol, pastries, chocolate;
• replace animal fats with vegetable fats. Include olive, sunflower oil in the diet;
• do not eat offal in any form: liver, kidneys;
• introduce low-fat dairy products into the daily diet;
• control the water balance. It is necessary to drink 1.5-2 liters of clear liquid every day.

Fasting and specific diets are not allowed. You need to have 4-5 full meals a day. These clinical guidelines are indicated for all pregnant women with hypertension of any severity.

Non-drug therapy in some cases also includes the appointment of physiotherapy procedures, including:

• electrosleep - exposure to the brain with small electrical discharges normalizes blood circulation, improves metabolism and functions of all organs and systems;
• inductothermy of the areas of the legs and feet stabilizes the pressure indicators;
• diathermy of the kidney area helps to significantly reduce blood pressure, normalize blood flow;
• hyperbaric oxygen therapy - high pressure oxygen treatment using pressure chambers.

Additionally, healing baths with a sedative effect, aromatherapy or herbal medicine using herbal infusions and solutions are prescribed.

Physiotherapy is prescribed at different stages of treatment. It helps to enhance the effect of other therapeutic measures, reduce the dose of drugs, improve metabolic processes in the body of a pregnant woman and child, and stabilize the state of her cardiovascular system.

Non-drug treatment has no contraindications. His recommendations are relevant not only for patients with hypertension, but also for healthy women. Compliance with the correct diet, sleep and rest, the absence of nervous and emotional overstrain, stress protects the body of the mother and child from health problems.

Traditional medicine methods

Some funds have a beneficial supportive effect, strengthen the immune system and allow you to reduce pressure indicators to the required level. For this purpose, herbal teas and tinctures are used.

For their preparation, the following plants are used:

• herbs that have a sedative effect (mint, lemon balm, valerian). They calm the nervous system, relieve tension and stress. They are used to make teas and infusions;
• herbs that have a hypotensive effect (St. John's wort, hawthorn, blackcurrant leaves). In some cases, they help stabilize pressure indicators;
• tonic and strengthening herbs are used for general strengthening of the body and saturating it with vitamins. For this purpose, drinks based on chamomile, dandelion leaves, and rose hips are consumed.

In medical practice, certain types of herbs are rarely prescribed. For a complex effect, herbal preparations are used, in which several types of plants with different therapeutic effects are combined. The use of any drinks for traditional medicine recipes should be discussed with your doctor. It is necessary to make sure that there is no allergy to all components of herbal preparations and other contraindications for use.

Prevention of hypertension

If there is a tendency to hypertension, women should pay attention to some preventive measures before pregnancy. During the bearing of a child, they will help protect her and the fetus from the development of complications. Remember that it is always better to prevent pathology than to eliminate it later.

Preparing to become a mother, women should consider the following clinical recommendations:

• it is necessary to establish a mode of work and rest, to avoid physical and emotional overstrain;
• exclude fatty, salty, smoked foods from the diet;
• establish a diet: eat in small portions 4-5 times a day, eat fruits and vegetables, vitamins;
• be observed by a doctor and periodically undergo the necessary clinical studies in order to detect the onset of the development of pathologies in time;
• avoid overeating, a sharp increase or decrease in body weight.

Preparing for pregnancy allows you to avoid possible diseases. An important preventive aspect is educational work among those planning to become a mother and pregnant women. The necessary knowledge about hypertension, its risks, threats, complications and treatment methods allow women to take all the necessary tests in a timely manner and seek help from specialists.