Hypertension during pregnancy

Hypertension during pregnancy is often detected for the first time.

According to the latest statistics, hypertension in pregnant women occurs quite often: both with the onset of bearing a child, and long before this event.

Such gestational pathology requires special individual approaches in treatment.

This disease brings with it many complications of this physiological condition, often causing maternal death. Despite numerous breakthroughs in medicine (and obstetrics in particular), hypertension in pregnant women occurs more often in economically developed countries, worsens the quality of life of women and their unborn children.

Condition pathogenesis

Hypertension in women "in position" creates a risk of abnormal location of the placenta and its untimely detachment, which is usually accompanied by intense and multi-volume bleeding.

Hypertension brings with it:

• a greater likelihood of eclampsia in women;
• transient or persistent disorders of the blood supply to the brain;
• retinal detachment.

In the modern world, hypertension occurs in approximately every third inhabitant of the globe.

Gestational hypertension also develops in patients with overweight, with concomitant diabetes, and in individuals with other metabolic disorders. If high blood pressure began to be observed in a woman during the bearing of a child for the first time, then, most likely, the symptoms of hypertension will persist after delivery.

The severity of this physiological condition is directly determined by the age of the expectant mother: after 26 years, the risk of gestational problems increases dramatically, and hypertension during pregnancy becomes one hundred percent likely.

The danger lies in the fact that the condition of not only the mother, but also the fetus or unborn child is deteriorating.

Babies are at increased risk for:

• cardiovascular pathologies;
• hormonal disorders;
• metabolic failures.

Modern medicine is trying to provide all the conditions for children to be born healthy, but the health of the mother and the possibility of her subsequent pregnancies always come to the fore.

Pregnancy hypertension is a diagnosis given to women with systolic blood pressure levels over 140 mmHg. Art., diastolic - over 90. Doctors also take into account the fact that physiologically, blood pressure in pregnant women tends to decrease and only by the third trimester reaches the level usual before conception. An increase in pressure of more than 25 mm from baseline to pregnancy is a factor for making this diagnosis, even if the value does not go beyond the established figures.

Clinical classification

When specifying the degree of hypertension in pregnant women, they may somewhat “depart” from the usual classification.

Typically, such patients receive one of the subtypes of diagnoses:

1. Chronic arterial hypertension during pregnancy occurs at a time when conception has not yet occurred. This condition is not associated with bearing a child, it is usually diagnosed before 20 weeks of the term.
2. Gestational hypertension is usually fixed in women after the middle of the expected period of bearing a child, requires constant monitoring, especially during childbirth and after 12 weeks after delivery.
3. Preeclampsia and eclampsia are symptom complexes characteristic of pregnant women with a persistent increase in pressure and excretion of protein in the urine.

Eclampsia, as a more serious complication, is characterized by the occurrence of convulsive seizures in the expectant mother. In their absence, preeclampsia has a lack of functioning of some organs, which makes it difficult for a pregnant woman to function normally.

In accordance with this clinical picture, the classification of hypertension by degrees is simplified:

• moderate;
• heavy.

This allows you to decide on the tactics of pregnancy, compensated treatment, method of delivery.

Pregnancy with severe hypertension has an increased risk of hemorrhage in the mother's brain. Moreover, an acute condition occurs at the time of childbirth or in the first hours after them. The culprit is hemorrhagic bleeding against the background of a sharp rise in systolic blood pressure or both.

The optimal level of this diagnostic component immediately after childbirth is set at around 150/90 mm Hg. Art.

A woman should be evaluated for target organ damage in hypertension during pregnancy. If, after three months, the mother's blood pressure does not return to normal, the diagnosis of "gestational hypertension" is replaced by "hypertension".

The pressure can also normalize, then arterial hypertension receives the status of a transient pathological process.

Statistical data reflect that gestational pathology goes away rather slowly. After three months from the moment of birth, it is rare for any of the mothers to fully recover so that the cardiovascular system begins to work as before. Even after six months, patients have high blood pressure, so a second pregnancy is undesirable for new mothers for about two more years.

To prevent acquired hypertension from becoming chronic, women after delivery undergo the following examination:

• Examination by a general therapeutic specialist.
• If necessary, consultation with an ophthalmologist, endocrinologist, cardiologist.
• Monitoring of blood pressure during the day, ultrasound of the heart, kidneys, large vessels.
• Laboratory study of blood, urine, biochemical study of the lipid spectrum.

If the patient during pregnancy has not been examined for secondary hypertension, studies are carried out to clarify the etiology of the disease. Hormonal changes during childbearing can “disguise” some diseases, and may exacerbate hidden pathologies.

Therapeutic tactics

Arterial hypertension in women during the physiological state of pregnancy requires special treatment tactics and careful selection of the drug. The pharmacological range of drugs in patients of this kind is significantly narrowed, often drugs are used that have lost their relevance in other therapeutic groups.

Clinical trials of drugs for pregnant women are ethically limited.

A number of drugs are strictly defined that cannot be used in any period of the gestational period:

• ACE inhibitors;
• angiotensin II receptor antagonists.

Preparations of this series adversely affect the condition of the fetus:

• There is a general delay in intrauterine development.
• The ossification of the skull is broken.
• Limbs tend to shorten.
• All types of renal failure are possible.
• Possible fetal death.

During the monitoring of hypertension, doctors have established a drug for this category of patients - Methyldopa. The drug is equally safe for mother and child, and also produces the maximum therapeutic effect. The active substance of the drug crosses the placental barrier, but has no side effects. The blood supply to the uterus against the background of the medication remains adequate, the hemodynamics of the child also remains stable.

Arterial hypertension is successfully compensated almost instantly with modern drugs, which is not typical of Methyldopa.

In addition, long-term use of the drug entails:

• the risk of developing depression;
• sleep disorders;
• deviations in behavior.

Reception of all medicines is coordinated with the doctor!

Innovative developments have made it possible to identify agents with an extensive organoprotective effect, which is not characteristic of Methyldopa. Pregnancy is usually accompanied by the accumulation of fluid in the body and the difficulty of its outflow, which further enhances the alpha-agonist. The toxicity of the active substance is also applicable to the bone marrow, which reacts to this with an anemic syndrome, which is characteristic even of absolutely healthy women. For a long time of using Methyldopa, anemia develops in newborns, which can be aggravated by the phenomenon of hypotension.

Arterial hypertension during pregnancy can be successfully compensated by Labetalol. Foreign researchers assure of its safety for the mother and fetus, the restoration of hemodynamic parameters necessary for the normal course of pregnancy, the formation of the fetus according to the gestational age, and the timely onset of childbirth. The time of use of the drug is not limited if women do not develop side effects due to individual intolerance.

For rapid relief of a sharp rise in pressure, a calcium antagonist, Nifedipine, is usually used. All drugs of this series are used with caution in view of the likely teratogenicity. For Nifedipine, this effect was not observed, and its ability to normalize blood pressure in a short time extends to any severity of the disease. The drug has the effect of lowering uterine blood flow, so the drug should be taken strictly under stationary conditions.