Blood pressure (BP) in the body forces blood to move through the vessels and supply organs and tissues with nutrients. The force of pressure on the vessels is measured in millimeters of mercury (mmHg). Upper, or systolic, pressure is a condition in which the heart muscle is absolutely compressed to further pump blood through the vessels. The lower pressure, diastolic, is an indicator of complete relaxation of the heart muscle. Upper pressure readings from 90 to 120 mm Hg are considered normal. Art. Blood pressure up to 130/80-60 is allowed. But during pregnancy, these norms sometimes deviate. Arterial hypertension in pregnant women, just like diagnosed hypertension in pregnant women, occurs for several reasons.

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

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

1. Heredity. The doctor finds out whether any of the relatives suffer from hypertension and the level of blood pressure before pregnancy.
2. The woman's age. After 30-35 years of age, there is a greater chance that hypertension may develop during pregnancy.
3. Order of pregnancy. The doctor analyzes the characteristics of previous pregnancies to get an overall picture.
4. Interval between births. A period of two years is considered optimal. If the body has not had time to rest from a previous pregnancy, the likelihood that a woman will develop gestational hypertension or hypertension increases many times over.
5. Multiple births. Hypertension in pregnant women with multiple pregnancies almost always occurs, but usually disappears immediately after birth. Exception: if the woman previously suffered from hypertension.

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

Hypertension in pregnant women is often provoked by concomitant diseases:

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

Classifications of hypertension during pregnancy

Arterial hypertension during pregnancy is classified into the following types:

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

In moderate to severe forms of the pregnant patient, hospitalization or bed rest, drug treatment to preserve the fetus are indicated.

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

If the diagnosis is made before 34 weeks, the patient is prescribed corticosteroids to accelerate lung development in the fetus, followed by premature delivery.

1. Preeclampsia is an increase in blood pressure in the second and third trimesters of pregnancy. It is a complication resulting from the persistence of high blood pressure during pregnancy, characterized by the appearance of swelling and protein in the urine. Later, kidney failure, brain damage, and seizures like epilepsy appear. Doctors call the main cause of gestosis a large weight gain in pregnant women. That's why doctors regularly weigh expectant mothers during appointments. The danger is that the vessels of the placenta during gestosis are damaged due to the accumulation of excess fluid and edema, and the fetus does not receive enough oxygen and nutrition, the condition develops into the next form.
2. Eclampsia. This form is extremely dangerous and is the leading cause of death among pregnant women. A pregnant woman experiences convulsions as in epilepsy and loses consciousness.

Symptoms of hypertension in pregnant women

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

• severe pain in the head, upper peritoneum, dizziness;
• blurred vision, fear of light, tinnitus;
• sudden nausea turning into vomiting;
• increased heart rate - tachycardia;
• weight gain due to fluid retention;
• shortness of breath, weakness;
• nosebleeds;
• liver dysfunction, resulting in dark stool and yellowing of the skin;
• facial redness due to flushing;
• a decrease in the level of platelets in the blood due to poor clotting. Visible from blood test;
• mental disorders: the appearance of fear of death, anxiety.

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

When you inhale deeply, the chest rises slightly, and when you exhale forcefully, it contracts. In a pregnant woman, a growing belly does not allow the chest to contract normally, which causes an increase in blood pressure. The heart muscle has to work harder to deliver oxygen to all organs, including the placenta.

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

Diagnosis of pregnant women with high blood pressure

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

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

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

Treatment and contraindications

Drug treatment in pregnant women is limited to adjusting antihypertensive therapy. Pregnant women cannot take the usual medications that lower blood pressure, so they are not prescribed ATP inhibitors: Captopril, Enalapril.

Also, during pregnancy, you should not take angiotensin II receptor blockers: Valsartan, Losartan, as their teratogenic properties cause pathologies and fetal deformities. For the same reason, due to its teratogenic effect, the drug Diltiazem is contraindicated.

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

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

Drug treatment of pregnant women in case of emergency care with blood pressure levels from 140/90 mm Hg. Art.:

1. "Nifedipine" (10 mg): under the tongue, one tablet. It is recommended to take up to three pieces per day. During administration, you must be in a supine position due to possible dizziness after taking the medicine.
2. “Magnesia”, or magnesium sulfate, is given intravenously, sometimes after a rapid infusion a dropper is placed into a vein. Anticonvulsant with hypotensive effect. The dosage is prescribed only by a doctor.
3. “Nitroglycerin” – intravenously, by dropper, by slow infusion. Rarely used if other medications do not help. A strong vasodilator with a hypotensive effect.

Non-drug treatment for pregnant women comes down to early registration: up to 12 weeks. By this time, the issue of maintaining or terminating the pregnancy is usually decided. With late calls, the issue of interruption becomes problematic. Subsequently, the patient's blood pressure is measured in both arms at each visit. antenatal clinic. If a pregnant woman has arterial hypertension, it is recommended to keep a daily diary, where she should record her blood pressure and pulse in the morning and evening. When taking the medicine, it is necessary to count the number of daily urinations.

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

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

In case of stage II hypertension (up to 160/95 mm Hg), pregnancy is left under the careful supervision of a specialist. But this is possible if there are no concomitant diseases: diabetes, heart rhythm disturbances, kidney diseases.

If stage II hypertension cannot be corrected or stage III develops, this is a reason to terminate the pregnancy.

The second stage of hospitalization is carried out at 28-32 weeks. A pregnant woman is placed in the cardiology department to assess compensatory cardiac activity. At this stage, the vascular bed is maximally loaded with fluid; in the case of an unstable state of the cardiovascular system, the issue of early birth is resolved.

The third stage of hospitalization occurs approximately two weeks before birth. At this time, the issue of the method of obstetric care is decided, and the risks for the mother and baby are assessed.

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

Preventive actions

Pregnancy and concomitant hypertension is a serious test for a woman’s body. Ignoring symptoms and hoping that “everything will go away” is irresponsible.

As with any disease, with arterial hypertension or hypertension it is necessary to follow preventive measures:

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

It is important to remember that self-medication of pregnant women with arterial hypertension or hypertension is strictly contraindicated. Improper use of medications leads to the development of complications: eclampsia, preeclampsia, which ranks first among the causes of death in pregnant women.

Changes in the body of a pregnant woman normally lead to a decrease in blood pressure. Under the influence of placental estrogens and progesterones, blood vessels lose sensitivity to the hormone angiotensin-II. They are in an expanded state, their resistance to blood flow decreases. This is necessary for normal height vessels of the placenta and providing nutrition to the fetus.

Therefore, in the first trimester, the pressure decreases from the original by 5-15 mm Hg. Art., falls a little more in the second. And in the third there is a return to the physiological norm. But in some women, conception occurs against the background of high blood pressure or hypertension occurs during pregnancy. This condition is dangerous for the mother and the fetus.

In what cases can we talk about hypertension?

In pregnant women, arterial hypertension is diagnosed in 4-8% of all pregnancies. Despite such a small percentage of the disease, it ranks second among the causes of maternal mortality. Therefore, the disease must be detected and treated promptly.

If pressure above normal was determined during a single measurement, then this does not mean anything. For diagnosis, several conditions must be met:

1. Increase in blood pressure to 140/90 mm Hg. Art. and higher.
2. Increase in indicators in comparison with the period before pregnancy: systolic by 25 mm Hg. Art., diastolic - by 15 mm Hg. Art.
3. Changes are determined by two consecutive measurements, between which at least 4 hours have passed.
4. Single-time increased diastolic pressure above 110 mm Hg. Art.

Hypertension in pregnant women proceeds in stages similar to conventional hypertension:

• Stage 1 – pressure from 140/90 to 159/99 mm Hg. Art.;
• Stage 2 – blood pressure from 160/100 to 179/109 mm Hg. Art.;
• Stage 3 – blood pressure from 180/110 or more.

According to classification, pathology can be of several types. Depending on the date of appearance:

• Hypertension that existed before pregnancy - the woman was diagnosed with hypertension or the first signs appeared before the 20th week of gestation, symptoms of this form persist more than 42 days after birth.
• Gestational hypertension - initially normal blood pressure after 20 weeks rises to significant levels above normal.
• Preeclampsia is a combination of high blood pressure and protein in the urine.
• Existing hypertension in combination with proteinuria and gestational hypertension - the pregnant woman was diagnosed, but after 20 weeks the symptoms begin to increase, protein appears in the urine.
• Unclassifiable hypertension due to lack of information.

The course of the disease is gradual. At the initial stage, there is no damage to target organs. As the condition progresses, pathological changes in the kidneys are observed, up to renal failure. Signs of ischemia increase in the heart, angina pectoris and heart failure develop. Damage to the blood vessels of the brain, retina, and the development of atherosclerosis of the carotid arteries are also possible.

Why does blood pressure rise?

It is generally accepted that initially any hypertension has neurotic causes. This is a deep neurosis that leads to disruption of the regulation of blood vessels. The development of pathology is aggravated by existing diseases of the blood vessels, brain, and kidneys in the past. The situation is aggravated by excess weight and excessive consumption. table salt, smoking and alcohol.

The development mechanism is associated with a physiological increase in the volume of circulating blood. If there is a lack of placental 17-hydroxyprogesterone, then the high sensitivity of the vessels to the hormone vasopressin remains, they easily go into a state of spasm, which entails an increase in pressure.

Changes in the heart (hypertrophy) are aimed at compensating for the condition of hypertension, but this leads to even greater deterioration. The vessels of the kidneys are gradually affected, which further perpetuates the pathology.

What does this mean?

Hypertension and pregnancy are a dangerous combination. With high pressure, the lumen of blood vessels narrows. At the same time, already at early stages pregnancy, blood flow in the placenta is disrupted. The fetus does not receive enough nutrition and oxygen, its development slows down and, according to ultrasound results, does not correspond to the term. In some cases, disruption of blood flow ends with spontaneous termination of gestation at an early stage.

At a later stage, generalized vasospasm can lead to a normally located placenta. In most cases, with such a development of events, the child cannot be saved.

High blood pressure can develop into full-fledged gestosis. At the same time, swelling of varying degrees of severity occurs, and protein appears in the urine. The disease can progress and lead to preeclampsia or eclampsia - the appearance of seizures and loss of consciousness, even to coma.

Changes in the placenta with this pathology form placental insufficiency, which is manifested by a violation of the supply of nutrients, a delay in its development and, in severe cases, death.

What causes the pathology?

Chronic hypertension during pregnancy can be either a primary disease or secondary to the pathology of other organs. Then it is called symptomatic.

The following reasons lead to an increase in blood pressure during pregnancy:

• existing hypertension (90% of cases);
• kidney pathologies: glomerulonephritis, pyelonephritis, polycystic disease, kidney infarction, diabetic damage, nephrosclerosis;
• diseases of the endocrine system: acromegaly, hypothyroidism, pheochromocytoma, hypercortisolism, Itsenko-Cushing's disease, thyrotoxicosis;
• vascular pathologies: coarctation of the aorta, aortic valve insufficiency, arteriosclerosis, periarteritis nodosa;
• neurogenic and psychogenic causes: stress and nervous strain, hypothalamic syndrome;

Hypertension carries risks of damage to the kidneys, heart and brain, and impaired fetal development. But it itself can be a consequence of pathology of internal organs.

How does hypertension manifest?

Physiologically, pressure during pregnancy naturally decreases during the first two trimesters, and only by the time of birth it returns to its normal state. But with existing hypertension, pressure can behave differently. In some cases, it decreases and stabilizes. But the condition may also worsen - increased blood pressure, swelling and proteinuria.

When visiting a doctor, women may complain of increased fatigue and headaches. Sometimes the following symptoms bother you:

• sleep disorders;
• rapid heartbeat, which is felt independently;
• dizziness;
• coldness of hands and feet;
• chest pain;
• dyspnea;
• blurred vision in the form of flickering spots before the eyes, blurred vision;
• noise or ringing in the ears;
• paresthesia in the form of a feeling of “crawling goosebumps”;
• unmotivated feeling of anxiety;
• nosebleeds;
• rarely – thirst, frequent night urination.

Initially, the pressure increases periodically, but gradually, with increasing severity, hypertension becomes permanent.

Additional examination

It would be right to find out, even when planning a pregnancy, whether there are prerequisites for an increase in blood pressure. For those who come to the doctor after receiving positive test for pregnancy, you need to remember whether there were episodes of increased blood pressure before gestation or during the previous pregnancy. This data is necessary for the doctor to assign a risk group, to plan further management of pregnancy and carry out the necessary diagnostics, and determine methods of prevention.

Data on smoking habits is required expectant mother, existing diabetes mellitus, overweight or diagnosed obesity, imbalance of blood lipids. What matters is the presence of cardiovascular diseases in young relatives and death from them at a young age.

Arterial hypertension is a therapeutic pathology, so the gynecologist conducts examination and treatment of such women together with a therapist.

Be sure to clarify the time of onset of complaints, whether they grew gradually or appeared suddenly, and correlate this with the duration of pregnancy. Special attention is given to the weight of the expectant mother. A body mass index of more than 27 significantly increases the risk of developing hypertension. Therefore, even before pregnancy, it is recommended to lose at least 10% of weight for those who exceed this figure.

The following tests may be used during the examination:

• Auscultation and palpation of the carotid arteries - allows you to identify their narrowing;
• examination and auscultation of the heart and lungs may reveal signs of left ventricular hypertrophy or cardiac decompensation;
• Palpation of the kidneys allows in some cases to identify cystic changes;
• Be sure to examine the thyroid gland for enlargement.

If there are neurological symptoms, then they check for stability in the Romberg position.

• on two hands, and compare the result obtained;
• in a lying position, and then standing;
• examine the pulse in the femoral arteries and the pressure in the lower extremities once.

If, when moving from a horizontal to a vertical position, diastolic pressure increases, then this speaks in favor of hypertension. A decrease in this indicator is symptomatic hypertension.

Diagnostics includes mandatory examination methods and additional ones, which are used in case of disease progression or treatment failure. The following methods are mandatory:

• clinical blood test (general indicators, hemoglobin);
• biochemical blood test: glucose, protein and its fractions, liver enzymes, basic electrolytes (potassium, calcium, chlorine, sodium);
• general urinalysis, the presence of glucose, red blood cells, as well as daily protein content;

All women have their blood pressure measured at every doctor's visit. On the eve of the visit, the pregnant woman must undergo a general urine test.

Additional methods are prescribed selectively depending on the clinical picture, as well as the suspected cause of increased pressure:

• urine tests according to Nechiporenko and Zimnitsky;
• Ultrasound of the kidneys;
• blood lipid profile;
• determination of aldosterone, renin, blood sodium and potassium ratio;
• urine test for 17-ketosteroids;
• blood for adrenocorticotropic hormone and 17-hydroxycorticosteroids;
• Ultrasound of the heart;
• consultation with an ophthalmologist and examination of the fundus vessels;
• 24-hour blood pressure monitoring;
• urine test for bacteria.

The condition of the fetus is monitored using ultrasound and Dopplerography of the vessels of the placenta and fetoplacental complex.

Principles of therapy

During pregnancy, treatment for hypertension is aimed at reducing the risk of complications for the mother and.

With a slight increase in blood pressure, treatment can be done on an outpatient basis, but always with periodic visits to the doctor. The absolute indication for hospitalization is a rise in blood pressure of more than 30 mm Hg. Art. or the appearance of symptoms of involvement in the pathology of the central nervous system.

If the disease is detected for the first time, hospitalization is recommended to clarify the diagnosis and in-depth examination. This will also make it possible to determine how great the risk is of progression of the condition, its transition to gestosis or the occurrence of pregnancy complications. Pregnant women who are undergoing outpatient treatment are hospitalized, but without positive dynamics.

1. Non-drug treatment.
2. Drug therapy.
3. Combating complications.

Non-drug treatment

The technique is used for all pregnant women diagnosed with hypertension. Arterial hypertension is primarily a psychosomatic disease, a long-term neurosis. Therefore, it is necessary to create conditions in which there will be the least amount of stressful situations.

What should those who are at home do? You need to evenly distribute your daily routine, leaving time for daytime rest, or better yet, short sleep. In the evening, going to bed should also be no later than 22:00. Reduce time spent at the computer and watching TV, eliminate programs that make you nervous. It is also necessary to distance yourself as much as possible from all life situations that can provoke nervous tension, or try to change your attitude towards them from a sharp emotional one to a neutral one.

Additionally, reasonable physical activity is required. This could be walking in the fresh air, swimming or special gymnastics for pregnant women.

Both in the hospital and at home, changes in the nature of nutrition are provided. Frequent fractional meals 5 times a day, with the last meal no later than 3 hours before bedtime. Limit table salt intake to 4 g per day. It’s best to cook food without it, and add a little salt directly on your plate. For overweight women, the amount of fat and simple carbohydrates is limited. All pregnant women are recommended to increase the proportion of vegetables and fruits, grains, and fermented milk products in their diet.

For those undergoing outpatient or inpatient treatment, physiotherapeutic treatment may be prescribed:

• electrosleep;
• hyperbaric oxygen therapy;
• inductothermy on the feet and legs;
• diathermy of the kidney area.

Additionally, psychotherapeutic treatment and improvement of the general emotional state are necessary.

Treatment with medications

Tablets under certain conditions:

• pressure rises higher than 130/90-100 mm Hg. Art.;
• systolic pressure increased by more than 30 units from normal for a woman or diastolic pressure by more than 15 mm Hg. Art.;
• regardless of blood pressure indicators in the presence of signs of gestosis or pathology of the fetoplacental system.

Treatment of pregnant women is associated with the danger of the drugs influencing the fetus, therefore they are selected medicines in minimal dosages that can be used as monotherapy. Taking pills should be regular, regardless of the tonometer readings. Sometimes, having decided that the measurement results and general well-being are satisfactory, women voluntarily decide to stop taking medications. This threatens sudden jumps in blood pressure, which can lead to premature birth and fetal death.

Do not use or use as a last resort for health reasons:

• ACE blockers: Captopril, Lisinopril, Enalapril;
• angiotensin receptor antagonists: Valsartan, Losartan, Eprosartan;
• diuretics: Lasix, Hydrochlorothiazide, Indapamide, Mannitol, Spironolactone.

Preference is given to long-acting drugs. In case of ineffectiveness, combination therapy with several drugs may be used.

Drugs for the treatment of hypertension in pregnant women belong to several groups of antihypertensive drugs:

Atenolol is on the list of approved drugs, but it is used very rarely, because There is evidence that it causes fetal growth retardation. The choice of a specific drug depends on the severity of hypertension:

• 1-2 degrees - Methyldopa is considered the first-line drug, 2 lines - Labetolol, Pindolol, Oxprenolol, Nifedipine;
• Stage 3 – 1st line drug – Hydralazine or Labetolol are used intravenously, or Nifedipine is prescribed to be taken every 3 hours.

In some situations, the listed methods are ineffective, and there is a need to prescribe slow calcium channel blockers. This is possible if the benefits outweigh the risks of their use.

Additionally, treatment is aimed at correcting feto-placental insufficiency. They use agents that normalize vascular tone, improve metabolism and microcirculation in the placenta.

Treatment of complications

If gestational complications develop, treatment methods depend on the duration of pregnancy. In the first trimester, it is necessary to prevent the threat of its interruption. Therefore, sedative therapy, antispasmodics and progesterone treatment (Duphaston, Utrozhestan) are prescribed.

In the second and third trimester, correction of placental insufficiency is necessary. Therefore, drugs are prescribed that improve microcirculation, metabolism in the placenta (Pentoxifylline, Phlebodia), hepatoprotectors (Essentiale), antioxidants (vitamins A, E, C). Treatment is carried out against the background of antihypertensive therapy. If necessary, infusion therapy and detoxification are carried out.

Choosing your due date

Maintaining pregnancy directly depends on the effectiveness of the treatment. If blood pressure is well controlled, it is possible to extend gestation until the fetus reaches term. Childbirth is carried out under strict monitoring of the condition of the mother and fetus and against the background of antihypertensive therapy.

Premature birth is necessary in the following situations:

• treatment-resistant severe hypertension;
• worsening of the fetus;
• serious complications of hypertension: heart attack, stroke, retinal detachment;
• severe forms of gestosis: , ;
• premature detachment of a normally located placenta.

Natural birth is preferred; amniotomy is performed at an early stage. Pain relief and careful blood pressure monitoring are mandatory. In the postpartum period, there is a high risk of bleeding, so the administration of uterotonics (Oxytocin) is necessary.

Prevention options

It is not always possible to avoid hypertension during pregnancy, but you can reduce the risk of its development. To do this, you need to plan your pregnancy. Overweight women are advised to switch to proper nutrition to gradually lose weight. But you can’t use strict diets or fasting. After them, in most cases, the extra pounds return.

If you have diseases of the kidneys, thyroid gland, heart, or diabetes, it is necessary to stabilize the condition and select adequate therapy that will minimize the possibility of worsening the condition during pregnancy.

Women who are diagnosed with hypertension while carrying a child are recommended to be hospitalized three times during pregnancy to clarify the condition and correct the therapy.

It is important to remember about non-drug methods that are used for any form of hypertension. With a slight increase in pressure and no complications, they are sufficient to stabilize the condition. In other cases, you must strictly follow the doctor's recommendations.

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3. Determination of fetal weight. The importance of fetal anthropometric data for the outcome of pregnancy and childbirth.

1. Postpartum purulent-septic diseases. Etiology, pathogenesis, features of the course in modern conditions. Diagnosis, treatment, prevention.

2. Primary and secondary weakness of labor. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention.

3. Emergency care and intensive care for eclampsia.

1. Postpartum sepsis. Clinical forms. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention.

2. Discoordinated labor activity. Classification, etiology, pathogenesis, clinic, diagnosis, treatment, prevention.

3. Management plan for preterm birth.

1. Septic shock. Etiology, pathogenesis, clinical picture, diagnosis, complications, treatment, prevention.

2.Uterine ruptures. Etiology, classification, diagnosis, treatment, prevention. Uterine rupture.

3. Plan for the management of childbirth with heart defects.

1. Anaerobic sepsis. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention.

2. Fetal hypoxia during childbirth. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention. Fetal hypoxia.

3 degrees of severity.

3. Labor management plan for hypertension.

1. Preeclampsia. Modern ideas about etiology and pathogenesis Classification. Prevention of gestosis.

2. Bleeding in the afterbirth period. Causes, clinic, diagnosis, treatment, prevention.

3. Conditions for performing a caesarean section. Prevention of septic complications.

1. Thromboembolic complications in obstetrics. Etiology, clinical picture, diagnosis, treatment, prevention.

2. Placenta previa. Etiology, classification, clinical picture, diagnosis. Management of pregnancy and childbirth.

3. Plan for the management of labor in breech presentations.

2. Bleeding in the early and late postpartum periods. Causes, clinic, diagnosis, treatment, prevention.

3 Methods of pain relief during childbirth. Prevention of disorders of uterine contractility during childbirth.

1. Hemorrhagic shock. Degrees of severity. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention. Hemorrhagic shock.

3. Manual aids for breech presentations according to Tsovyanov. Indications, technique.

2. Endometritis after childbirth. Etiology, pathogenesis, types, clinic, diagnosis, treatment, prevention.

3. Management of pregnancy and childbirth in women with a uterine scar. Signs of scar failure. Scar on the uterus after cesarean section.

1. Fetoplacental insufficiency. Etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention. Fetoplacental insufficiency (FPI).

2. Caesarean section, indications, conditions, contraindications, methods of performing the operation.

2. Hypertension and pregnancy. Management of pregnancy and childbirth. Hypertension (HB) and pregnancy.

GB is a disease whose leading symptom is arterial hypertension (HT) of unknown etiology.

Causes.

Neurogenic theory of Lang–Myasnikov

Excess NaCl intake

Membranopathy (Postnov): defect in the transport of potassium, sodium, calcium, magnesium ions. This leads to an increase in calcium concentration, which provokes spasm of smooth muscles. This leads to an increase in OPS + spasm of cardiomyocytes, resulting in an increase in MOS.

HD complicates pregnancy, causes premature birth and perinatal fetal mortality. It is associated with 20–33% of maternal deaths.

Increased blood pressure is the main clinical manifestation of hypertension and a sign of various variants of symptomatic hypertension, including kidney disease and VS, PTB, etc.

To assess the value of blood pressure, consider the system. and diast. pressure. O diast. pressure is judged not by the disappearance, but by the muffling of Korotkoff tones, which is more consistent with direct measurement.

To assess the pressure, you need to measure it 2 - 3 times on both hands after 5 - 10 minutes. The most reliable is the lowest pressure. The fact is that an increase in blood pressure is a reaction by the woman herself to the process of measuring blood pressure, to the presence of a doctor, to hospitalization (if blood pressure is measured in the emergency room). But gradually she calms down and blood pressure approaches normal.

Due to rare asymmetry, blood pressure should be measured on both arms, in the hospital, 2 times a day (morning and evening), and in the same position (lying or sitting).

In non-pregnant women it is considered:

Increased blood pressure – 160/95 and above

Transitional 140/90 – 159/94.

In pregnant women, complications depending on hypertension begin to appear at lower pressures, increased blood pressure - over 140/90 - 130/80 mm Hg.

If you have hypertension before pregnancy, an increase in syst is considered elevated. Blood pressure at 30 mmHg, diast. Blood pressure at 15 mmHg; this blood pressure level should be recorded twice with an interval of at least 6 hours. Hypertension can be present in women before pregnancy - it is determined by taking an anamnesis, but it can also be detected for the first time during pregnancy. Pregnancy for many women is a kind of stress, accompanied by a variety of reactions, including vascular ones.

Predisposing factors.

Heredity and OGA - gestosis

Severe form of PTB in a previous pregnancy

Nephropathy III

Eclampsia

Pathogenesis.

Hypertension and stabilization of gastrointestinal tract in patients are associated with disturbances of central nervous activity and neurohumoral reactions. The clinic uses the GB (Butchers) classification:

1 tbsp. phase A– latent. Prehypertensive. There is only a tendency to increase blood pressure under the influence of emotions, cold and some factors. This is not yet a disease, hyperactivity against the background of pronounced nephropathic reactions.

Phase B – transient - the increase in blood pressure is unstable and short-term. Under the influence of rest, diet, treatment or without visible reasons Blood pressure normalizes, all symptoms of the disease disappear. The stage is reversible.

2 tbsp. Phase A– unstable. Lability of constantly elevated blood pressure. With treatment, reverse development is possible.

Phase B – sustainable. Blood pressure is stably elevated, but the functional nature of the disease remains, since there are no gross anatomical changes in the organs.

3 tbsp. Phase A – compensated. Blood pressure is persistently elevated, dystrophic and fibrosclerotic changes in organs and tissues are expressed due to arteriolohyalinosis and arteriolonecrosis + the addition of atherosclerosis of large vessels of the brain, heart, and kidneys. However, the function of the organs is largely compensated.

Phase B – decompensated. Persistent increase in blood pressure, severe impairment of the functional state of internal organs. The patients are completely disabled. GB-3 is extremely rare in pregnant women. This is due to:

Pregnancy may not occur

Application of new effective means treatment of hypertension,

According to Myasnikov's classification.

Benign headache

Malignant headache (3%)

For occlusive lesions of the renal arteries 30%

Chronic glomerulonephritis 21.9%

Chronic pyelonephritis 13.7%

Determining criteria for the malignancy of HD (Arabidze):

Extreme increase in blood pressure (over 220/130 mmHg)

Severe damage to the fundus of the eye (retinopathy)

Hemorrhages and exudate in the retina

Organic changes in the kidneys are often combined with kidney failure.

Concomitant criteria for the malignancy of GT (Arabidze):

Hypertensive encephalopathy

Acute left ventricular failure

Microangiopathic hemolytic anemia.

Blood pressure fluctuates during pregnancy: it increases at the beginning and end of pregnancy and decreases in the middle of pregnancy; during pregnancy, the course of hypertension worsens (pregnancy contributes to an increase and stabilization of blood pressure). During pregnancy, sudden exacerbations or crises may occur. Hypertensive crises are a “clot” of all symptoms. Crises develop unexpectedly against the background of the favorable state of the pregnant woman: a sharp increase in blood pressure, dizziness, nausea, vomiting, tinnitus, flashing of flies, the appearance of red spots on the face and chest. After a crisis there is proteinuria, so it is necessary to differentiate a crisis from PTB, in particular, from preeclampsia.

Objectively.

Pain in the epigastric region of a cardio-neurotic nature.

There are no signs of coronary insufficiency on the ECG.

In 30% of cases there is left ventricular hypertrophy (ECG).

Rarely - systolic murmur at the apex and accent of the second tone on the aorta (with milder degrees of hypertension without pronounced organic changes in the heart).

Cerebral pathology:

Headache in the occipital region, begins in the morning, then gradually goes away.

Dizziness - increases or disappears with excitement.

Signs of neurosis:

Increased excitability

Heartbeat

Headache

Stitching, pinching, dull pain in the heart area

Blood pressure lability

Hyperemia of the facial skin and upper half body

sweating

In 50% of patients with hypertension there are changes in the vessels of the fundus:

The majority have a type of hypertensive angiopathy (uniform narrowing of retinal arterioles and dilatation of veins)

Less commonly – Solyus’s symptom (arteriovenous decussation), Twist’s symptom (tortuosity of the veins around macular spot), signs of arteriosclerosis of retinal vessels

Rarely - hypertensive retinopathy (swelling and hemorrhages in the retina), this has prognostic significance for maintaining pregnancy, since vision deteriorates sharply.

The condition of the fundus is used to judge the effectiveness of the therapy.

In stage 2 hypertension – decreased renal blood flow

Microproteinuria (less than 0.5 g/l) (with the development of nephroangiosclerosis (rare))

Microhematuria

There is no chronic renal failure or impaired renal concentration function.

PTB of varying severity up to eclampsia – 36%. Appears at 24–26 weeks (early). Accompanied by a predominance of hypertensive syndrome with moderate edema and proteinuria. But if there is no edema and proteinuria, then there is more reason to assume the development of an exacerbation of hypertension.

In the second half of pregnancy the following are possible:

Spontaneous abortion 5.5%

Premature birth 23%

Intrauterine fetal death at 26–35 weeks 2.6%

Could be eclampsia

PONRP, bleeding in periods 3 and 4

Weakness of labor forces, untimely outpouring of water

Fetal asphyxia

Management of pregnant women(together with the therapist).

early arrival up to 12 weeks

identifying women with hypertension as a high-risk group. Risk to the woman and fetus regarding progression and complications of the disease and in relation to pregnancy.

The degree of risk depends on:

stages of the disease

forms of the disease

features of the course of hypertension that affect the health of the woman and the conditions of intrauterine existence of the fetus.

3 levels of risk:

1st degree – minimal. Pregnancy complications occur in no more than 20% of women. Pregnancy worsens the course of the disease (less than 20%). Corresponds to 1st degree of headache.

2nd degree – pronounced. Corresponds to 2 A degree GB. Pregnancy complications occur in 20–50% of cases:

Spontaneous abortion

Premature birth

Hypotrophy

Worsening of the disease during pregnancy or after childbirth in more than 20% of women.

Level 3 – maximum. Corresponds to grade 3 hypertension and malignant HT. More than 50% of women have pregnancy complications:

Rarely full-term babies

Pregnancy is a danger to women's lives

Increased perinatal mortality

AtIdegree of risk:

Nephropathy 20%

Premature birth 12%

Rare hypertensive crises

Conclusion: pregnancy is acceptable

At risk degree II:

Nephropathy 50%

Premature birth 20%

Antenatal fetal death 20%

Reasons for termination of pregnancy: - coronary insufficiency

severe hypertensive crises

blood pressure stabilization

progression of PTB

At risk degree III:

GT 2 B degree – stable, but difficult to treat

GT 3 degrees: decompensated condition of the kidneys (uremia), brain (NMC), heart (circulatory failure)

Conclusion: termination of pregnancy at any stage. Pregnancy is contraindicated!

Pregnant women should be registered with a therapist.

At risk level 1 – turnout 2 times a month. Outpatient observation. In the 2nd half of pregnancy - inpatient treatment for timely diagnosis and treatment of PTB

With risk degree 3 - careful observation in the residential complex, re-hospitalization:

1 – up to 12 weeks to clarify the diagnosis (degree of disease) and decide whether to continue the pregnancy

2 – if the condition worsens: - increase in blood pressure more than 140/90 within a week

Hypertensive crisis

Attacks of angina

Attacks of cardiac asthma

Signs of PTB

Symptoms of fetal distress.

Outpatient treatment for at least 7–10 days. The last hospitalization is 3–4 weeks before birth to decide on the timing and method of delivery and to prepare for it.

Treatment of hypertension during pregnancy.

Optimal work and rest regime

If blood pressure is high, limit NaCl intake to 5 g/day. If blood pressure is normal, the restriction is lifted, food is normal.

Treatment with antihypertensive drugs:

Better: antispasmodics, saluretics, sympatholytics do not affect the fetus (methyldopa, clonidine).

Restricted or contraindicated: rauwolfia drugs, ganglion blockers, alpha and beta blockers.

Antispasmodics

Dibazol, papaverine, no-spa, aminophylline, magnesium sulfate. Better parenteral than per os. They are used to relieve hypertensive crises, and not to treat hypertension.

Saluretics.

They have a diuretic and hypotensive effect.

Prescribed in intermittent courses with short (1 - 2 days) intervals 1 - 3 times a week, depending on individual sensitivity:

Dichlorothiazide 25 – 50 – 100 mg

Clopamid 20 – 60 mg

Oxodoline 25 – 100 mg 1 time on an empty stomach

Furosemide and ethacrynic acid are not suitable for long-term treatment due to their rapid but short-term action. Prescribed for hypertensive crises, preferably parenterally (1 - 2 ml - furosemide). To prevent hypokalemia - potassium preparations (potassium chloride). It is better to use saluretics in combination with other antihypertensive drugs to potentiate their action and with drugs that retain sodium and water (sympatholytics, methyldopa).

Natriuretics (spironolactone) – effective for hyperaldosteronism. But in patients with hypertension, the secretion of aldosterone is increased, so the effect is insignificant.

Sympatholytics.

Octazine, suobarin, sanotensin, guanethidine.

Very strong hypotensive effect. Used in hospitals for special indications. In outpatient settings - constant monitoring, because there are side effects: orthostatic collapse, dizziness, adynamia, nausea, diarrhea. Treatment begins with small doses of 1.25 mg, increasing to 50 - 75 mg.

A pregnant woman should not get out of bed abruptly, but should sit for a few minutes after sleep. It works better in an upright position, so you need to walk and sit more, rather than lie down. Stop treatment 2 weeks before CS to avoid collapse or cardiac arrest during anesthesia.

Methyldopa preparations.

Aldomet, dopegit.

Effect on central and peripheral nervous regulation of vascular tone. Dopegyt retains sodium and water. Take 0.25 2 – 4 times along with saluretics.

Clonidine preparations.

Clonidine, hemetone, catapressan.

They pass through the BBB and act centrally: they reduce heart rate and blood pressure. Effect in 80 - 90% of women with hypertension and renal failure. Clonidine is prescribed in small doses (0.15 mg), gradually increasing to 0.3 mg, is non-toxic, does not cause orthostatic hypotension.

Rauwolfia preparations.

Hypotensive, sedative effect.

Reserpine (0.3 - 0.75 mg/day), raunatin (0.006 - 0.012 mg/day) 2 - 3 times a day. Negative effects: rhinitis, bradycardia, arrhythmia, diarrhea, bronchospasm, depression, anxiety, can retain sodium and water along with saluretics.

Newborns are caused by nasal congestion, impaired sucking and swallowing, conjunctivitis, bradycardia, and depression should not be prescribed in the last weeks of pregnancy and after childbirth.

Ganglioblockers.

Pentamin, benzohexonium.

They inhibit the conduction of nerve impulses in the sympathetic and parasympathetic ganglia: the tone of the arteries and veins decreases, the blood flow to the heart decreases, the systolic output decreases, orthostatic collapse. Negative effects in a pregnant woman. Violates the autonomic innervation of internal organs, increased heart rate, dizziness, impaired accommodation, atony Bladder and intestines, the condition of the kidneys worsens.

Negative effects in the fetus: dynamic intestinal obstruction, atony of the bladder, increased secretion of the bronchial glands in newborns whose mothers are being treated.

Can be used for a short time in emergency cases (during childbirth) 1 - 2 ml of a 5% solution of pentamine intravenously under blood pressure control or in case of a hypertensive crisis that threatens the life of a woman.

Alpha adrenergic blockers.

Phentolamine, tropafene.

Block alpha-one receptors. Better than tropafen.

Beta blockers.

Anaprilin, oxprenolone.

They reduce CO and renin secretion, lower blood pressure (for the treatment of hypertension in non-pregnant women), uterine contractility increases, and pregnancy can be terminated. During childbirth, it reduces the IOC (-), anaprilin inhibits the fetal heart rate (-).

Thus, combined treatment with 2 – 3 or more drugs is better:

Clonidine – dichlorothiazide – anaprilin

Apressin – spironolactone

Octadine – dichlorothiazide

Apressin - clonidine - dichlorothiazide - methyldopa.

For hypertensive crises - IM, IV - reserpine, but not more than 2 days (side effects), it is better to combine with Lasix, Hemitone.

Magnesium sulfate (25% 10 – 20 ml) IM, IV. Effects:

Decreased blood pressure

Anticonvulsant

Sedative

Diuretic

Tocolytic.

Sedatives:

The central action is droperidol, aminazine.

Up to 16 weeks - preparations of valerian, motherwort (do not adversely affect the fetus)

After 16 weeks - minor tranquilizers: elenium, no bromides (depression of the central nervous system, fetus and chromosomal disorders), no barbiturates (depress the respiratory center of the fetus).

Physiotherapy:

Galvanization of the collar area

Endonasal galvanization up to 16 weeks

Centimeter and decimeter microwaves on the kidney area: improve renal hemodynamics, limit the effect of the renal mechanism of hypertension

Ultrasound on the kidney area (like microwaves), action in a pulsed radiation mode. Antispasmodic.

Electroanalgesia: normalization of cortical-subcortical connections, normalization of autonomic centers, for the prevention of PTB, treatment of the initial stage of hypertension.

The course of labor.

Often preeclampsia, eclampsia, increased blood loss in the 2nd stage of labor, in the first hours after birth, blood pressure drops to 90 - 105 mm Hg.

Complications of pregnancy:

Complications during childbirth:

Premature rupture of water

Bleeding in periods 3 and 4.

Management of pregnancy.

Early appearance up to 12 weeks - solving the issue of pregnancy

In the middle of pregnancy - if the condition worsens.

3 – 4 weeks before birth.

Treatment of hypertension during childbirth:

Course treatment started during pregnancy.

When pushing, blood pressure increases - parenterally: dibazol, papaverine, aminophylline. If the effect is insufficient, use ganglion blockers under blood pressure control.

Birth management plan.

Childbirth should be carried out conservatively and expectantly through the natural birth canal in the presence of an anesthesiologist and therapist with background information.

Indications for CS:

Retinal disinsertion

Progressive hypoxia

Cerebrovascular disorder.

Period 1: early amniotomy, antispasmodics in the active phase.

Rational pain relief during all periods of labor.

CTG, prevention of hypoxia.

Monitoring blood pressure every 30 minutes and antihypertensive therapy: dibazol 2% 2 ml, papaverine 2% 2 ml, previously used, aminophylline 2.4% 1 ml. Now: haloperidol - a centrally acting antispasmodic, aprofen, spazgan, spasmalgon, trigan, tromal, maxigan, baralgin, epidural block during childbirth - anesthesia + lowering blood pressure.

2nd period with a needle in a vein, washed hands. If there is no effect from antihypertensive therapy, they switch to controlled normotension with ganglion blockers (periods 1 and 2).

Pudendal anesthesia, episiotomy to speed up and facilitate the 2nd period. If blood pressure does not decrease, use obstetric forceps under anesthesia (switch off pushing).

PPC - 1 ml of oxytocin (methylergometrine is not allowed - it increases blood pressure).

DC 0.2 – 0.3% of body weight.

Postpartum period: blood pressure control 3–4 times a day and antihypertensive therapy.

This is an abnormal increase in blood pressure (BP) above standard normal or patient-specific levels, occurring before conception or associated with gestation. Usually manifested by headaches, dizziness, tinnitus, shortness of breath, palpitations, and fatigue. Diagnosed by measuring blood pressure, ECG, echocardiography, ultrasound of the adrenal glands and kidneys, laboratory tests of blood and urine. Standard treatment involves the prescription of antihypertensive drugs (selective β1-blockers, α2-adrenergic agonists, calcium antagonists, vasodilators) in combination with drugs that improve the functioning of the fetoplacental complex.

ICD-10

O10 O13 O16

General information

Complications

Arterial hypertension during pregnancy can be complicated by gestosis, placental insufficiency, spontaneous abortion, premature birth, premature abruption of a normally located placenta, massive coagulopathic bleeding, and antenatal fetal death. The high frequency of gestosis in pregnant women with hypertension (from 28.0 to 89.2%) is due to common pathogenetic mechanisms of dysregulation of vascular tone and kidney function. The course of gestosis that occurs against the background of arterial hypertension is extremely severe. It usually forms at 24-26 weeks, is characterized by high therapeutic resistance and a tendency to re-develop during subsequent pregnancies.

The risk of premature termination of gestation increases as hypertension becomes more severe and averages 10-12%. During pregnancy and childbirth, women with high blood pressure are more likely to have cerebral circulation, the retina is detached, pulmonary edema, multiple organ and renal failure, and HELLP syndrome are diagnosed. Hypertension is still the second most common cause of maternal mortality after embolism, which, according to WHO, reaches 40%. Most often, the immediate cause of a woman’s death is DIC, caused by bleeding due to premature placental abruption.

Diagnostics

Identification of complaints in a pregnant woman characteristic of hypertension and increased blood pressure during a single tonometry is a sufficient basis for prescribing a comprehensive examination, which makes it possible to clarify the clinical form of the pathology, determine the functional viability of various organs and systems, and identify possible reasons and complications of the disease. The most informative methods for diagnosing hypertension during pregnancy are:

• Blood pressure measurement. Determination of blood pressure using a tonometer and a phonendoscope or a combined electronic device reliably detects hypertension. To confirm the diagnosis and identify circadian rhythms of pressure fluctuations, daily monitoring is performed if necessary. An increase in systolic pressure to ≥140 mm Hg is of diagnostic significance. Art., diastolic - up to ≥90 mm Hg. Art.
• Electrocardiography and echocardiography. An instrumental examination of the heart is aimed at assessing its functionality (ECG), anatomical and morphological features and pressure in the cavities (EchoCG). Using these methods, the severity of hypertension is assessed based on data on myocardial hypertrophy, focal pathological changes that occur during overload, possible conduction disturbances and heart rhythm.
• Ultrasound of the kidneys and adrenal glands. A significant proportion of cases of symptomatic hypertension are associated with impaired secretion of components of the vasopressor and depressor systems in the kidneys and adrenal glands. Ultrasonography allows you to detect tissue hyperplasia, focal inflammatory and neoplastic processes. Additional ultrasound scanning of the renal vessels reveals possible disturbances in blood flow in the organ.
• Lab tests. A general urine test can detect red blood cells and protein. The presence of leukocytes and bacteria indicates the possible inflammatory nature of changes in the renal tissue. To assess the functionality of the kidneys, Rehberg and Zimnitsky tests are performed. Diagnostically significant indicators are potassium, triglycerides, total cholesterol, creatinine, renin, aldosterone in blood plasma, 17-ketosteroids in urine.
• Direct ophthalmoscopy. During the examination of the fundus, characteristic hypertensive changes are revealed. The lumen of the arteries is narrowed, the veins are expanded. With a long course of hypertension, sclerosis of blood vessels is possible (symptoms of “copper” and “silver wire”). Arteriovenous chiasm (Salus-Hun symptom) is considered pathognomonic for the disease. The normal branching of blood vessels is disrupted (symptom of “bull’s horns”).

Taking into account high probability development of fetoplacental insufficiency, it is recommended to conduct studies to monitor the functionality of the placenta and fetal development - ultrasound of uteroplacental blood flow, fetometry, cardiotocography. During pregnancy, differential diagnosis of hypertension is carried out with kidney diseases (chronic pyelonephritis, diffuse diabetic glomerulosclerosis, polycystic disease, developmental anomalies), encephalitis, brain tumors, aortic coarctation, periarteritis nodosa, endocrine diseases (Cushing's syndrome, thyrotoxicosis). The patient was recommended to consult a cardiologist, neurologist, urologist, endocrinologist, ophthalmologist, and, if indicated, a neurosurgeon or oncologist.

Treatment of hypertension during pregnancy

The main therapeutic goal in the management of pregnant women with hypertension is to effectively lower blood pressure. Antihypertensive drugs are prescribed when blood pressure is ≥130/90-100 mmHg. Art., systolic pressure exceeding normal for a particular patient by 30 units, diastolic pressure by 15, identifying signs of fetoplacental insufficiency or gestosis. Treatment of hypertension, whenever possible, is carried out with a single drug in a minimal dosage with a chronotherapeutic approach to taking medications. Medicines with a prolonged effect are preferred. To reduce blood pressure during gestation, it is recommended to use the following groups of antihypertensive drugs:

• α2-adrenergic agonists. Drugs in this group bind to α2 receptors of sympathetic fibers, preventing the release of catecholamines (adrenaline, norepinephrine) - mediators that have a vasopressor effect. As a result, the overall peripheral resistance of the vascular bed decreases, heart contractions slow down, which ultimately leads to a decrease in pressure.
• Selective β1-blockers. The drugs act on β-adrenergic receptors of the myocardium and vascular smooth muscle fibers. Under their influence, the strength and frequency of heart contractions predominantly decrease, and electrical conductivity in the heart is inhibited. A feature of selective beta-adrenergic receptor blockers is a reduction in oxygen consumption by the heart muscle.
• Slow calcium channel blockers. Calcium antagonists have a blocking effect on slow L-type channels. As a result, the penetration of calcium ions from the intercellular spaces into the smooth muscle cells of the heart and blood vessels is inhibited. The expansion of arterioles, coronary and peripheral arteries is accompanied by a decrease in vascular resistance and a decrease in blood pressure.
• Myotropic vasodilators. The main effects of antispasmodics are a decrease in tone and a decrease in the contractile activity of smooth muscle fibers. Dilatation of peripheral vessels is clinically manifested by a drop in blood pressure. Vasodilators are effective in relieving crises. Typically, vasodilator drugs are combined with medications from other groups.

Diuretics, angiotensin receptor antagonists, and ACE blockers are not recommended for the treatment of hypertension during the gestational period. Complex drug therapy for high blood pressure during pregnancy involves the administration of peripheral vasodilators that improve microcirculation in the fetoplacental system, metabolism and bioenergetics of the placenta, and protein biosynthesis.

The preferred method of delivery is natural birth. With good blood pressure control, a favorable obstetric history, and a satisfactory condition of the child, gestation is prolonged to full term. During labor, antihypertensive therapy is continued, adequate analgesia and prevention of fetal hypoxia are provided. To shorten the expulsion period, perineotomy is performed or obstetric forceps are applied according to indications. In case of high therapeutic refractoriness, the presence of serious organ complications (heart attack, stroke, retinal detachment), severe and complicated gestosis, or deterioration of the child’s condition, delivery is carried out ahead of schedule.

Prognosis and prevention

The outcome of gestation depends on the severity of hypertensive syndrome, the functional state of the fetoplacental complex and target organs, and the effectiveness of antihypertensive treatment. Taking into account the severity of the disease, specialists in the field of obstetrics distinguish 3 degrees of risk of pregnancy and childbirth. With mild hypertension with signs of the hypotensive effect of gestation in the first trimester (risk group I), the prognosis is favorable. In pregnant women with mild and moderate hypertension without a physiological hypotensive effect in the early stages (risk group II), more than 20% of gestations are complicated. With moderate and severe hypertension with a malignant course (risk group III), complications are detected in more than half of pregnant women, the likelihood of having a full-term baby is sharply reduced, and the risk of perinatal and maternal mortality increases.

To prevent hypertension, women planning pregnancy are advised to reduce excess weight, treat detected somatic and endocrine pathologies, and avoid stressful situations. Pregnant patients with hypertension are considered an increased risk group for clinical observation and specialized treatment by a therapist with at least 2-3 examinations during the gestational period.

According to statistics, arterial hypertension during pregnancy occurs in 10-12% of women. During this period, the disease develops rapidly and can progress without the correct course of treatment. This disease cannot be ignored, because it can cause the development of pathologies in both the expectant mother and the baby inside the womb. Therefore, it is important to recognize the first “signals” and consult a doctor in a timely manner.

During pregnancy, a woman experiences hormonal changes in her body. At this point, problems with blood pressure may also appear. It may decrease or increase, but this phenomenon is most often temporary and after childbirth the indicators return to normal.

Pregnancy is a colossal burden on the body, which can also cause problems with blood pressure.

An increase in blood pressure usually occurs during later(third trimester). This is due to excessive load on the kidneys, resulting in fluid retention in the body. This increases the load on the heart muscle, which can cause increased blood pressure.

We can talk about hypertension when high systolic pressure (over 135-140 mm Hg) is constant and there is a hypertensive syndrome, which includes a number of different symptoms.

What are the dangers of hypertension during pregnancy?

Hypertension in most cases aggravates the course of pregnancy and is dangerous due to the fact that:

• Placental abruption occurs;
• The tone of the uterus increases;
• Metabolic functions and blood circulation are disrupted;
• It is difficult for the required amount of nutrients to reach the placenta.

These phenomena can subsequently lead to oxygen starvation of the fetus (hypoxia), premature birth, and in severe cases of hypertension, the death of the baby inside the womb is possible.

In addition, high-risk pathology can cause uterine bleeding and the development of uterine hypertension during pregnancy (at any stage).

Important! If the pathology is not treated, it often leads to very serious consequences. That is why it is important to consult a doctor in time and begin the prescribed course of treatment. This will help maintain pregnancy and protect the baby inside the womb from the development of complications incompatible with life.

Causes of hypertension in pregnant women

The reasons that influenced the onset of the disease can be both hereditary and physical factors. Most often, arterial hypertension during pregnancy is diagnosed due to the occurrence of hypertension before the conception of the child. Also to largest group at risk include women who have:

• Excess body weight;
• Diabetes;
• Hormonal disbalance;
• Vegetovascular dystonia;
• Kidney dysfunction;
• Disorders of the nervous and cardiovascular system.

Other causes may include bad habits, genetic predisposition, poor diet and excessive salt consumption.

Classification of hypertension in pregnant women

In medicine, there are several types of hypertension during pregnancy:

Type	Peculiarities
Gestational hypertension	Develops directly during pregnancy (in later stages). The causes of gestational hypertension during pregnancy could be disturbances in the functioning of various organs, genetic predisposition, multiple pregnancies, toxicosis, etc. In some cases, drug treatment is required, most often the problem is eliminated after the birth of the child.
Chronic	Hypertension that was diagnosed before the child was conceived. High blood pressure in this form is usually permanent. With hypertension of the first degree of risk and compliance with all doctor’s recommendations, no complications during pregnancy most often occur. If hypertension has entered the second stage, then constant monitoring by a specialist is required, and, if necessary, medication.
Preeclampsia	The condition is dangerous for both the expectant mother and the child. With this pathology, disturbances in cardiovascular system, kidneys and brain cells. The blood pressure in this condition is consistently elevated, and treatment requires hospitalization.
Eclampsia	Pressure during eclampsia can reach levels that become life-threatening for the mother and child. Most often, eclampsia is accompanied by convulsive syndrome, loss of consciousness and other dangerous pathologies. In addition, there is a risk of cerebral hemorrhage, premature placental abruption, and pulmonary edema. IN in this case Urgent hospitalization of the woman is required, as the slightest delay can cost her life.

Any deviation during pregnancy should not be ignored. If high blood pressure is accompanied by any symptoms, you should immediately consult a doctor and undergo the necessary examination.

Symptoms of high blood pressure

Depending on the course of the disease, symptoms may vary. The more complex the pathology, the more serious the side effects.

• With gestational and chronic hypertension, a woman may experience dizziness, regular headaches, breathing problems, pain in the chest, and general weakness. Most often, symptoms intensify with a sudden change in body position or after physical exertion (even minor);
• If a woman has been diagnosed with preeclampsia, then the above symptoms may be accompanied by nosebleeds, heart rhythm disturbances, increased anxiety, sleep disturbances and a feeling of panic;
• Eclampsia is accompanied by more severe symptoms such as lightheadedness, shortness of breath, convulsions, trembling of fingers, clouding of consciousness, loss of orientation in space.

Any form of hypertension is accompanied by persistent high blood pressure. Moreover, in some cases it cannot be normalized until the main cause that influenced the development of the pathology is eliminated.

The main sign of arterial hypertension is high blood pressure, which is why blood pressure is monitored at every appointment with a gynecologist.

Diagnostics

At each scheduled appointment, the doctor measures the pregnant woman’s blood pressure and compares the data with previous measurements. If blood pressure is elevated, the specialist can prescribe the necessary diagnostic measures to eliminate the risk of developing pathology.

The main diagnostic measures include:

• General blood and/or urine test;
• Electrocardiography of the heart;
• Ultrasound examination of the kidneys.

Also, to make an accurate diagnosis, 24-hour blood pressure monitoring and an examination by an ophthalmologist to examine the fundus may be prescribed.

Features of treatment

If the disease is mild, then measures such as:

• Diet therapy;
• Normalization of sleep and rest patterns;
• Limiting salt intake;
• Elimination of stressful situations;
• Taking vitamin complexes (in consultation with your doctor);
• Aromatherapy (if there are no contraindications);
• Walks in the open air.

Pregnancy with stage 2 hypertension should be under the supervision of a specialist. In this case, drug treatment is usually required. The list of drugs is small, but it is still possible to choose a course of therapy. In the early stages, medications with a sedative and hypotensive effect, hormones, and antispasmodics are most often used.

In the second trimester, with gestosis, as an addition to antihypertensive drugs, hepatoprotectors (to normalize liver function), immunomodulators and tablets for restoring cell membranes can be prescribed.

Treatment of hypertension during pregnancy in the third trimester most often involves the use of drugs for high blood pressure and drugs to improve the functioning of the central nervous system.

Important! During pregnancy, you should never self-medicate. Many drugs have serious contraindications and can harm both the body of the woman and the baby. That is why only a doctor can recommend what to do and how to improve your well-being.

Choosing your due date

Unfortunately, the disease does not always proceed without complications and in some cases doctors may recommend early delivery. This may happen if:

• Serious complications have appeared that are life-threatening for the expectant mother and/or child;
• Fetal hypoxia inside the womb was diagnosed;
• The condition of preeclampsia or eclampsia develops.

Childbirth with mild hypertension most often occurs without complications. For heart failure, in most cases it is prescribed C-section, as there is a risk of stroke and other dangerous complications.

Preventive measures

To avoid hypertension during pregnancy, a woman must carefully monitor her lifestyle. To do this you need:

• Control your body weight;
• Eat foods rich in proteins and microelements;
• Refuse bad habits, coffee and strong black tea;
• Monitor sleep, rest and nutrition patterns;
• Limit salt and liquid intake.

If hypertension was diagnosed before pregnancy and there is a doctor’s prescription, then you cannot stop taking medications or change dosages on your own. You should also avoid stressful situations and perform a number of simple physical exercises (if there are no contraindications).

In the first stage, the prognosis is usually favorable. If the disease has become severe, then protect yourself and your baby as much as possible from negative consequences Recommendations from a specialist will help, as well as compliance with preventive measures.