pregnancy in hypertension

8/9/2019 Pregnancy in Hypertension

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PREGNANCY INHYPERTENSION


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Classification

There are five types of hypertensive disease:

Gestational hypertension (formerly pregnancy-induced hypertension that included transient

hypertension). Chronic hypertension

Preeclampsia.

Eclampsia.

Preeclampsia superimposed on chronichypertension.


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Diagnosis of Hypertensive Disorders

Complicating Pregnancy

1. Preeclampsia

Minimum criteria

BP 140/90 mm Hg after 20 weeks' gestation

Proteinuria 300 mg/24 hours or 1+dipstick

Increased certainty of preeclampsia

BP 160/110 mg Hg

Proteinuria 2.0 g/24 hours or 2+ dipstick

Serum creatinine > 1.2 mg/dL unless known to be previously

elevatedPlatelets < 100,000/mm3

Microangiopathic hemolysis (increased LDH)

Elevated ALT or AST

Persistent headache or other cerebral or visual disturbance,

Persistent epigastric pain


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2. Eclampsia

Seizures that mg/24 hours in hypertensive women but no

proteinuria before 20 weeks' gestation

3. Superimposed Preeclampsia (on chronic hypertension)

New-onset proteinuria 300 mg/24 hours in hypertensive women

but no proteinuria before 20 weeks' gestation

A sudden increase in proteinuria or blood pressure or platelet

count < 100,000/mm3 in women with hypertension and

proteinuria before 20 weeks' gestation


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4. Gestational hypertension

BP 140/90 mm Hg for first time during pregnancy

No proteinuria

BP returns to normal < 12 weeks' postpartumFinal diagnosis made only postpartum

May have other signs or symptoms of preeclampsia, for example,

epigastric discomfort or thrombocytopenia

5. Chronic Hypertension

BP 140/90 mm Hg before pregnancy or diagnosed before 20 weeks'gestation not attributable to gestational trophoblastic

disease or

Hypertension first diagnosed after 20 weeks' gestation and

persistent after 12 weeks' postpartum


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Pregnancy in Chronic

Hypertension

Stage Diagnostics Criteria

I There is a rise in blood pressure, but no change, but the cardiac-vascular

system, caused by arterial hypertension (no left ventricular hypertrophy on

ECG data. Changes retinopathy).

II There is a rise in blood pressure, combined with changes in the cardiovascular

system, caused by both arterial hypertension (left ventricular hypertrophy on

ECG. Angiopathy of retina), and coronary heart disease (angina) or brain

(hemodynamic disturbance of brain) but function of internal organs is notimpaired.

III Previously, high blood pressure may drop because of a heart attack or stroke.

There is significant dysfunction of the heart (heart failure), and / or brain

(stroke). and / or kidney (chronic renal insufficiency).

Classification of hypertension, used inRussia


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Classification of the degree of arterial

hypertension (WHO, 1999)

DegreeArterial Blood Pressure (mm Hg)

Systolic DiastolicI 140-159 and/or 90-99

II 160-179 and/or 100-109

III > 180 and/or > 110


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Diagnosis

Medical history, including family history.

Complaints of headaches, nose bleed, pain in

the heart region, etc. Examination: measuring blood pressure on both

hand and by repeating the measurements 5

minutes after decreasing emotional stress in

women.

ECG and fundoscopy

US, Chest X-ray, CT scan


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Clinical features

Stage I

do not feel significant physical limitations. In history, we can find complaints

of recurrent headaches, tinnitus, sleep disturbances, episodic nosebleeds.

In ECG, signs of hyperfunction of left ventricular can detect. Changes in

eye fundus are absent. Functions of kidney id not disturbed. Stage II

constant headache, shortness of breath on physical activity is seen. this

stage of disease is characterized by hypertensive crisis. Signs of

hypertrophy left ventricle are clearly showed. In eye fundus, narrowing of

arteries and arterioles lumen is detected. Moderate thickening of their walls,

compression of veins compacted arterioles. No changes in urine analysis. Stage III

Rarely pregnant,decrease ability of this group of women to conceive.

Differential diagnosis of early stages of hypertension and gestosis, as a rule, does

not cause serious difficulties, since I and II stages of the disease there are no

changes in the urine, swelling do not occur, no hypoproteinemia, no reduction of


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Effects of Chronic Hypertension on

Pregnancy

Renal or cardiopulmonary dysfunction, Aortic

dissection at term

Superimposed Preeclampsia

Placental Abruption

Maternal Economic and Lifestyle Factors

Fetal Growth Restriction Perinatal death


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Treatment

Antihypertensive medication may be withheld or discontinued.If not, convince patient of effectiveness of therapy and goodoutcome of pregnancy. Ask patient to pay attention andcomply with strict regime of the day (work, rest, sleep) andfood. Food should be easily digestible, rich in proteins andvitamins.

Antihypertensive drugs: diuretics (dichlothiazide. spironolactone. furosemide. brinaldix)

drugs acting at different levels of sympathetic system including-and -adrenergic receptors (anaprilin/propanolol, clonidine,

methyldopa), vasodilators and calcium antagonists (apressin, verapamil,

phenytidin),

antispasmodic (dibasol, papaverine, no-spa, aminophylline).

Physiotherapy shall be selected together with drug therapy:

conversations electrons, inductothermy of feet and lower


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Contraindications

ACE inhibitors should be avoided during pregnancy,as they are associated with fetal renal dysgenesis ordeath when used in the second and third trimestersand with increased risk of cardiovascular and central

nervous system malformations when used in the firsttrimester.

Angiotensin II receptor antagonists/blockers are notused during pregnancy because they have amechanism of action similar to that of ACE inhibitors.

Diuretics do not cause fetal malformations but aregenerally avoided in pregnancy, as they prevent thephysiologic volume expansion seen in normalpregnancy. They may be used in states of volume-dependent hypertension, such as renal or cardiacdisease.


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Management algorithm for severe

chronic hypertension in pregnancy


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Hospitalization

The first hospitalization of patients is in the early period of

pregnancy (up to 12 weeks.). In stage I hypertensive disease,

pregnancy continues with regular monitoring of therapist and

obstetrician. If you have stage II disease, the pregnancy can bemaintained with the absence of accompanying disorders of

cardiovascular system, kidneys, etc. Stage III of disease is an

indication of abortion.

The second hospitalization is necessary in the period of maximum

load of cardiovascular system, i.e., in 28-32 weeks. In the antenataldepartment, conduct a thorough examination of the patient and

correction of the treatment.

The third planned hospitalization should be carried out for 2-3

weeks until presumed childbirth to prepare women for childbirth.


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Labor Management

Typically, birth takes place through the birth canal. At the

same time, I stage of labor is conducted with adequate

anesthesia with ongoing antihypertensive therapy and early

amniotomy, during severe hypertension, therapy is increasedwith ganglion blockers to decrease BP to manageable hypo-

or, rather, normo-tension.

Depends on the condition of mother and fetus, period of II

stage of labor is decrease, it is indication for perineotomy or

obstetrics forceps. In III stage of labor, preventive measures are carried out to

reduce blood loss, with the latest attempts to introduce 1 ml

methylergometrine. Throughout the act of birth, prevention of

fetal hypoxia is periodically carried out.


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THE END

pregnancy in hypertension

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