Hypertension is one of the most frequent and most serious problems during pregnancy. It is one of the manifestations of pre-eclampsia - a condition whose severe form can lead to the death of the mother, as well as to violations of fetal development and premature birth. Identifying early signs of preeclampsia can save a woman's life.
Types of hypertension in pregnancy
Pre-eclampsia and other conditions, accompanied by an increase in blood pressure, are detected in about 10% of the primipara. However, for most pregnant women, hypertension does not cause significant discomfort, except that they have to undergo a medical examination at the end of the pregnancy.
There are three main types of hypertension in pregnant women:
- pre-existing hypertension - complicates a normally occurring pregnancy; sometimes an increase in blood pressure is first diagnosed during pregnancy;
- Gestational hypertension - develops on the background of pregnancy. In this case, there is no protein in the urine, and blood pressure completely returns to normal within six weeks after delivery;
- pre-eclampsia - increased blood pressure has a pathological effect on other body systems; usually accompanied by the appearance of protein in the urine.
Preeclampsia can have serious consequences that threaten the life of both the future mother and the fetus. With increasing blood pressure, a pregnant woman needs emergency treatment in order to prevent the development of eclampsia, which is accompanied by convulsions and coma. Early detection of signs and timely treatment can prevent the development of eclampsia. Usually it is accompanied by the following symptoms:
- the appearance of flashes of light, stripes, "flies" in front of the eyes, darkening in the eyes;
- photophobia;
- headache;
- pain in the upper abdomen or in the right upper quadrant;
- vomiting;
- general malaise.
With an increase in blood pressure, it is important to determine the cause and assess the severity of hypertension. Hospitalization for this is usually not required, but sometimes there is a need for additional research. There are several risk factors for the development of preeclampsia:
- first pregnancy;
- the presence of pre-eclampsia in previous pregnancies;
- age younger than 20 or older than 35 years;
- low growth;
- migraine;
- cases of preeclampsia or eclampsia in women in the family;
- pre-existing hypertension;
- lack of body weight;
- multiple pregnancies;
- The presence of concomitant diseases, such as systemic lupus, diabetes mellitus and Raynaud's disease.
In some pregnant women, the typical symptoms of hypertension are absent, and the increase in blood pressure is first detected by the next examination in a women's consultation. After a while, a repeated control measurement of blood pressure is carried out. Normally its indices do not exceed 140/90 mm Hg. st., and a stable increase is considered a pathology. Urine is also analyzed for the presence of protein with the help of special reagents. Its level can be designated as "0", "traces", "+", "+ +" or "+ + +". The indicator "+" or higher is diagnostically significant and requires further examination.
Hospitalization
If the arterial blood pressure remains high, an additional in-hospital examination is performed to determine the severity of the disease. For accurate diagnosis, a 24-hour urine sample with a protein level measurement is performed. Excretion in the urine of more than 300 mg of protein per day confirms the diagnosis of pre-eclampsia. A blood test is also performed to determine the cellular composition and the renal and hepatic function. The fetal condition is monitored by monitoring the heart rate during cardiotocography (CTG) and performing ultrasound scanning to assess its development, the volume of amniotic fluid and the blood flow in the umbilical cord (Soppler study). For some women, a more thorough observation can be organized without hospitalization, for example, visiting the day hospital of the antenatal ward, several times a week. More severe cases require hospitalization to monitor blood pressure levels every four hours, as well as planning the timing of delivery. Hypertension, not associated with preeclampsia, can be stopped with labetalol, methyldopa and nifedipine. If necessary, antihypertensive therapy can be started at any time of pregnancy. Thus, it is possible to prevent serious complications of pregnancy. With the development of pre-eclampsia, a short course of antihypertensive therapy can be conducted, but in all cases, with the exception of mild forms, the main type of treatment is artificial delivery. Fortunately, in most cases, preeclampsia develops in late pregnancy. In severe forms, premature delivery (usually by caesarean section) can be performed at an early stage. After the 34th week of pregnancy, the birth activity is usually stimulated. Severe preeclampsia can progress, turning into eclampsia attacks. However, they are extremely rare, as most women undergo artificial delivery at earlier stages.
Relapses of hypertension in case of repeated pregnancy
Preeclampsia tends to recur in subsequent pregnancies. The mild forms of the disease recur less frequently (in 5-10% of cases). The recurrence rate of severe preeclampsia is 20-25%. After eclampsia, about a quarter of repeated pregnancies are complicated by preeclampsia, but only 2% of cases again develop eclampsia. After pre-eclampsia, about 15% develop chronic hypertension within two years after childbirth. After eclampsia or severe preeclampsia, its frequency is 30-50%.