Gestational hypertension (pregnancy poisoning, gestosis)

Proven content

Gestational hypertension is defined as disease symptoms such as proteinuria, body edema and hypertension, which may occur individually or in combination. It may be activated in the second half of pregnancy, more often in women with multiple pregnancies, diabetics, hypertension or with chronic kidney disease.

What is Gestational Hypertension?

Gestational hypertension is usually the first sign of the disease. The increase in pressure above 140/90 mm Hg should be considered a pathological symptom. This complication, even in a mild form, is dangerous for both the pregnant woman and the developing fetus, which may show the features of the so-called inhibition of intrauterine development, so it grows much more slowly and disproportionately during pregnancy. In extreme cases, the mother may die, as well as the intrauterine death of the child, therefore hypertension in pregnancy should be classified as the most dangerous disease and still posing serious problems with treatment. Gestational hypertension is diagnosed in approximately 6% of pregnant women. The reasons for its formation are not fully known, but it may be caused by changes during pregnancy or diseases that appeared earlier for other reasons. Unfortunately, this condition can lead to chronic hypertension later in life. Pregnant women with diagnosed risk factors or moderate risk of gestational hypertension should be under close medical supervision. They are treated with acetylsalicylic acid, which reduces the incidence of pre-eclampsia and IUGR9-11 even twice.

Gestational hypertension – types

There are two main types of hypertension in pregnancy:

1. chronic hypertension – occurs even before pregnancy,
2. gestational hypertension – occurs during pregnancy and disappears after the baby is born.

Very high blood pressure caused by pregnancy can be:

1. pre-eclampsia – this is a sharp rise in blood pressure accompanied by proteinuria and swelling all over the body. It can be caused by uterine ischemia, CNS hypersensitivity, genetic defects, excessive uterine stretching, impaired blood flow through the placenta, epithelial damage and hypervolaemia. The risk factors related to pregnancy include: diabetes mellitus in pregnant women, impaired trophoblast proliferation, multiple pregnancy, generalized fetal edema and urinary tract infection. Women with pre-eclampsia develop vision problems, vomiting, headaches and photosensitivity. In addition, an increase in peripheral vascular resistance is observed, moreover, the circulating blood volume and the stroke volume of the heart are significantly lower.

2. eclampsia – that is, tonic-clonic seizures, caused by damage to the central nervous system. They occur in women who previously had symptoms of pre-eclampsia (mainly proteinuria, hypertension and edema). The presence of high blood pressure in a pregnant woman is not only a threat to the life of the baby, but also the mother. In extreme cases, brain hypoxia occurs. Eclampsia may have a tendency to recur, with a markedly worsening condition

prognosis.

3. pre-eclampsia accompanied by chronic hypertension.

A higher risk of gestational hypertension may be due to a genetic predisposition. As part of diagnostics, you can perform genetic tests for cardiovascular diseases directed to women planning pregnancy, which consist in blood analysis for the PAI-1 4G / 5G mutation.

The HELLP team

This ailment is characterized by the presence of three most important features: haemolysis, thrombocytopenia and increased activity of alanine and aspartate aminotransferases. Symptoms such as pain in the right hypochondrium, headache, nausea and vomiting, proteinuria, edema and diastolic blood pressure greater than 110 mmHg are observed in pregnant women with Hellp Syndrome. In extreme cases, the ailment causes liver failure and full-blown intravascular coagulation syndrome. In women over 34 weeks of pregnancy, there are indications for its termination within XNUMX hours (natural or surgically). On the other hand, in women with a less advanced pregnancy, steroid therapy is introduced, aimed at accelerating the maturity of the fetal lungs. Pregnant women with HELLP syndrome are at risk of eclampsia.

Gestational hypertension – management

Women with gestosis do not require hospitalization, so treatment may be outpatient. In case of gentle blood pressure must be monitored more than once a week, but there is no need for antihypertensive treatment. In order to check the pressure level regularly, it is worth buying your own blood pressure monitor, which will always be at hand. Order PRIME + NOVAMA upper arm blood pressure monitor with ESH and IHB for pregnant women today.

In addition, it is important to have a urine test at each visit. Pregnant with hypertension moderate also do not require a hospital stay, but they already use preparations to lower the pressure, usually methyldopa or nifedipine. Such severe patients require more frequent blood pressure and proteinuria evaluation. Diagnostics is often extended to include electrolytes, kidney function, blood counts, and the activity of transaminases and bilirubin.

Important! In women with mild to moderate gestational hypertension diagnosed before 34 weeks gestation, it is necessary to monitor the fetus by ultrasound. It assesses amniotic fluid volume, fetal growth, and umbilical artery blood flow.

In the case of severe gestational hypertension, hospitalization is required, especially when the pressure is 160/110 mmHg or higher. During the hospital stay, the patient is administered antihypertensive preparations aimed at keeping the blood pressure below 150 / 80-100 mm Hg, the pressure is monitored several times a day. Once a week, blood counts, electrolyte tests are performed, and kidney function is assessed for proteinuria. If the treatment was effective – the pregnant woman is discharged from the hospital with the recommendation to measure blood pressure and control proteinuria twice a week until delivery. Childbirth is vaginal, unless there is severe hypertension that is unresponsive to any treatment, in which case a caesarean section is necessary.

Gestational hypertension can also be minimized with a proper diet. Pregnant women should exclude processed products from their diets, such as fast food and those containing a large amount of salt. It is not recommended to eat smoked and canned products. Remember that overweight and obesity raise blood pressure.

In postpartum women, antihypertensive treatment should be continued, drug doses are reduced depending on the blood pressure. On the other hand, in women with gestational hypertension who were not treated during pregnancy, the therapy is initiated after delivery.

Drugs used in the treatment of gestational hypertension

1.methyldopa – is one of the best-studied antihypertensive drugs in pregnant women. Neither harmful nor teratogenic effects of this drug have been observed. Methyldopa acts centrally, taking the place of adrenaline and norepinephrine in the central nervous system and peripheral endings. It lowers peripheral resistance by stimulating presynaptic inhibitory α2 receptors;

2. nifedipine – the most commonly used drug in the treatment of gestational hypertension, it is administered as an emergency in the case of a pressure of 180/120 mmHg in order to lower it. Low doses are usually used, with blood pressure checked every 15-30 minutes. There are risks involved in lowering blood pressure too quickly and too much in a pregnant woman

a sharp decrease in uteroplacental flow, fetal heart dysfunction, hypoxia and even intrauterine death of the child;

3. labetalol – a more and more commonly used drug, intended mainly for women in the third trimester of pregnancy and in the perinatal period. Its action reduces peripheral resistance with a minimal impact on the cardiac output. Labetalol lowers blood pressure more slowly than nifedipine, without increasing the heart rate, so the risk of hypotension is lower than with intravenous administration of hydralazine;

4. dihydralazine – until recently, it was used in acute hypertension in pregnant women. However, it can cause tachycardia in the fetus and adversely affect the uteroplacental flow. However, administration of this preparation may induce hypotension in a woman with severe pre-eclampsia who is hypovolemic.

Prevention of gestational hypertension

In addition to systematic medical control, it plays an important role in preventing gestational hypertension proper diet pregnant woman, with the correct supply of proteins, vitamins and bioelements, especially calcium and magnesium, rational rest and spending time in the fresh air. The basic element in the prevention and treatment of mild gestational hypertension is lying down, a diet low in salt but high in protein. If you feel unwell, your blood pressure has increased or you notice symptoms such as problems with your vision or spots in front of the eyes, headaches or dizziness, clearly increasing swelling, low urine output or abdominal pain are an indication for immediate contact with a doctor and hospitalization. The most severe form of gestational hypertension is eclampsia, accompanied by loss of consciousness and seizures. It most often occurs during childbirth and requires treatment in a hospital ward.

A pregnant woman should monitor her blood pressure every day, so it is worth having her own blood pressure monitor. We recommend a sphygmomanometer with a TM-Z / S stethoscope or a wrist sphygmomanometer KTN-01 KARDIO-TEST in a case, which allows you to easily measure the pressure yourself.