Hypertension in pregnancy
- Szczegóły
- Nadrzędna kategoria: ROOT
- Kategoria: Nowości
- Opublikowano: poniedziałek, 15.05.2023, 19:00
- Odsłony: 770
Beata Niedźwiedzka
Hypertension can occur in 5 -10% of women during pregnancy. Predisposing factors are first pregnancy, maternal age below 20 or above 35, multiple pregnancies and poor socioeconomic conditions. Blood pressure during pregnancy is subject to changes. It generally decreases by 15 mmHg in the second trimester compared to pre-pregnancy values, and then increases again in the third trimester.
Arterial hypertension during pregnancy can occur as:
- hypertension present before pregnancy
- hypertension without proteinuria caused by pregnancy
- hypertension with proteinuria caused by pregnancy
- hypertension present before pregnancy with superimposed hypertension period of pregnancy with proteinuria
- hypertension unclassifiable before delivery.
Hypertension in pregnancy is a disease that still affects many women around the world. Its complications can vary, untreated it can lead to the death of the baby, the mother or both of them. That's why research is still underway around the world to find an effective treatment for the disease.
Non-pharmacologic management should be considered in pregnant women with a systolic blood pressure of 140-149 mmHg or a diastolic blood pressure of 90-99 mmHg, measured in the office setting. Depending on the level of blood pressure, gestational age and the coexistence of maternal and fetal risk factors, management includes close surveillance, restriction of activity and frequent rest in the supine position. A normal diet without salt restriction is recommended. They have not found conclusive confirmed in studies such methods of management as supplementation with calcium, fish oils or low doses of acetylsalicylic acid. Only in cases of eclampsia in a subsequent pregnancy, low doses of acetylsalicylic acid are recommended prophylactically.
https://en.wikipedia.org/wiki/Pregnancy#
With blood pressure ≥ 170/110 mHg, hospitalization of the pregnant woman is absolutely necessary.
Proponents of more vigorous measures believe that pharmacotherapy should be implemented from a value of 140/90 mmHg, while others cite 150/95 mmHg as the value requiring pharmacological treatment.
Absolutely contraindicated in pregnant women are ACE inhibitors and antihypertensives. ACE inhibitors and angiotensin II receptor antagonists.
About 10% of pregnant women worldwide suffer from various hypertension-related disorders. These include chronic hypertension, pregnancy-induced hypertension, pre-eclampsia and eclampsia. These diseases are a significant cause of disability and mortality among both mothers and their children.
Pre-eclampsia is a multi-organ disorder that occurs during pregnancy. It appears after the 20th week of pregnancy.
Pre-eclampsia is diagnosed when the following symptoms occur: an increase in blood pressure above 140/90 mmHg (measured 2 times at 4-6 hour intervals) and proteinuria >300 mg per day. The cause of the development of preeclampsia has not yet been discovered. Endothelial damage, immunological disorders and abnormal implantation of the trophoblast into the spiral arteries of the uterine muscle are considered the most likely cause.
Policies are outlined in the guidelines "The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention"
Sources:
1. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Preeclampsia (PE): A Pragmatic Guide for First Trimester Screening and Prevention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944283/
2. Pre-eclampsia
https://pubmed.ncbi.nlm.nih.gov/36797292/
3, Preeclampsia: Clinical features and diagnosis
https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis
4. Postępowanie w nadciśnieniu tętniczym u kobiet w ciąży. Zapobieganie, diagnostyka, leczenie i odległe rokowanie Stanowisko Polskiego Towarzystwa Nadciśnienia Tętniczego, Polskiego Towarzystwa Kardiologicznego oraz Polskiego Towarzystwa Ginekologów i Położników
Beata Niedźwiedzka
GdL 5/2023