Many pregnant women face such a problem as gestational hypertension, which manifests itself in the form of an increase in blood pressure (from 140/90 mm Hg). Such a pathology usually does not pose a threat to the health and life of both the woman and her unborn child, but can cause serious complications. This pathology occurs in 8% of pregnant women, which leads in 40% of cases to metabolic syndrome, cerebrovascular accident, bleeding, retinal detachment, fetal death, eclampsia.
Description and description of the problem
Gestational arterial hypertension is an increase in blood pressure after the twentieth week of pregnancy in women who have a history of normal physiological parameters, and its normalization at the sixth week after labor.
Usually a normal pregnancy is characterized by a constancy of blood pressure, only in the second trimester its slight decrease is possible. The criterion for diagnosis is an increase in blood pressure values of more than 140/90 mm. RT Art. with three measurements of blood pressure at intervals of four hours. It is important to timely identify such a condition in order to reduce the risk of serious consequences for both the expectant mother and the fetus.
Reasons for the development of pathology
The causes of gestational hypertension can be different. Often it is provoked by the development of the following pathologies:
- Diseases of the heart and blood vessels (atherosclerosis, heart failure, arteriovenous fistula).
- Pathology of the thyroid gland.
- Severe infectious diseases.
- Diseases of the internal organs, in particular the kidneys.
- Tumors
- Mental disorders.
- VVD, hypothalamic syndrome.
- Diabetes.
- Hypertension.
Also, gestational hypertension during pregnancy can occur as a result of fluctuations in the levels of the pressor and depressive hormonal systems. Among the possible causes of the development of pathology, the following violations are also considered:
- Placental disorders, utero-placental hypoxia, violation of maternal tolerance to the placenta.
- Disorders of vascular reactivity, increased levels of cytokines, deficiency of minerals and vitamins, oxidative stress, increased production of free radicals.
- Hyperinsulinemia.
- Immunological disorders.
- Genetic predisposition.
Also, the measurement of blood pressure during pregnancy occurs under the influence of the following provoking factors:
- improper nutrition, the presence in the products of a large amount of salt; constant fatigue, lack of sleep;
- drinking caffeinated beverages;
- alcohol and smoking;
- physical and emotional overload;
- stressful situations.
Gestational arterial hypertension: classification
According to the US Department of Health, the following types of pathology are distinguished:
- Hypertension, which is not peculiar to pregnant women.
- Gestational hypertension.
- Preeclampsia or eclampsia, which is characteristic of pregnant women.
- Unclassified hypertension.
As a result, this classification was correlated with the heading ICD-10. Thus, gestational arterial hypertension according to ICD-10 has numbers O10 - O16.
WHO classifies pathology according to severity:
- The first degree is characterized by the absence of damage to target organs, blood pressure ranges from 140/90 to 159/99 mm RT. Art.
- The second degree is caused by left ventricular hypertrophy, narrowing of the vessels of the retina, proteinuria, increased creatinine in the blood, atherosclerotic lesions of veins and arteries. Blood pressure ranges from 160/100 to 179/109 mm Hg. Art.
- The third degree is characterized by the development of angina pectoris, cardiac and renal failure, impaired cerebral circulation, damage to arteries, the development of stroke, heart attack. Blood pressure ranges from 180/110 mm Hg. and higher.
Symptoms and signs
If the symptoms of gestational arterial hypertension are manifested clearly, this indicates that the disease is in the final stages of development. Signs of hypotension will depend on the presence of concomitant pathologies and its severity.
A pregnant woman experiences a jump in blood pressure. Very rarely, blood pressure indicators can, on the contrary, decrease or remain normal, which complicates the diagnosis. Typically, gestational hypertension exhibits the following symptoms:
- loss of strength, weakness;
- dizziness, nausea;
- chest pain
- sleep disturbance, tinnitus;
- development of nosebleeds;
- limb cooling;
- development of anxiety and fear;
- an admixture of blood in the urine.
Doctors distinguish several life-threatening conditions of pregnant women:
- Preeclampsia is characterized by convulsive readiness. A woman develops a headache, dry mouth, darkening in her eyes. The appearance of goosebumps in front of eyes, gestosis is not observed.
- Eclampsia is characterized by fainting and seizures. The prognosis for such a pathology is unfavorable.
Gestational arterial hypertension with normal renal function gives good predictions for both the woman and the fetus. In this case, non-drug therapy is used.
Diagnostic measures
Diagnosis of gestational arterial hypertension begins with a study of the medical history of the disease, a survey during which the presence of addictions, a tendency to obesity, and the presence of concomitant pathologies are revealed. Then the doctor palpates the abdomen, carotid arteries and thyroid gland, listens to the lungs, reveals swelling on the body.
To diagnose the disease, a number of additional examinations are necessary. First, the doctor regularly measures blood pressure using the Korotkov method, the results of which are logged in order to study the change in indicators. All measurements are carried out in the seated position of the patient, while the cuffs must be worn correctly in order to obtain accurate results.
Then carry out daily monitoring of blood pressure. Contraindication to such an examination is atonic dermatitis. The monitoring duration is about twenty-four hours.
Further, the doctor prescribes such diagnostic methods:
- Electrocardiography, in which you can detect signs of left ventricular hypertrophy.
- Echocardiography to assess hemodynamic status.
- Dopplerography for determining the state of the cardiovascular system.
- Ophthalmic examination to determine the condition of arterioles and fundus.
- Laboratory tests of blood and urine.
- Ultrasound of the kidneys, heart and thyroid gland.
The doctor also performs prenatal diagnosis using the following methods:
- Sonography of the fetus.
- Cardiography.
- Dopplerography.
- Ultrasound of the fetus.
The main attention is paid to the breathing of the fetus, its motor activity, muscle tone, the amount of amniotic fluid.
Differential diagnosis
The doctor differentiates the pathology with diseases such as chronic pyelonephritis, diffuse diabetic glomerulosclerosis, renovascular hypertension, abnormalities of the kidneys, periarthritis, as well as aortic coarctation, thyrotoxicosis, Conn's disease, Itsenko-Cushing's syndrome, encephalitis, brain tumor, ak. Differential diagnosis is carried out on the basis of a medical history and laboratory results.
Complications and consequences
The main complications in this pathology are the development of gestosis, premature birth and fetoplacental insufficiency (FPN).
It is customary to distinguish three degrees of risk of complications:
- In the first degree, the risk of negative consequences is minimal, usually complications occur in 20% of women.
- The second degree is characterized in 50% of cases by the development of gestosis, spontaneous abortion or premature birth. Often occurs fetal malnutrition.
- At the third maximum degree, most women experience complications, babies are born prematurely, and the pregnancy itself becomes life threatening to the patient. Severe gestosis develops, which is difficult to treat and usually recurs during subsequent pregnancies of a woman. The most dangerous complication is considered to be premature detachment of a normally located placenta (PONP).
Therapy
Treatment of gestational hypertension should be comprehensive. At the same time, therapy is of some difficulty, since many drugs are contraindicated for pregnant women. Often, the disease goes away on its own after labor. But this does not mean at all that a woman should wait for childbirth and endure all the unpleasant symptoms. Therefore, high blood pressure in any case must be reduced.
A doctor prescribes drugs for gestational hypertension:
- Sedatives of plant origin, for example, motherwort or valerian. It is also allowed to take drugs such as Persen, Relaxin, or Sedavit.
- Vitamins with antioxidant effects, together with omega-3 acids.
- Agonists, for example, "Dopegit" or "Dopanol." They will help lower your blood pressure.
- Antispasmodics: Papaverine, No-shpa.
- Beta-blockers, for example, Metoprolol. But these drugs are prescribed only when other drugs are ineffective.
Typically, the doctor prescribes several groups of drugs at once to normalize blood pressure. But all of them should be used strictly under the supervision of a specialist. When manifestation of negative symptoms, medication is stopped. The doctor will prescribe other means that are safe for the pregnant woman.
Gestational Arterial Hypertension: Clinical Recommendations
The attending physician prescribes a special diet. A pregnant woman should consume up to three and a half thousand calories per day, but food should be healthy. The menu should be full and varied, fasting is unacceptable. The diet includes those products that contribute to the normalization of blood pressure: nuts, carrots, sweet peppers, dried apricots, beets and others. Doctors also recommend discussing all nutritional considerations with your doctor.
The clinical recommendations are:
- avoidance of emotional stress;
- moderate physical activity;
- daytime sleep;
- control of risk factors for increased blood pressure;
- exception for obesity from the diet of foods that contain saturated fats, cholesterol and a lot of salt.
Also, all pregnant women are recommended to carry out activities aimed at changing their lifestyle:
- take a course of rational psychotherapy;
- to be in the open air for at least two hours a day;
- physiotherapy;
- hyperbaric oxygenation.
Alternative medicine
Traditional medicine can only be used with the approval of a doctor. Since some of them can cause irreparable harm to the fetus and reduce the effectiveness of drug therapy. You can take such funds:
- In equal quantities, mix lemon juice, honey, carrots and horseradish. The tool is consumed in two teaspoons twice a day, one hour before a meal.
- One tablespoon of chokeberry is poured with a glass of boiling water, insisted for about two hours, then the berries are kneading well. In this form, the drug is taken once a day, the portion can be divided into several receptions.
All these recipes play the role of adjuvant therapy and must be approved by the attending physician. Self-medication in this case is unacceptable.
Forecast and Prevention
The disease in the initial stages has favorable prognoses. Blood pressure usually normalizes after labor. But such a pathology requires therapy to reduce the manifestation of negative symptoms. After labor, a woman is recommended to undergo examination by various specialists, in particular a cardiologist, optometrist and therapist. With any deviations in health, treatment should be continued, the only way to achieve complete recovery.
In severe and neglected cases, the risk of developing serious complications increases several times, so it is important not to prevent the development of pathology, but to conduct effective therapy.
For the purpose of prevention, it is necessary to timely treat various diseases, lead a healthy and healthy lifestyle, eat right, engage in physical activity, plan pregnancy.
Gestational arterial hypertension is a fairly common occurrence among pregnant women. In some cases, it proceeds without pronounced symptoms, in others it leads to the development of negative consequences, which can even threaten the health and life of both the woman and the fetus. Therefore, it is important to comply with all the appointments and prescriptions of the attending physician, then the pregnancy will pass without complications and the woman will give birth to a healthy child. In case of non-compliance with the recommendations, the risk of premature birth and spontaneous miscarriage increases.