What is high blood pressure (hypertension)?
'Blood pressure' is the pressure of blood on the vessel wall when blood is pumped with each heartbeat. High blood pressure is called 'hypertension'. Hypertension is diagnosed if systolic blood pressure is ≥ 140 mmHg or diastolic blood pressure is ≥ 90 mmHg.
How is blood pressure measured?
Since high blood pressure is the diagnostic criterion for hypertension during pregnancy. Accurate measurement of blood pressure is very important. Blood pressure should be measured in a sitting or semi-sitting position, with the arm to be measured at the same level as the heart. It should be measured after resting for at least 10 minutes. Two measurements should be made at least 4 hours apart and at most 1 week apart. However, if the blood pressure is high at the first measurement, the interval required for the second measurement may be shortened.
Why is hypertension important during pregnancy?
The most common health problem during pregnancy is high blood pressure ( hypertension). It is seen in 5-10% of pregnancies. It is the 3rd cause of maternal deaths worldwide, but the 2nd cause in Turkey. Severe or uncontrolled hypertension during pregnancy causes serious problems for you and your baby. In the last 20 years, the frequency of hypertension during pregnancy has been increasing due to the increase in some risk factors.
What are the problems that develop in the mother due to hypertension during pregnancy? The risk increases for the following conditions:
Abrupt placenta (premature separation of the baby's partner)
Disseminated intravascular coagulation
Acute respiratory distress
Pulmonary edema
Aspiration pneumonia
Acute renal failure
Liver damage, bleeding, failure
Cerebral hemorrhage
Stroke
Hypertensive encephalopathy
Death
Due to hypertension during pregnancy What are the problems that develop in the baby?
The risk increases for the following conditions:
Growth-development restriction
Premature birth
Low amniotic fluid
Death in the womb
Increase in the frequency of cesarean section
What are hypertension diseases during pregnancy?
Hypertension during pregnancy, its onset time and how it affects the body It is examined in 4 groups according to its effect:
Chronic hypertension
Gestational hypertension
Preeclampsia – Eclampsia
Superposed preeclampsia (preeclampsia added to chronic hypertension)
What is chronic hypertension?
High blood pressure detected before conception or before the 20th week of pregnancy is called 'chronic hypertension'. Hypertension is diagnosed if systole is >140 and/or diastole is >90 mmHg. It is due to reasons such as essential hypertension or underlying kidney or hormone diseases.
Even if you got pregnant using pre-pregnancy medication and your blood pressure is normal, you are considered 'chronic hypertensive'. Since blood pressure normally decreases in the second trimester of pregnancy, blood pressure may remain normal in patients with chronic hypertension during this period. There is high blood pressure that persists beyond 12 weeks after birth.
It is classified as mild (≤ 179/109 mm Hg) and severe (≥ 180/110 mm Hg) according to its severity. It is more common in pregnant women of advanced maternal age. Medications should be reviewed before becoming pregnant. The safest is methyldopa. Calcium channel blockers may also be used. Angiotensin-converting enzyme (ACE) inhibitors are not used during pregnancy because they cause structural anomalies in the fetus.
The frequency of problems they cause for both the mother and the baby increases depending on the severity and duration of high blood pressure.
Chronic. due to hypertension What are the problems that develop?
Exacerbation of hypertension in my mother causes preeclampsia, congestive heart failure, intracerebral hemorrhage, acute renal failure and detachment (separation of the baby's partner before birth).
In the fetus, it causes prematurity (early birth), growth and development restriction and low amniotic fluid.
How is chronic hypertension managed?
In this group of pregnant women Laboratory tests for blood pressure, organ damage, the baby's development and amniotic fluid amount should be monitored, and the patient should be educated about the leading signs of complications and awareness should be provided regarding these. Treatment may require stopping the medication, adjusting the dosage, or adding another medication. The goal is to keep blood pressure below 150/100 mm Hg. If there is organ damage due to hypertension, such as kidney or eye involvement, then the blood pressure is desired to be below 140/90 mm Hg. However, diastole should not be lowered below 80 mm Hg. The medication used before pregnancy can be restarted within two days after birth.
What is gestational hypertension?
20. High blood pressure that develops after the first week of pregnancy or in the first 24 hours after birth is called 'gestational hypertension'. Diagnostic criteria:
• High blood pressure (systole ≥ 140 or diastole ≥ 90 mm Hg, but systole<160, diastole<110 mmHg)
• Previously normal blood pressure
• No protein in the urine
• There are no additional complaints.
The diagnosis is often made retrospectively. Patients with high blood pressure who do not develop any complaints or laboratory findings and patients whose blood pressure returns to normal in the first 3 months after birth constitute this group. Even if high blood pressure decreases after birth, these people are candidates for hypertension in the future.
Preeclampsia is a serious blood pressure disease that can affect all organs in pregnant women. If a pregnant woman with hypertension has complaints and symptoms related to the affected organ disorder or is accompanied by laboratory findings, it is called 'preeclampsia'. One of these findings is proteinuria (protein in the urine).
What is proteinuria?
Proteinuria is the presence of protein in the urine that should not normally be present. ' is called. The most commonly used method for diagnosis is the total protein amount in urine ≥ 300 mg/day. Additionally, a urine protein to creatinine ratio of ≥ 0.3 is another diagnostic method. Another diagnostic method is to have protein ≥ +1 in at least two urine samples examined with a 'dipstick' (a special paper stick dipped into the urine) every 4-6 hours. In this last method, + 1 protein = 0.3 g/l, + 2 protein = 1 g/l, + 3 protein = 3 g/l corresponds to proteinuria.
How is preeclampsia divided into?
It is divided into 'mild' and 'severe' preeclampsia, depending on the degree of laboratory findings and the severity of the complaints. Severe hypertension, platelet count below 100 thousand, creatinine >1.1 mg/dl in newly impaired kidney function tests, enzymes more than doubling in liver function tests, upper abdominal pain, headache, blurred vision and fluid accumulation in the lungs are signs of severe preeclampsia.
When does preeclampsia develop?
Preeclampsia develops after the 20th week of pregnancy. Those that develop before the 34th week are called 'early onset'. Sometimes it may develop after birth or at the time of birth. >What develops at 34 weeks is 'late onset' preeclampsia.
What are the symptoms of preeclampsia?
Clinical findings occur depending on the system involved. Ell Skin and facial swelling, headache, flies in the eyes, blurred vision, upper abdominal pain, nausea, vomiting, sudden weight gain and respiratory distress are the complaints seen in patients.
Who is at risk for the development of preeclampsia?
The following group of pregnant women are at risk for preeclampsia:
Those with chronic hypertension
Who developed preeclampsia in their previous pregnancy
First pregnancy
p>Multiple pregnancy
>Pregnancy at age 40
Obesity
Diabetes
Autoimmune diseases: Lupus, antiphospholipid syndrome
p>Kidney disease
History of preeclampsia in a close relative
IVF pregnancy
What risks increase in pregnant women who develop preeclampsia?
Those who develop preeclampsia during pregnancy, especially those who give birth prematurely, have an increased risk of cardiovascular diseases, kidney disease, heart attack, stroke and hypertension in later ages. There is a risk of recurrence in subsequent pregnancies. Additionally, 'eclampsia' or HELLP syndrome with seizures may also develop.
What is HELLP syndrome?
HELLP syndrome is a medical emergency. It can cause long-term permanent organ damage or even death. A clinical picture develops due to bleeding, increased liver enzymes, and low clotting cells.
What is superimposed preeclampsia?
Preeclampsia that develops on the basis of chronic hypertension is called 'superimposed preeclampsia'. It is sudden, persistent, progressive hypertension (≥160/110 mmHg) and/or new proteinuria and/or a progressive and permanent increase in existing proteinuria, often more than doubling.
Gestational hypertension and mild preeclampsia. How is it managed?
Both of these tables can be followed on foot. Ensure that the pregnant woman stays at home to rest and avoid stress and fatigue. ir. Strict blood pressure monitoring is done. The pregnant woman monitors herself for signs of severe preeclampsia. The mother follows the baby's movements. Depending on the complaints, the patient is called for control once or twice a week. Birth is not recommended until 38 weeks.
How is severe preeclampsia managed?
Preeclampsia carries risks for both the mother and her baby. However, it is the mother's disease. The most basic approach is delivery to detect it early and minimize risks. If the pregnancy is at term, the decision is easy: give birth. When deciding on birth, the risks that increase as a result of the continuation of the table and the risks that may develop in the baby due to premature birth are weighed. If the pregnancy is not close to term, the pregnant woman is hospitalized and closely monitored. Laboratory tests are repeated at regular intervals, the baby's development and amniotic fluid amount are monitored, the baby's blood flow values are measured, and the baby's well-being is checked. The goals of treatment are to prevent the development of eclampsia, reduce blood pressure and delay the time of birth.
How is the decision to give birth made in severe preeclampsia?
The definitive treatment of preeclampsia is birth. Medicine (corticosteroid) is administered to the mother for the baby's lung development. Birth is initiated 24 hours after this application. However, if severe findings that do not respond to treatment persist, organ failure is detected, placental abruption develops, or the baby's condition worsens, the pregnant woman is delivered without waiting.
The first choice for delivery is vaginal delivery, as lung functions are impaired in preeclampsia patients. If an emergency caesarean section is required, epidural-spinal anesthesia is preferred instead of general anesthesia
What is the postnatal management?
Eclampsia can also develop after birth, especially in the first 48 hours. Therefore, preventive treatment (magnesium sulfate) started before birth is continued. Usually the placenta separates After treatment, the situation improves quickly and dramatically. Sometimes preeclampsia and eclampsia may develop for the first time after birth, and the condition may become more severe before it improves. If severe preeclampsia symptoms develop, notify your doctor immediately. However, severe hypertension, bleeding or anesthesia-related problems may cause sequelae.
Blood pressure monitoring is continued according to the general condition of the puerperal. If you are taking blood pressure medication, your blood pressure should be 130/80 mm Hg.
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