Every gynecologist in the antenatal clinic at least once a day hears the question: “How to reduce the pressure during pregnancy?”. This question is very difficult and does not have an unequivocal answer, since it consists of the following questions:
- Save or terminate a pregnancy?
- How not to harm my mother?
- How not to harm the baby?
The problem of arterial hypertension during pregnancy is, in fact, one of the cornerstones of modern obstetrics, so let’s try to figure it out.
What is hypertension?
Arterial hypertension – persistent increase in blood pressure to 140 \ 90
How to measure blood pressure?
In pregnant women, blood pressure should be measured while sitting, after 5–10 minutes of rest. It is better to use an old manometer with a “Soviet” type pear, but to use this device you need skill and experience, nor can they measure the pressure to itself – the readings will be inaccurate. Electronic tonometers are unreliable and their data are often overestimated, but for inexperienced patients this is the best choice.
It is worth remembering that sometimes when measuring blood pressure, falsely elevated results are possible:
- drinking coffee, Coca-Cola, strong tea, large amounts of chocolate before measuring,
- being in a smoke-filled room
- use of plant stimulants – lemongrass, ginseng, guarana, etc.
In the gynecologist’s office, falsely high blood pressure indicators may occur for the following reasons:
- hurried to the consultation, was a quick step,
- walking upstairs
- nervous sitting in line
- white coat syndrome.
Classification of arterial hypertension during pregnancy
- Gestational hypertension – an increase in blood pressure caused by pregnancy, without increasing protein in the urine and edema – occurs after 20 weeks of pregnancy and passes after delivery, is the body’s pathological reaction to pregnancy.
- Preeclampsia – hypertension in combination with an increase in protein in the urine (proteinuria) above 0.3 g / l and edema, occurs after 20 weeks of pregnancy and is assessed as preeclampsia in the second half of pregnancy.
- Chronic arterial hypertension – an increase in pressure that existed before pregnancy or occurred up to week 20.
- Combined preeclampsia – chronic hypertension overlaps with symptoms of preeclampsia (proteinuria and edema).
Treatment of hypertension during pregnancy
Any pregnant woman has a reasonable question: why lower blood pressure? I answer:
- the risk of premature birth and perinatal death (death of the infant during childbirth) increases significantly,
- increased risk of stroke, retinal detachment (blindness in the outcome), massive bleeding,
- Scientists have found a decrease in the intellectual level of a newborn from a mother with hypertension.
The goal of treatment is to maintain a normal level of blood pressure right up to the birth. The choice of the drug, the dosage regimen and the dose of the medication should be prescribed only by a qualified doctor, I will only describe the possible risks of the drugs, which the doctors “forget” to tell their patients:
- Methyldopa (dopegit) is the most studied and therefore the most common drug for lowering blood pressure in pregnant women. It does not have a teratogenic effect on any timing. Of the side effects observed: headache, drowsiness, weakness, nausea, constipation.
- Clonidine (clonidine) is also a fairly safe drug, but less studied than methyldopa. Side effects: dry mouth, thirst, drowsiness, depression. May cause withdrawal in a newborn, manifested by increased agitation and sleep disturbance in the first 3-5 days from the moment of birth.
- Beta-adrenergic blockers (atenolol, propranolol, metoprolol, labetalol, etc.) – do not give a teratogenic effect, but can cause intrauterine growth retardation, as well as withdrawal syndrome. Labetalol is the drug of choice from this group, as it is the safest for the fetus.
- Hydralazine (apressin) is a very popular drug in the past, but today it has faded into the background due to possible thrombocytopenia in an infant, on the mother’s side, it can cause palpitations and headache.
- Diuretics – as a hypotensive agent are not used, as they can cause a dangerous decrease in the volume of circulating blood and lack of water. Can be used when joining renal pathology or heart failure.
- Magnesium sulfate – is used as an emergency aid for crises or preeclampsia.
- Calcium antagonists (verapamil, diltiazem, nifedipine) – inhibit generic activity, especially in combination with magnesium sulfate) and can cause prolonged exposure, and therefore are canceled 2-3 weeks before delivery.
In conclusion about the indications for early termination of pregnancy in arterial hypertension:
- Chronic arterial hypertension 2 – 3 degrees (systolic blood pressure above 160