Topic 3 Hypertension in pregnancy and its classification
Hypertension during pregnancy is a pathological increase in blood pressure (BP) above standard normal or characteristic for the patient indicators, which occurred before conception or associated with gestation. Usually manifested by headaches, dizziness, tinnitus, shortness of breath, palpitations, rapid fatigue. It is diagnosed by measuring blood PRESSURE, ECG, EchoCG, ultrasound of the adrenal glands and kidneys, laboratory tests of blood and urine. Standard treatment involves the administration of antihypertensive drugs (selective β1-blockers, α2adrenomimetics, calcium antagonists, vasodilators) in combination with agents that improve the functioning of the fetoplacental complex.
Classification The traditional division of hypertensive States into primary and symptomatic, systolic and diastolic, light, medium and severe during pregnancy should be rationally supplemented with a classification based on the criteria of the time of onset of the disease and its connection with gestation. In accordance with the recommendations of the European society for the study of arterial hypertension, the following forms of arterial hypertension are identified in pregnant women: * Chronic hypertension. Pathological increase in blood pressure was diagnosed before gestation or during its first half. It is noted in 1-5% of pregnancies. Usually, the disease becomes persistent and persists after childbirth. * Gestational AG. Hypertensive syndrome is detected in the second half of pregnancy (more often-after the 37th week) in 5-10% of patients with previously normal blood pressure. Blood PRESSURE is fully normalized by the 43rd day of the postpartum period.
• Preeclampsia. In addition to signs of arterial hypertension, proteinuria is observed. The level of protein in the urine exceeds 300 mg / l (500 mg / day), or with a qualitative analysis of a single serving, the protein content meets the ''++'criterion. * Complicated pre-existing hypertension. A pregnant woman who suffered from hypertension before childbirth, after 20 weeks of gestation, is found to have a heavier arterial hypertension. In the urine, protein begins to be determined in concentrations corresponding to preeclampsia. • Unclassified AG. A patient with elevated blood PRESSURE was admitted to the supervision of an obstetrician-gynecologist for a period that does not allow classifying the disease. Information about the previous course of the disease is insufficient. Symptoms of hypertension during pregnancy The severity of clinical symptoms depends on the level of blood pressure, the functional state of the cardiovascular system and parenchymal organs, hemodynamic features, and rheological characteristics of blood. The mild course of the disease may be asymptomatic, although more often pregnant women complain of periodic headaches, dizziness, noise or ringing in the ears, increased fatigue, shortness of breath, chest pain, heart palpitations. The patient may feel thirst, paresthesia, cold extremities, visual disturbances, increased urination at night. Often, night sleep worsens, there are unmotivated attacks of anxiety. It is possible to detect small blood impurities in the urine. Sometimes there are nosebleeds.