Women with hypertension should be evaluated before pregnancy to determine how high their blood pressure is and to plan lifestyle choices that may require pregnancy.
As recommended in JNC VI, the 2Pr test result should be verified using various parameters and include blood pressure readings at home or away from the office. If blood pressure is confirmed and especially severe (stage 3 systolic pressure ≥180 mm Hg or diastolic pressure ≥ 110 mm Hg), a woman should be evaluated for reversible causes.
Angiotensin converting enzyme inhibitors and AII receptor antagonists should be discontinued. (For a discussion of drug treatment, see the next section.) Women with years of high blood pressure, including left ventricular hypertrophy, retinopathy, and kidney disease, should be evaluated for a specific disability. If there is an injury, the woman should be warned that the pregnancy may worsen.
Women with chronic hypertension in pregnancy with early proteinuria during pregnancy are at high risk for premature birth defects.
Pregnancy outcomes are difficult to diagnose, but only if the risk of miscarriage and accelerated maternal kidney disease exceeds 1.4 mg / dL during pregnancy.
In patients with kidney failure, abortion is reported to be ten times more likely to occur when blood pressure is low and uncontrollable.
Chronic hypertension in pregnancy or before pregnancy requires planning lifestyle changes. For example, pregnant women with high blood pressure may need to limit their activities at work and home and refrain from strenuous physical activity.
Although regular exercise is important for people who are not pregnant and have high blood pressure and is safe for normal pregnant women, there is no safety information on chronic hypertension in pregnancy.
Our advice is to encourage aerobic exercise in pregnant women with high blood pressure until more information is available on the theoretical basis for adequate placental blood flow in women with high blood pressure at high risk of preeclampsia.
Weight loss is not recommended for obese women during pregnancy. Although overeating can be dangerous for preeclampsia, there is no evidence that weight loss is a risk factor.
Although evidence is rare in pregnant women, many experts recommend that sodium intake be equal to the 2.4 g sodium recommended for high blood pressure. Women who already have a very restricted sodium level can continue this diet. The consumption of alcohol and tobacco should be strictly prohibited during pregnancy. Both have a negative effect on the fetus and the mother. Overdose can cause or worsen maternal blood pressure. Tobacco is associated with a significant risk of miscarriage and fetal development.
Treatment of Chronic Hypertension in Pregnancy
Most women with chronic hypertension in pregnancy have 1 to 2 blood pressure (translated as diastolic blood pressure of 140 to 179 mm Hg or 90 to 109 mm Hg) and short-term cardiovascular (blood pressure). The plumbing problems are low. The pregnancy.
Most pregnant women in stages 1 to 2 of pregnancy High blood pressure and normal kidney function Most pregnancies have good maternal and infant outcomes.
These women are candidates for drug therapy because, to date, there is no evidence that drug therapy has improved pediatric outcomes.
High blood pressure usually falls in the first half of pregnancy, so it can be easier to control with little or no medication. The ongoing cost of antihypertensive medications for pregnant women with chronic hypertension remains a hotly debated topic.
While lowering blood pressure can help the mother to lower her blood pressure, low blood pressure can distort the uterus placental secretion and thus jeopardize fetal growth.
Although they generally disagree that treatment for high blood pressure is beneficial or harmful for pregnancy, many studies offer some clinical guidelines. During the past 30 years, at least seven studies have compared antihypertensive treatment with placebo in pregnant women without medication or with mild hypertension.
Significant fetal loss was seen during the second trimester in untreated women in several early trials, but this finding was not confirmed.
Of course, the overall prevalence of these negative effects was very low. Itsreviewed the treatment of chronic hypertension in pregnancy by 298 pregnant women that was discontinued or reduced during early pregnancy.
Excessive pre-eclampsia, prenatal, abortion or maternal mortality did not decrease compared to the untreated groups.
The uncertainty about the benefits of lowering blood pressure for pregnant women with mild to moderate hypertension arises from very small published trials to identify moderate reductions in complications of childbirth.
Evidence from several studies shows the effectiveness of antihypertensive medications in preventing chronic hypertension in pregnancy.
These tests included many women, such as early hypertension and gestational diabetes, various pregnancy restrictions during pregnancy, and the presence or absence of protein, and often included multiple treatment agents.
Chronic hypertension in pregnancy is the most common risk factor for preeclampsia.Preeclampsia is more common in women with chronic hypertension, making pregnancy 25% more complicated.
The risk is even higher if blood pressure is associated with kidney failure, high blood pressure for at least 4 years, and a history of early pregnancy.
In the presence of overactive preeclampsia, the space in the placenta increases significantly.
According to the report, some centers now treat women with high blood pressure by closely monitoring their blood pressure medications.
In patients with high blood pressure over many years, evidence of a specific disability or multiple blood pressure control agents can be based on blood pressure readings, but should be continued if necessary to control blood pressure.
End points for recovery include the presence of systolic 150–160 mm Hg or diastolic or diastolic 100–110 mm Hg lesions, such as left ventricular hypertrophy or renal failure. Most professionals prefer methyldopa.
Alternatively, women who are well acquainted with prenatal antihypertensive treatment can remain on the same agents during pregnancy (except angiotensin converting enzyme inhibitors, AII receptor antagonists) during pregnancy.
ANTIHYPERTENSIVE DRUG SELECTION
Although the treatment of chronic hypertension in pregnancy is to reduce the risk to the mother, the selected agents must be effective and safe for the fetus, especially in the case of acute and chronic neurological effects.
Based on reports of stable uteroplacental blood flow and fetal hemodynamics in a limited number of children and a follow-up study 7.5 years later, methyldopa is preferred by many clinicians as first-line treatment for children exposed to mitochondria in utero.
Methyldopa causes drowsiness in many people. If this agent is intolerable, alternatives such as labetalol have been selected based on very limited clinical experience. If Methyldopa is not effective, substitute alternatives considering logical methods (see below).
On the other hand, salt accumulation can lead to referral to vasodilator therapy, 13 in which case a diuretic added to the regimen can control blood pressure and prolong pregnancy.
Much of the published experience with other agents comes from experiments using adrenergic blocking drugs, including beta blockers and alpha beta blockers labetalol.
It has been suggested that beta-blockers may be prescribed in early pregnancy, especially atherosclerosis.
On the other hand, none of these agents was associated with any consistent disease outcome; however, long-term follow-up studies are lacking. Experience with calcium channel blockers is limited, and most of the reported uses are delayed during pregnancy. For the first time, a multicenter drug exposure study did not report a significant increase in the main therapeutic properties of these agents.
A recent multidisciplinary study reported no benefit or harm of nifedipinetreatment for patients with slow release nifedipineor no treatment from the second trimester, and the use of diuretic agents during pregnancy is not discussed.
The main concern is theory. Pregnancy is associated with a decrease in plasma levels and is worse in women with chronic hypertension who are unable to increase their plasma levels.
It is not clear if this is a cause and effect relationship. However, women who use diuretics during pregnancy often do not increase the amount of blood that occurs during normal pregnancy. Due to theoretical concerns, they generally do not use diuretics as first aid.
Nine randomized controlled trials from more than 7,000 directors have shown that women are less prone to bloating and / or hypertension and not more prone to miscarriages.
However, if used, they are safe and effective agents, they can show significant reactions to other antihypertensive agents, and uteroplacental ointment is not contraindicated in pregnancy, except for pre-existing preparations (pre-eclampsia and uterine growth retardation).
Although there is little information on the use of contraceptives in pregnant women with significant blood pressure, this group concludes that it does not prohibit the use of contraceptives to reduce or control the blood pressure of pregnant women who have had or developed a preterm pregnancy. Angiotensin converting enzyme inhibitors are contraindicated during pregnancy due to fetal growth retardation, oligohydramnios, neonatal renal failure, and neonatal death.
Although angiotensin II receptor antagonists have no data on human use, adverse effects may be similar to those that alter angiotensin enzymes, and these agents should be avoided.
There are no placebo-controlled trials for the treatment of severe hypertension during pregnancy and none of them can be conducted for ethical reasons. The first reports of severe hypertension in the first three months reported infertility and 50 percent maternal mortality.
Most side effects are compounded by pre-eclampsia during pregnancy.
PREGNANCY, HYPERTENSION AND RENAL DISEASE
In pregnant women with mild kidney disease (serum creatinine below 1.4 mg / dL), fetal survival is slightly reduced and the underlying disease generally does not worsen.
Women with progressive kidney disease should be encouraged to complete labor with good kidney function. High blood pressure before or during pregnancy increases the risk of maternal and fetal complications, with a ten times greater risk of miscarriage.
Moderate or severe kidney failure can accelerate pregnancy and jeopardize fetal survival.
More than half of these pregnancies cause high blood pressure. Weight loss at birth is directly related to the accumulation of maternal serum creatinine.
As kidney failure progresses, blood pressure may become too high and may require sodium restriction, use of loop diuretics, or dialysis.
Excessive pre-eclampsia can be difficult to diagnose, as protein content is often increased in women with glomerular disease.
Chronic dialysis during pregnancy is associated with severe maternal pain and pregnancy should be discouraged. Postpartum (74 to 80%) Dialysis during pregnancy begins in pregnancy (40 to 50 percent), 123X, 124Re probably earlier women with high kidney function. . Babies’ survival can be improved during a major kidney transplant each week.
Despite regulations on low birth weight and prenatal delivery, the prognosis appears to be improving. Clinical note: Magnesium sulfate is dangerous for women with severe kidney problems, so maintenance doses should be reduced. A normal loading volume can be delivered because it is distributed throughout the body and does not affect kidney function.
Magnesium should then be administered at a dose of one hour per hour, with magnesium levels up to two hours per hour. Phenytoin can be taken as an alternative. Kidney transplants are recommended for 1.5 to 2 years after a successful pregnancy and only if kidney function is stable at 2.0 mg / dL or less.
In 115 cycloprene kidney transplant patients in 115 kidney transplant registries, maternal blood pressure and serum creatinine levels above 1.5 mg / dl were reported. 55% premature ripening; therefore, all transplant pregnancies are considered high risk.
TREATING HYPERTENSION THAT PERSISTS POSTPARTUM
Women with chronic hypertension in pregnancy are more likely to develop encephalitis, heart failure, and pneumonia and kidney failure in the postpartum period. Risk factors include heart disease, chronic kidney disease, second trimester hyperactive preeclampsia, complicated vascular dysfunction, and multiple antihypertensive agents.
High blood pressure during pregnancy passes quickly in the first few days after birth.
Hypertension is very rapid in patients with high blood pressure during pregnancy and can be delayed in people with pre-eclampsia, especially those with prolonged pre-eclampsia and severe kidney disease.
This delay may reflect the time it takes for Australia to recover. Oral contraceptives may be required for women who have had hypertension before pregnancy, especially maternal hypertension.
If prenatal hypertension is normal or unexplained, it is advisable to stop taking oral medication after 3 to 4 weeks and observe blood pressure ranges for 1 to 2 weeks for 1 month, then 3 to 6 months for 1 year. . If high blood pressure reoccurs, it needs to be treated.
TREATING HYPERTENSION DURING LACTATION
Breastfeeding should be encouraged and the choice of antihypertensive drugs can be made with limited restrictions. For mothers with low blood pressure who wish to breastfeed for a few months, the clinic may consider closely monitoring their blood pressure and prescribing medication. Once nurses quit smoking, blood pressure treatment can be restored.
For people with very high blood pressure and taking an antihypertensive agent, the doctor may consider lowering the dose and then closely monitoring the mother and baby. There is little information on antibodies in human breast milk and their effects on the newborn.
Furthermore, these drugs do not have long-term effects in infants at risk. Briggs and his colleagues quote the reader in a 30Pr article and recommendations from the American Academy of Pediatrics Committee on Pharmacy.
Evidence suggests that all learned agents are excreted in human breast milk, although differences in the milk / plasma ratio are related to lipid fluid and ionization levels at physiological pH.
No short-term adverse effects have been reported from methyldopa or hydrogen. Although the drug committee considers anabolics to be compatible with breastfeeding, it appears to be a beta blocker, as does metoprolol and nadololin breast milk.
This property is not shared by propranolol or labetalol; For this reason, if a beta blocker is suggested, these agents are recommended. There are no reports of calcium channel blockage and lactation. Diuretics can reduce milk production and eliminate lactation.
Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists should be eliminated based on reports of adverse fetal and neonatal renal failure. Due to the lack of information, mothers taking antihypertensive agents should be closely monitored for possible side effects.
FETAL ASSESSMENT IN CHRONIC HYPERTENSIONIN PREGNANCY
Much of the prenatal disease and death associated with chronic hypertension can be severe PMS and / or fetal development.
The prenatal evaluation plan is guided by these findings. Therefore, efforts should be made to limit prenatal diagnosis and fetal development.
If these are not included, then an extensive prenatal exam is not necessary. Fetal size and dating the first evaluation of the literature should be carried out between 18 and 20 weeks of gestation. Next, fetal development should be carefully assessed.
This should be done monthly, for 28 to 32 weeks and up to a month, according to the standard clinical assumption of financial support (eg, maternal obesity or multiple sclerosis).
If there is evidence of developmental impairment, fetal health should be assessed as usual for the developing fetus using stress tests or biophysical profiles. Similarly, if preeclampsia cannot be ruled out, a fetal evaluation is appropriate for a woman with preeclampsia.
However, there is no evidence for these studies if the baby is normal and preeclampsia can be ruled out.