Lectures on hypertension in pregnancy and pre-eclampsia

2021-03-21 12:00 AM

Diagnosis of mild pre-eclampsia and severe pre-eclampsia: Based on the symptoms described above. Need differential diagnosis with Chronic hypertension and pregnancy

Definition of hypertension in pregnancy

Hypertension that occurs from the 20th week of pregnancy and disappears no later than 6 weeks postpartum, may be accompanied by proteinuria or oedema or both. It is called pre-eclampsia or eclampsia (if a woman has a seizure and ends in a coma).

How to determine hypertension during pregnancy

For women who do not know their blood pressure numbers in advance

If the blood pressure is measured at rest at least 15 minutes and measured 2 times in 2 hours apart and the blood pressure is 140/90 or higher, it is called hypertension.

For pregnant women with known blood pressure figures

If the systolic blood pressure increases by 30 mmHg and the diastolic pressure increases by 15 mmHg, it is considered hypertension.

Hypertension during pregnancy has the following characteristics:

It is possible to increase both the systolic and diastolic blood pressure numbers.

There may be only systolic or only diastolic hypertension.

The number of blood pressure returns to normal no later than 6 weeks after the woman gives birth.

Blood pressure can rise and change with circadian rhythms.

Clinical symptoms of hypertension

High blood pressure during pregnancy has 3 main symptoms:

Hypertension (calculated as above).

Oedema: Characterized by soft oedema, concave, white. Need to weigh the pregnant woman's weight when seen to increase over 500 g / 1 week or 2250 g / month.

Proteinuria: When Proteinuria is considered as (+) when the amount of Protein in the urine is ³ 0.3 g / liter / 24 hours or Proteinuria is  ³ 0.5 g / liter in a random urine sample. The higher the amount of proteinuria, the more swelling and the more severe the disease.

Other signs:

The patient may be accompanied by other symptoms such as:

Nerve signs: Headache, dizziness, dizziness.

Epigastric pain: In severe cases, it is caused by a stretched hepatic capsule.

Anemia.

Blue skin due to anemia.

Laboratory testing

Proteinuria (discussed above).

Uric acid is elevated in heavy form.

Serum urea and crêatinin may be normal or elevated in severe form.

Liver enzymes may be normal or elevated in severe form.

The platelet count may be normal or elevated in a severe form.

Serum bilirubin is normal but elevated in severe form.

The fetal umbilical artery doppler changes, in severe cases the diastolic flow rate in the umbilical artery blood is zero.

Ultrasound: The amount of amniotic fluid is usually low, the fetus is underdeveloped.

Monitoring fetal heart rate by Obstetric Monitoring: fetal heart rate can be normal or "flat rhythm" in case of severe illness. To evaluate the fetal status in the uterus can be combined with a "Critic test" such as nipple or oxytocin infusion ... will see fetal heart rate change, a manifestation of chronic fetal failure and fetal response. The child is very poor with stimuli generated by means of exploration.

All of the above are clinical symptoms of mild pre-eclampsia (if accompanied by signs of hypertension of 160/110 mmHg or more; Protinuria of 3 g / l or more combined with oedema and biochemical tests increase the manifestation of liver failure, kidney failure, heart failure ... Especially when the 3 sets of subclinical symptoms appear: serum bilirubin increases above 1.2 mg / DL ; liver enzymes (SGOT, SGPT) that rise above 70 UI / l and platelet count below 100,000 / mm3 of blood make up the clinical picture of HELL (Hemolisio Eluated liver Low Platelets). It is so severe that the majority of the authors believe that pregnancy must be suspended in order to save the mother.

Diagnosis of mild pre-eclampsia and severe pre-eclampsia: Based on the symptoms described above. Need differential diagnosis with: Chronic hypertension and pregnancy; Chronic nephritis and pregnancy; Edema due to cardiovascular diseases.

Complications caused by pre-eclampsia

Complications for the mother

Eclampsia.

Young vegetables.

Liver failure.

CKD.

Pulmonary oedema.

Bleed.

Chronic nephritis.

Complications for children

Stillbirth in the womb.

Underdeveloped pregnancy.

Đẻ not.

Immediately after giving birth.

Treatment attitude

Nursing

Rest, eat enough protein, limit salt, prevent eclampsia.

Medicine

Low pressure: Aldomet, Hydralefin, Trandat ...

Diuretic: Only used when the amount of urine <800 ml / 24 hours.

Sedation: Valium.

Antibiotic:

Magnesium Sulfate: 2 - 4 g / day. Severe pre-eclampsia can be increased to 12 g / day. Must monitor complications of magnesium sulphate: knee reflexes, breathing ... detoxification by intravenous calcium gluconate.