Hypertension (systolic blood pressure ? 140 mm Hg, diastolic blood pressure ? 90 mmHg, or both) in pregnancy can be classified as follows:
(. Overview of hypertension) Hypertension (systolic blood pressure ? 140 mm Hg, diastolic blood pressure ? 90 mmHg, or both) in pregnancy can be classified as follows: Chronic: The blood pressure has been high before pregnancy or before the 20th week is , A chronic hypertension results in 1-5% of all pregnancies to complications. Pregnancy induced: Hypertension (typically after the 37th) develops after 20 weeks and 6 weeks after birth decline. It occurs in 5-10% of pregnancies, while often in a multiple pregnancy. Both types of hypertension increase the risk of pre-eclampsia, eclampsia (pre-eclampsia and eclampsia) and other causes of maternal mortality and morbidity, including hypertensive encephalopathy, stroke, kidney failure, left ventricular failure and HELLP syndrome (p. O.). Because of decreased uteroplacental blood flow, which can cause vasospasm, growth, hypoxia and premature detachment of the placenta, the risk of fetal mortality and morbidity increases. The course of the disease worsens, when the hypertension threatening (blood pressure> 160/110 mmHg), or from a renal insufficiency (z. B. creatinine [> 180 .mu.mol / l] <60 ml / min, serum creatinine> 2 mg / dl) accompanied is. Clinical Calculator: creatinine clearance (measured) Clinical Calculator: estimate the glomerular filtration rate according to the equation of the MDRD study diagnostic tests to rule out other causes of high blood pressure Blood pressure is measured routinely in prenatal care. If a significant hypertension for the first time in a pregnant woman that does not have multiple pregnancy or gestational trophoblastic disease, studies to rule out other causes of hypertension (eg. As renal artery stenosis, coarctation of the aorta, Cushing’s syndrome must SLE [systemic lupus erythematosus] , pheochromocytoma) be considered (overview of hypertension: tests) treatment in mild hypertension, conservative measures and, if necessary, then antihypertensives First methyldopa, ?-blockers or calcium channel blockers are trying avoid ACE inhibitors, angiotensin II receptor blockers (ARB ), aldosterone antagonists In moderate or severe hypertension antihypertensive therapy, close-knit Practice rwachung and, if the condition worsens, possibly termination of pregnancy or childbirth, depending on the gestational age Treatment of mild to mäßiggradigen hypertension without renal insufficiency during pregnancy is controversial; the questions are whether treatment improved the course and whether the risks of drug therapy outweigh the risks of untreated disease. Since the uteroplacental blood stream is maximized far made and not able to regulate itself, a falling through medication maternal blood pressure can reduce the uteroplacental blood flow suddenly. Diuretics effectively reduce the circulating maternal blood volume. A steady reduction increases the risk of fetal growth retardation. However, hypertension is treated with renal failure, even if it is a mild to moderate hypertension. The recommendations for chronic and pregnancy-induced hypertension are similar and depend on the severity. However, chronic hypertension can be more severe. In gestational hypertension, the increase in blood pressure often occurs late in pregnancy and may not be able to be treated. For mild to moderate hypertension (systolic blood pressure 140 to 159 mmHg or diastolic blood pressure 90 to 109 mm Hg) with unstable blood pressure can lower blood pressure and improve fetal growth decreased physical activity, with the perinatal risks assimilate those of women without hypertension. If this conservative measure, however, does not lower blood pressure, drug therapy is recommended by many doctors. Women who have taken methyldopa a ?-blocker, a calcium channel blocker or a combined preparation, these drugs can continue to take during pregnancy. However, taking ACE inhibitors, and angiotensin II receptor blockers should be stopped as soon as pregnancy is confirmed. In severe hypertension (systolic blood pressure> 160 mmHg or diastolic blood pressure> 110 mmHg) is a drug therapy appears. The risk of maternal complications (progression of Endorganstörungen, pre-eclampsia) and fetal complications (immaturity, growth retardation, stillbirth) is significantly increased. Several antihypertensive drugs may be necessary. In systolic blood pressure> 185 mmHg or diastolic blood pressure> 110 mmHg an immediate investigation is indicated. Numerous drugs are often necessary. It can also be a residential treatment for most of the last pregnancy section necessary. If the situation of women deteriorated, termination of pregnancy may be advised. All women with chronic hypertension in pregnancy should be shown how they themselves measure blood pressure, and they should be evaluated for end-organ damage. Conducted evaluation at baseline and at regular intervals thereafter, serum creatinine, electrolytes and uric acid levels comprises determining the liver (Function) parameter platelet protein in urine Normally Funduscopy echocardiography of the mother should be considered when the women for> have 4 years hypertension. Ultrasound examinations are performed monthly to monitor fetal growth; the prenatal examinations begin in the 32nd week of pregnancy or earlier if Komplilationen occur. The birth was in the 37th-39th SSW are made or if a pre-eclampsia or fetal growth restriction is detected or the investigation of fetuses show abnormal findings, even earlier. Drug therapy The drugs of first choice for hypertension during pregnancy are methyldopa ?-blockers calcium channel blockers The initial dose of methyldopa is 250 mg p.o. 2 times / day, increased as required up to a total of 2 g / day as long as it does not get to the occurrence of strong sleepiness, depression or symptomatic orthostatic hypotension. The most commonly used ?-blocker is labetalol (a ?-blocker with a certain ?1-blocking effect), which can be either alone or, if the maximum daily dose of methyldopa has been reached, applied together with methyldopa. The usual dose is 100 mg 2 times or 3 times a day, it will be increased if necessary to a maximum daily dose of 2400 mg. Among the side effects of ?-blockers include an increased risk of fetal growth retardation and lack of drive and depression of the mother. Slow-release nifedipine, a calcium channel blocker, is sometimes preferred, since it is only given 1 time / day (initial dose 30 mg; maximum daily dose 120 mg). The side effects include headaches and pretibial edema. Thiazide diuretics should only be used during pregnancy to treat chronic hypertension, unless the potential benefit justifies the potential risk to the fetus. The dose can be adjusted to minimize side effects such as hypokalemia. Several antihypertensive classes are avoided during pregnancy tend to be: ACE inhibitors are contraindicated because they include an increased risk of abnormalities of the fetal urogenital tract. Angiotensin II receptor blockers are contraindicated because they increase the risk of fetal renal dysfunction, pulmonary hypoplasia, skeletal abnormalities and death. Aldosterone antagonist (spironolactone and eplerenone) should be avoided as they can cause feminization of a male fetus. Summary Chronic and pregnancy-induced hypertension increase the risk of pre-eclampsia, eclampsia, other causes of maternal mortality and morbidity (eg. As hypertensive encephalopathy, stroke, kidney failure, left ventricular failure, HELLP syndrome) and uteroplacental hypoperfusion. It should be checked other causes of high blood pressure when severe hypertension occurs for the first time in a pregnant woman without multiple pregnancy and gestational trophoblastic tumors without. When a medical treatment is necessary (for. Example, blood pressure> 150/100 mmHg) is started with methyldopa, a ?-blocker, or a calcium channel blocker. ACE inhibitors, angiotensin II receptor blockers or aldosterone antagonists. A hospital stay or termination of pregnancy should be gezögen in a blood pressure> 180/110 mmHg considered.