Professor G.S.Babajanova Chair of obstetric and gynecology of therapeutic and medical prophylactic faculties Topic: hypertensive conditions during pregnancy Lection for students 4 courses of therapeutic and medico- pedagogical faculties

To hypertensive conditions of pregnant belong the pathological states, which occur only during pregnancy and vanish after they is terminated or in fourth stage of labor.

Classification Differentiate three types of arterial hypertension during pregnancy: I. arterial hypertension induced by the pregnancy (hypertension of pregnant ) I. A. arterial hypertension without proteinuria - pregnancy hypertension (gestational hypertension )

Classification I. B. arterial hypertension with proteinuria - preeclampsia II. chronical arterial hypertension, antecedent pregnancy III. chronical arterial hypertension with additional preeclampsia or eclampsia

Relevance The hypertension type essentially influence: On tactics maintaining pregnancy On need and intensity of antihypertensive therapy For a while delivery parturition

Hypertension induced by the pregnancy (HIP ) HIP is of increasing hells after 20 weeks. Increasing hells during pregnancy it is considered by the adaptive organism reaction, arising in response to perfusion inadequacy of different regions of vascular channel of pregnant, vital organ

Criteria Increasing of DP above 90 mm. Hg Increasing of SP above 140 mm. Hg (escrow ) About true increasing hell it is possible pass to judgement on a foundation the minimum two of multiple measurement hells during 4 hours

Risk factors on the development of HIP 1. Pregnancy 2. Signs, indicative of insufficient increase of intravascular volume ( increasing HB above 130 г / л, hematocrit increasing 40 and more ) 3. Absence of physiology lowering of DP in the second trimester (lower 75 mm. Hg. )

Risk factors on the development of HIP 4. Increasing of SP on 30 mm. Hg. from source, other than achieving mm. Hg. 5. Increasing of DP by 15 mm. Hg. from source, other than achieving 90 mm. Hg. 6. Intrauterine delay of fetal growth

To high-risk population on the development of bends belong the women, having - chronical arterial hypertension - chronical renal disease - diabetes mellitus - age 35 years - severe pre-eclampsia when previous deliveries - multiple pregnancy

Antigen induced by the pregnancy without proteinuria (gestational arterial hypertension ) Pathophysiology Increasing hells, first registered in II pregnancy half, is answer to increasing of peripheric resistance of blood vessels. Such reaction is adaptive, aimed at maintaining of appropriate blood perfusion in vital organ (the brain, the liver, the kidneys )

If the preeclampsia is not confirmed, then: 1. The bed rest at the position on the left side on 1-2 hour after each food intake is recommended 2. The hypotensive therapy has been shown only in those cases when diastolic hell is in excess of 110 mm.Hg. and mother (the warning stage hells above 160/110 or average hells (gardens ) above 125 mm.Hg. begins is real to threaten )

3. When hypotensive therapy shouldn't reduce hell up to low figures, fairly the reduction of up to safe level mm. Hg OBP=SP+2 DP/3 In rate should not exceed 85 mm. Hg

AH by the pregnancy with proteinuria preeclampsia Is arterial hypertension + proteinuria in II pregnancy half (after 20 weeks. Basic clinical symptoms of preeclampsia are three cardinal symptom: Hypertension Proteinuria Edema

Diagnostic criteria Upon the recommendation of WHO the preeclampsia divide by 2 forms: Light and heavy Easy preeclampsia is twice noted rise of diastolic pressure above 90 up to 110 mm.Hg during 4 hours with proteinuria above 0, 3 g/l up to 1 g/l

Diagnostic criteria The severe pre-eclampsia is the rise of diastolic pressure above 110 MM HG. + the proteinuria above 1 g/l, or to easy preeclampsia joins any one of signs posing a threat to eclampsia

Signs posing a threat to eclampsia Abrupt change of emotional state Abrupt and very high of hell Hyperreflexia Acute headache (often strengthening, not treated usual analgetics Disturbance of vision (improving or failing sight ) Oliguria (<400 urines magnetic tapes in 24 hour )

Signs posing a threat to eclampsia (continuation ) Pains in the pit of the stomach or in right upper quadrant Yellowness of dermal covers Abrupt edema, especially in the area of low back and face Increasing of liver ferment in blood Thrombocytopenia Changes in clotting system Signs of pulmonary edema

Therapy principles of preeclampsia Hypotensive therapy (dibazole, papaverine, euphylline, corinfar, clofelin, ganglioblockers ) Magnesia therapy. The sulfuric acid magnesia has easy narcotic and tranqualitic action, diuretic, hypotensive, anticonvulsant, spasmolytic effect, reduces the intracranial pressure

Magnesia therapy Intravenous injection of magnesia: Load dose: ml 25% solution (4-6g. during 20 minutes in a stream) Maintenance dose: i/v 80ml 25% solution (20g. in 500 мл 0, 9% of soln of NaCL 16 droplets in mine (50ml/h )

Magnesia therapy Intramuscular injection of magnesia: Load dose: 20 ml25% solution in each muscul (10g. dry substance, on 5g. In each of muscul Maintenance dose: 20 ml 25% solution each 4 hours alternately in right and left buttock

Therapy principles Maximum daily dose of MgSO4 – 24g (96 magnetic tapes 25% solution of MgSO4 ). When overdose of MgSO4 is seen - oppression of tendon reflexes - respiratory depression, bradycardia - filtration reduce of urine by kidneys When overdose it is necessary to stop the introduction of MgSO4 and to introduce the antidote 10 mg of calcium chloride

Therapy principles Sedative therapy (seduxen, relanium, сибазон, diazepam ), droperidol, antihistamine drugs The hepatoprotectors (essenciale, lipostabyl ) The diuretic agents aggravates the hypovolemia, shall be used only when complicated by forms of severe pre-eclampsia Distress syndrome prevention of fruit (dexamethasone on 12 mg every 12 hours – 3 days )

Forms of severe pre-eclampsia Eclampsia HELLP-syndrom Acute fat hepatosis of pregnant

Indication to operative delivery parturition State deterioration of woman or signs rise posing a threat to eclampsia Emergence of palmuses Uncontrollable hypertension IULDF or deterioration of fetal state (from data US and CTG) Amourosis (blindness due to detached retina ) Obstetric indication

Complications of severe pre-eclampsia Brain oedema Intracerebral bleeding DIC-syndrom Acute hepatic impairment Acute renal failure Hypotonic or coagulopatic uterine hemorrhage Postpartum septic complications

Complications of severe pre-eclampsia Ante- and intrapartum fetal death Pre-term deliveries PDNSP Loss of reproductive organ (hysterectomy, in record on combating bleeding )