Hypertension, connected with pregnancy. Ethiopathogenesis, clinic, diagnostics Ziyasheva G.I. Department of obstetrics and gynecology

Gestation hypertensia Hypertensia, appeared after 20-y weeks to pregnancy without some sign polyorgans breaches and which passes during 3-h months after labor

Histosis. Definition. Histosis - this desadaptation disease full-grown, appearing consequense breaches immunologic relations of the organism full-grown and fetus.

Break of placental function Fetus antigens enter to maternal vessels Immune conflict CIC and down them Rapture of endothelia and local «oxygen stress» Breach of endothelia functions : prostocyclin reduction, III antitrombin, NO, increasing A2 tromboxan, fibronectin, Villebrand factor, collagen Prevalence trombogen factor on antitrombogens; Increasing contracted reaction container placentas; Breach to permeability container General angiospasm, hypovolemia, ishemia

Angiospasm ishemia of organs: Bud cortex ishemialayer kidney insufficiency, delay Na and water, proteinuria, activation renin-angiotensis-aldosteron system else greater narrowing container, delay Na and water; Liver reduction desintoxic and protein sintetic functions hypooncia, output of water in interstici, hypovolemia; Cerebrum hypoxia, edema increasing to convulsive readiness; Uterine-placental complex FPN, hypoxia fetus, delay of the development; PSNIP; Clinical manifestations histosis: increasing BP, edemas, protein in urine.

Preeclampsia – general endothelium diseases Vessels spasm hypertonic High penetrated, «run endothelia» edema hypovolemia Hypercoagulation trombosis

Microcirculation during preeclampsia Normal Preeclampsia pregnancy Erythrocytes Edema Hypovolemia Trombosis

Preeclampsia (1) Preeclampsia develops beside 3% pregnant women. Consequences for full-grown eclampsia, kidney and liver insufficiency, edema light, interbrain hemorrhage and others. Consequences for fruit placental insufficiency, low weight at birth and miscarriage. In developed country she is a reason 25% events of the birth newborn with very low weight (<1500) and 15% premature labor. BMJ (2003)

Preeclampsia (2) Raises perinatal death-rate in 5 once Relative risk of the birth dead fetus under preeclampsia increases in 9,6 once From preeclampsia annually all over the world die women Is one of 3 main reasons to maternal death-rate. Roberts JM (1998)

Classification of hypertension anomalies during pregnancy (МКБ-10) Chronic hypertension and/or disease bud diagnosed before 20- weeks or continuing in 6 weeks after labor Chronic hypertension with accompanying proteinuria accompanying preeclampsia Proteinuriya pregnant (transitory) Hypertension pregnant (transitory) Preeclampsia(hypertension in combination with proteinuria at pregnancy) Eclampsia (general cricks, cricks, not connected with epilepsy or other known pathology) Neklassificiruemaya hypertension and/or proteinuria

Hypertension condition of pregnant women Chronic hypertonic Hypertonic inducted pregnancy 1.Gestation hypertension 2.Preeclampsia Not serious Serious HELLP - syndrome Eclampsia 3. Preeclampsia under the chronic hypertension

Natural development history of preeclampsia Hypertension weeks, months Preeclampsia days, weeks (hhypertension and proteinuria) Proteinuria – first symptom of organs pathology Serious preeclampsia hours, days

Hypertension criteria's Hypertension - diastolic АД ≥110 mm. Sometimes or –diastolic АД ≥ 90 mm. 2 measurements with interval for 4 h Serious hypertension –diastolic АД ≥ 120 mm. Sometimes or –diastolic АД ≥ 110 mm. 2 measurements with interval for 4 h

Proteinuria criteria's Proteinuria –≥ 0,3 g/24 hours or –≥ 0,3 g/l or ≥ 1+ in 2 urine tests with interval 4 hours

Edemas Edemas by cyst and ankles often are a normal physiological reaction (50-80%) on reinforcement blood circulation and increase the weight at pregnancy For diagnostics of Preeclampsia this sign is nearly useless (if only edemas did not appear suddenly and are not strong), but under wrong using he can become the reason unnecessary hyperdiagnostic.

Hyperdiagnostic risks Too part hospitalization Excessive interference with unproved by efficiency or even dangerous for full-grown and child Necessary to use strict criteria for diagnostics Under weakly expressed disease more safe is a dispensary treatment

Preeclampsia : conclusions it is impossible prevent in whole populations it is impossible threat beside pregnant women its possible only diagnose with following careful controlled symptoms (strong hypertension and possible cricks) by introduction hypotension and anticonvulsion facilities No other ways of the treatment render positive influence upon improvement perinatal upshot Purpose of conduct such patients are not preventive maintenance, early diagnostics and early treatment, but revealing the dangerous change, their correct removal and well-timed birth.