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High blood pressure during pregnancy

High blood pressure can cause problems for you and your baby during pregnancy, including preeclampsia and premature birth.

High blood pressure usually doesn’t cause signs or symptoms. Go to all of your prenatal care visits so your provider can check your blood pressure.

If you need medicine to keep your blood pressure under control, take it every day.

If you’re at high risk for preeclampsia, your provider may want you to take low-dose aspirin to help prevent it.

What is high blood pressure?

Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. Each time your heart beats, it pumps blood to the arteries. If the pressure in your arteries becomes too high, you have high blood pressure (also called hypertension). High blood pressure can put extra stress on your organs. This can lead to heart attack, heart failure, stroke and kidney failure.

Some women have high blood pressure before they get pregnant. Others have high blood pressure for the first time during pregnancy. About 8 in 100 women (8 percent) have some kind of high blood pressure during pregnancy. If you have high blood pressure, talk to your health care provider. Managing your blood pressure can help you have a healthy pregnancy and a healthy baby.

How do you know if you have high blood pressure?

Your blood pressure reading is given as two numbers:

1. Systolic blood pressure. This is the upper (first) number in your reading. It’s the pressure when you heart contracts (gets tight). Your blood pressure is highest when your heart beats and pumps blood.
2. Diastolic blood pressure. This is the lower (second) number in your reading. It’s the pressure when your heart relaxes. Your blood pressure falls because your heart is at rest between beats.

Your blood pressure reading fits into one of five categories:

1. Normal. Your blood pressure is less than 120/80.
2. Elevated. This is when your systolic blood pressure is between 120-129 and your diastolic pressure is less than 80.
3. Stage 1 high blood pressure.  This is when your systolic pressure is between 130-139 or your diastolic pressure is between 80-89.
4. Stage 2 high blood pressure. This is when your systolic pressure is at least 140 or your diastolic is at least 90.
5. Hypertensive crisis. This is when your systolic pressure is higher than 180 and/or your diastolic pressure is higher than 120. Call your health care provider right away if your blood pressure is this high.

At each prenatal care checkup, your provider checks your blood pressure. To do this, she wraps a cuff (band) around your upper arm. She pumps air into the cuff to measure the pressure in your arteries when the heart contracts and then relaxes. If you have a high reading, your provider can recheck it to find out for sure if you have high blood pressure. Your blood pressure can go up or down during the day.

What pregnancy complications can high blood pressure cause?

High blood pressure can cause problems for you and your baby during pregnancy, including:

Problems for moms include:

• Preeclampsia.  This is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs and symptoms of preeclampsia include having protein in the urine, changes in vision and severe headaches. Preeclampsia can be a serious medical condition. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse. Without treatment, preeclampsia can cause serious health problems, including kidney, liver and brain damage. In rare cases, it can lead to life-threatening conditions called eclampsia and HELLP syndrome. Eclampsia causes seizures and can lead to coma. HELLP syndrome is when you have serious blood and liver problems. HELLP stands for hemolysis (H), elevated liver enzymes (EL), low platelet count (LP).
• Gestational diabetes. This is a kind of diabetes that only pregnant women get. It’s a condition in which your body has too much sugar (also called glucose). Most women get a test for gestational diabetes at 24 to 28 weeks of pregnancy.
• Heart attack (also called myocardial infarction).
• Kidney failure. This is a serious condition that happens when the kidneys don’t work well and allow waste to build up in the body.
• Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have serious bleeding from the vagina. The placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord.
• Postpartum hemorrhage (also called PPH). This is when a woman has heavy bleeding after giving birth. It’s a serious but rare condition. It usually happens 1 day after giving birth, but it can happen up to 12 weeks after having a baby.
• Pulmonary edema.  This is when fluid fills the lungs and leads to shortness of breath.
• Stroke. This is when blood flow to your brain stops. Stroke can happen if a blood clot blocks a vessel that brings blood to the brain or when a blood vessel in the brain bursts open.
• Pregnancy related death. This is when a woman dies during pregnancy or within 1 year after the end of her pregnancy from health problems related to pregnancy.

If you have high blood pressure during pregnancy, you’re also more likely have a cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

Problems for babies include:

• Premature birth. This is birth that happens too early, before 37 weeks of pregnancy. Even with treatment, a pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
• Fetal growth restriction. High blood pressure can narrow blood vessels in the umbilical cord. This is the cord that connects the baby to the placenta. It carries food and oxygen from the placenta to the baby. If you have high blood pressure, your baby may not get enough oxygen and nutrients, causing him to grow slowly.
• Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
• Fetal death. When a baby dies spontaneously in the womb at any time during pregnancy.
• Neonatal death. This is when a baby dies in the first 28 days of life.

What kinds of high blood pressure can affect pregnancy?

Two kinds of high blood pressure that can happen during pregnancy:

1. Chronic hypertension. This is high blood pressure that you have before you get pregnant or that develops before 20 weeks of pregnancy. It doesn’t go away once you give birth. About 1 in 4 women with chronic hypertension (25 percent) has preeclampsia during pregnancy. If you’re at high risk for preeclampsia, your provider may treat you with low-dose aspirin to prevent it.

   If you have chronic hypertension, your provider checks your blood pressure and urine at each prenatal care visit. You may need to check your blood pressure at home, too. Your provider may use ultrasound and fetal heart rate testing to check your baby’s growth and health. Your provider also checks for signs of preeclampsia.

   If you were taking medicine for chronic hypertension before pregnancy, your provider makes sure it’s safe to take during pregnancy. If it’s not, he switches you to a safer medicine. Some blood pressure medicines, called ACE inhibitors and angiotensin receptor blockers, can harm your baby during pregnancy.

   During the first half of pregnancy, blood pressure often falls. If you have mild hypertension and took medicine for it before pregnancy, your provider may lower the dose of medicine you take. Or you may be able to stop taking medicine during pregnancy. Don’t stop taking any medicine before you talk to your health care provider. Even if you didn’t take blood pressure medicine in the past, you may need to start taking it during pregnancy.
    

2. Gestational hypertension. This is high blood pressure that only pregnant women can get. It starts after 20 weeks of pregnancy and usually goes away after you give birth. It usually causes a small rise in blood pressure, but some women develop severe hypertension and may be at risk for more serious complications later in pregnancy, like preeclampsia.

During pregnancy, your provider checks your blood pressure and urine at every prenatal care checkup. She may use ultrasound and fetal heart rate testing to check your baby’s growth and health. Your provider may ask you to check your blood pressure at home and do kick counts to see when and how often your baby moves. Here are two ways to do kick counts:

1. Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider.
2. See how many movements you feel in 1 hour. Do this three times each week. If the number changes, tell your provider.

We don’t know how to prevent gestational hypertension. But if you’re overweight or obese, getting to a healthy weight before pregnancy may lower your chances of having this condition. And even though gestational hypertension usually goes away after birth, you may be more likely to develop hypertension later in life. Healthy eating, staying active and getting to a healthy weight after pregnancy can help prevent high blood pressure in the future.

How can you manage high blood during pregnancy?

Here’s what you can do:

• Go to all your prenatal care checkups, even if you’re feeling fine.
• If you need medicine to control your blood pressure, take it every day. Your provider can help you choose one that’s safe for you and your baby.
• Check your blood pressure at home. Ask your provider what to do if your blood pressure is high.
• Eat healthy foods. Don’t eat foods that are high in salt, like soup and canned foods. They can raise your blood pressure.
• Stay active. Being active for 30 minutes each day can help you manage your weight, reduce stress and prevent problems like preeclampsia.
• Don’t smoke, drink alcohol or use street drugs or abuse prescription drugs.

What can you do about high blood pressure before pregnancy?

Here’s what you can do:

• Get a preconception checkup. This is a medical checkup you get before pregnancy to take care of health conditions that may affect your pregnancy.
• Use birth control until your blood pressure is under control. Birth control is methods you can use to keep from getting pregnant. Condoms and birth control pills are examples of birth control.
• Get to a healthy weight. Talk to your provider about the weight that’s right for you.
• Eat healthy foods.
• Do something active every day.
• Don’t smoke. Smoking is dangerous for people with high blood pressure because it damages blood vessel walls.

Last reviewed: February, 2019

See also: Preeclampsia, HELLP syndrome

Pregnancy and blood pressure

Pressure and pregnancy

Pregnancy is a period when a woman's body uses all its potential, all its reserves to provide everything necessary for the full bearing of a child.

Blood pressure is one of the main parameters of blood flow intensity in the body. During the period of bearing a baby, a woman’s body is faced with the need to provide oxygen and nutrition not only for herself, but also for her unborn child. A change in the level of pressure during pregnancy becomes an indicator of disturbances in the functioning of the body that threaten the health of a woman and a child, and can also complicate the course of childbirth. nine0005

When blood pressure is measured

Blood pressure must be measured at every appointment with an obstetrician-gynecologist or therapist in the antenatal clinic of the expectant mother. But visits to the doctor's office should not be limited. It is necessary to independently measure this indicator in the morning and in the evening, so that the results can be compared, they must be recorded daily in a special notebook. Particular attention to their pressure should be shown by those women who previously had toxicosis of pregnancy, miscarriages, miscarriages. Women with hypertension, overweight, neurocircular and vegetovascular dystonia, diseases of the kidneys, heart, blood vessels should be on a special account, and measure pressure as often as recommended by the doctor. nine0005

Hourly measurement of blood pressure in pregnant women at risk is called daily monitoring. It is done three times during the entire period of pregnancy. The first time - at the very beginning of pregnancy, to identify a woman's tendency to hypertension, the second time - at 24-28 weeks of pregnancy, to identify a predisposition to preeclampsia or late toxicosis of pregnant women, the third time - before childbirth, to determine the degree of risk to the woman and the fetus , as well as to resolve the issue of the method of obstetrics. nine0005

If there are problems with pressure in a pregnant woman, then it is necessary to visit a cardiologist and a general practitioner who can advise what needs to be done to solve the problem of pressure during pregnancy.

Types of blood pressure monitors

There are two types of blood pressure monitors (blood pressure monitor) - mechanical and electronic.

• Mechanical blood pressure monitor used by physicians. It gives the most accurate results. You can learn how to use a mechanical tonometer at home. However, taking blood pressure on your own is very difficult, so if you want to use this type of blood pressure monitor, you will need an assistant. nine0024
• Electronic blood pressure monitor is easier to use. It is enough to put the cuff on your arm and press the button. The device itself will do the rest, and you will only have to read the results on the electronic scoreboard. An electronic tonometer shows the value of blood pressure and pulse, memorizing the indicators. There are blood pressure monitors, the cuff of which can be worn on the shoulder, on the wrist and even on the finger. For the home, the most suitable device is the cuff of which is worn on the shoulder. Wrist or finger gauges can be used to measure blood pressure at work or while traveling. nine0024

Correct measurement of blood pressure

Do not immediately panic because of high or low blood pressure during pregnancy, you need to make sure that the measurement is correct.

There are several important rules for the correct determination of blood pressure:

• Before measuring, sit down and rest for a couple of minutes, think about something pleasant. Stress is one of the factors in the short-term increase in pressure.
• Place the cuff on your bare arm or thin fabric. It must be sized. nine0024
• Measure blood pressure on both arms.
• Never round the received numbers and write them down.
• It is not recommended to determine the level of blood pressure after a meal or after exercise.

Blood pressure during pregnancy: norm and deviations

Blood pressure is the pressure force of blood flow on the wall of blood vessels. It is measured in millimeters of mercury (mm Hg) and is written in two numbers separated by a slash. nine0005

The first digit shows the pressure at the moment of maximum contraction of the heart (systolic blood pressure), and the second - at the time of its complete relaxation (diastolic blood pressure). If blood pressure is normal, we can safely say that the mother’s cardiovascular system is doing its job, which means that all organs receive a sufficient amount of oxygen and nutrients brought with the bloodstream.

Outside of pregnancy, normal blood pressure ranges from 100/60 to 130/80 mmHg. Art. During pregnancy, the pressure may differ slightly from the original: if it is 10% lower or higher than usual, then such changes are still within the normal range. If the pressure is lower or higher than usual by 15–20% or more, then we are dealing with arterial hypotension (low blood pressure) or arterial hypertension (high blood pressure). It is desirable for a woman to know her usual level of pressure, which was before pregnancy, so that the doctor can draw the right conclusions. nine0005

1.1 What is the danger of changes in blood pressure

During pregnancy, through the vasculature of the placenta, nutrients and oxygen constantly flow to the fetus, and back to the mother - the products of its vital activity.

This exchange is only possible at an optimum pressure level. Changes in blood pressure in one direction or the other can have adverse consequences.

Under reduced pressure, transport is impaired and the amount of nutrients needed by the baby is reduced, which can lead to fetal growth retardation syndrome. And a significant increase in blood pressure can cause damage to microvessels, foci of hemorrhages are formed, which can lead to placental abruption. That is why during pregnancy it is so important to control blood pressure and keep it at an optimal level. nine0005

Normal blood pressure during pregnancy

The norms of blood pressure accepted in general medicine range from 100/60 to 120/80 mm Hg. But during pregnancy, these indicators may change somewhat. Usually in the early stages (the entire 1st trimester and up to 20 weeks), these numbers slightly decrease, which is associated with a change in the hormonal background of the whole organism and a restructuring of metabolic processes.

Later, as the fetus grows and develops more intense blood flow to feed it, the pressure may increase relative to "non-pregnant" values. Because of this, the average norms for expectant mothers lie in a wider range - from 105/60 to 139/89 mmHg

Significant deviations from this range upwards are called gestational hypertension, and downwards are called hypotension.

Low blood pressure during pregnancy or hypotension

In the first months of pregnancy, the hormonal background of the expectant mother undergoes significant changes, works with a great load, creating a favorable background for the development of the child, and these changes are often accompanied by a decrease in blood pressure, hypotension.

1.1.1 Possible causes of hypotension

Sometimes it is impossible to determine the cause that provoked the appearance of such a disorder, but the following may play a role in its development:

• Hormonal changes;
• NDC for hypotonic type;
• Infectious diseases;
• Liver pathology;
• Taking certain medications;
• Features of woman's emotionality.

Pregnancy hypotension is often not perceived as a serious threat to the health and progress of pregnancy. However, it can be a serious pathogenic factor that provokes various disorders of the course of pregnancy:

1. Termination of pregnancy
2. Fetal growth retardation
3. Oxygen starvation baby
4. Weak labor activity
5. Possible bleeding after separation of the placenta
6. Relaxation of the uterus after childbirth and rebleeding

1.1.2 Main symptoms of hypotension:

1. Nausea, vomiting
2. Headache
3. Tinnitus
4. Shortness of breath
5. Dizziness
6. Increased fatigue
7. Drowsiness
8. Pale skin
9. Increased perspiration
10. Loss of consciousness

1.1.3 How to increase blood pressure or what to do with low blood pressure

In general, women with low blood pressure are not hospitalized unless there is a risk to the baby. Expectant mothers are observed by an obstetrician-gynecologist, a therapist and, if necessary, a cardiologist. Most often, in the third trimester, the pressure returns to normal. nine0005

Pregnant women should follow these guidelines:

• Get at least 8 hours of sleep (optimally 9-10 hours) and rest during the day if possible.
• Spend more time outdoors (at least 2 hours a day).
• Food should be taken in small portions, but throughout the day.
• Moderate physical activity recommended - do prenatal gymnastics; if possible, swim. nine0024
• Useful water treatments - showers, douches, contrast foot baths, as well as massage; physiotherapy (electrosleep, salt-coniferous and mineral baths) and acupuncture are successfully used for treatment.
• If necessary, doctors can prescribe drug therapy: usually, pregnant women are prescribed herbal preparations that increase the tone of the autonomic nervous system, such as extracts of eleutherococcus, radiols, tinctures of magnolia vine, aralia, zamaniha in combination with sedatives (valerian, motherwort), as well as drugs based on caffeine. nine0024

If a pregnant woman has lost consciousness due to a sudden drop in blood pressure, the first thing to do is to lay her horizontally on her side and call an ambulance. Then open the door or window, unfasten the collar, give a sniff of ammonia. You can massage the area between the nose and lip or act on the fingertips on the hands.

High blood pressure during pregnancy or hypertension

Arterial hypertension is a disease characterized by a persistent increase in blood pressure. The changes that occur in the body during pregnancy predispose to the development of hypertension and therefore pregnant women are at a higher risk of developing hypertension than the general population. Arterial hypertension is a risk factor for various complications of pregnancy and ranks second in the list of causes of maternal death. At the same time, the diagnosis and treatment of arterial hypertension in pregnant women requires a special approach. nine0005

If before pregnancy you noted that your blood pressure was higher than normal, drank pills, visited the appropriate doctors, be prepared that this problem will come up now. And, most likely, it will manifest itself with greater force.

Remember: now the situation is completely different, you do not need to take the same pills as before pregnancy.

Forms of arterial hypertension during pregnancy

Arterial hypertension of pregnancy is an increase in blood pressure during pregnancy. It is regarded as a persistent increase in systolic blood pressure above 140 mm Hg. and diastolic blood pressure above 90 mmHg in women with normal blood pressure before pregnancy. Women with such an increase in pressure require close medical supervision.

There are several types of arterial hypertension during pregnancy:

• Chronic hypertension is characterized by the presence of high blood pressure before pregnancy and its persistence after pregnancy.
• Arterial hypertension of pregnancy is a persistent increase in blood pressure that develops after the 20th week of pregnancy, which disappears at the end of pregnancy. nine0024
• Pre-eclampsia/eclampsia is a severe impairment of the cardiovascular system and kidneys during pregnancy, which includes: hypertension and impaired renal function.

In pregnant women, arterial hypertension occurs with a frequency of 4-8%, which is a very high figure, especially if we take into account the young age of most expectant mothers. During pregnancy, the woman's body adapts to new conditions of functioning, which include ensuring the life and development of the fetus. On the part of the cardiovascular system in the body of a pregnant woman, the following changes occur:

• An increase in the volume of circulating blood and the appearance of a placental circulatory system is necessary for the nutrition and development of the child. In pregnant women, the volume of circulating blood increases by 25-30%, which, in addition to ensuring the nutrition of the child, allows women to lose part of the blood during childbirth, without significant damage to health.
• Increased heart rate.
• Increased intra-abdominal pressure, an increase in the diaphragm and a change in the position of the heart in the chest due to a significant increase in the size of the uterus. nine0024
• Gradual weight gain in a pregnant woman.

Possible other causes of high blood pressure

• Exercise
• Drinking strong tea or coffee
• Chronic stress, fatigue, lack of sleep, emotional stress
• Smoking, alcohol abuse
• Unbalanced diet, lack of vitamins and minerals
• Obesity, overweight
• Multiple pregnancy
• Lack of physical activity
• Diseases of the thyroid gland
• Diseases of the adrenal glands
• Diabetes mellitus
• Head, brain and spinal cord injuries
• Encephalitis
• Myelitis
• Diseases of the heart and blood vessels
• Renal dysfunction
• Hereditary predisposition

Main symptoms of hypertension:

• Headache
• Nausea, vomiting
• Dizziness, weakness, impotence
• Redness of the skin of the hands and face
• Noise or ringing in the ears
• Visual impairment
• Edema
• Urinary protein excretion
• Convulsions

High blood pressure can cause complications such as retinal detachment or retinal haemorrhage, which can lead to partial or complete loss of vision. nine0005

If blood pressure began to rise in the second or third trimester of pregnancy, then we are probably dealing with a serious complication of pregnancy - preeclampsia.

Preeclampsia is a special condition that occurs only during pregnancy and ends with its completion. The manifestations of preeclampsia are varied, but the classic symptoms are:

• arterial hypertension
• edema
• proteinuria (protein in urine)

With preeclampsia, there is a violation of microcirculation in all vital organs: the blood supply to the brain worsens, kidney failure develops, the blood becomes viscous, and the resulting microthrombi disrupt the work of all organs and systems. Of particular danger is such damage to the vessels of the placenta and the brain. The most severe manifestation of preeclampsia - eclampsia - convulsive seizures, ending in a cerebral coma.

But preeclampsia often begins with a pathological weight gain. Expectant mothers often wonder why this doctor pays such attention to weight. Well, think about it, added a couple of extra pounds. nine0005

But after all, such an increase is due to fluid retention in the body, or the so-called latent edema.

And if treatment is not started in time, all manifestations of preeclampsia will not be long in coming. If there was an increase in blood pressure before the onset of pregnancy, then its successful course is possible only with good preparation and the correct selection of drugs that reduce pressure. With uncomplicated hypertension and a slight increase in pressure, only non-drug measures are sufficient. nine0005

More about preeclampsia

Treatment and prevention of arterial hypertension during pregnancy

Treatment of arterial hypertension during pregnancy is a complex and responsible task. Therefore, the basis of any type of treatment should be close cooperation between the patient and the doctor.

In the treatment of arterial hypertension in pregnancy, as well as in the treatment of arterial hypertension, the following methods are used: non-drug treatment and drug treatment. nine0005

Non-drug treatment, that is, treatment without drugs, is the most appropriate treatment for hypertension during pregnancy, as many of the drugs used in the treatment of this disease can be dangerous to the fetus.

What to do with pressure, how to reduce pressure during pregnancy

Non-drug treatment and prevention of arterial hypertension includes:

1. Diet. The main requirements for the diet of women suffering from hypertension are a reduction in the consumption of table salt, coffee, tea, and the rejection of bad habits. The allowable amount of salt per day for patients with hypertension is 5 grams, while the calculation must include not only the salt with which we season food, but also the salt contained in various foods. nine0024
2. Physical activity. Moderate physical activity has a positive effect on the general condition of the body, promotes fat burning, normalizes metabolism, improves blood supply to internal organs and the fetus, increases muscle tone and helps to establish the correct position of the fetus in the uterus. For the treatment and prevention of arterial hypertension during pregnancy, daily physical activity in the form of gymnastics (preferably with an instructor), hiking in the fresh air, and swimming are recommended. nine0024
3. Maintenance of normal body weight. The common expression that during pregnancy a woman "should eat for two" is not true. In fact, an "energy supplement" during pregnancy should not exceed 350 kcal. At the same time, maintaining normal body weight during pregnancy is extremely important for maintaining the health of the pregnant woman herself and her child (obesity contributes to the development of hypertension and diabetes). The normal weight gain of a pregnant woman by the end of pregnancy should not exceed 12 kg. nine0024

Drug treatment of hypertension during pregnancy should be carried out under the supervision of a specialist doctor and only with safe drugs.

1. With a single slight increase in pressure, treatment begins with the appointment of sedative natural drugs, for example: valerian, motherwort, novopassitis and others. Together with non-drug therapy, these measures are very effective.
2. For persistent high blood pressure, the following drugs can usually be prescribed, but only on the recommendation of a doctor. The main drug or "drug of choice" the most effective and safe is Methyldopa (Dopegyt), which can be used during pregnancy from a short gestation period. nine0024
3. A group of drugs that can be prescribed from the second trimester of pregnancy are calcium channel blockers: Verapamil, Nifedipine.
4. With persistent hypertension from the 2nd-3rd trimester, β-blockers can be prescribed, this group of drugs does not have a teratogenic effect.

Prenatal monitoring of the fetus is necessary while taking medications.

If the pressure rises suddenly and you feel unwell, urgent hospitalization is necessary. Only in a hospital is complete control over the condition of the child and mother and full therapy possible. nine0005

A birth plan and referral for pregnant women with high blood pressure is made in advance. If there are problems that cannot be corrected, a caesarean section is performed.

Follow your doctor's advice. He is a professional, he knows what is best for you and your child!

Tags: pregnancy

High blood pressure during pregnancy

But its meaning is not always correctly controlled and interpreted. Let's figure out how to properly control blood pressure during pregnancy, which blood pressure is considered elevated, why it can rise and what to do about it and what not to do.

Blood pressure measurement

Blood pressure is monitored using a tonometer: electronic, semi-automatic or mechanical. You can buy any that you can handle and the cuff of which suits you in diameter. The only thing to consider is that the blood pressure cuff should be worn on the upper arm, carpal blood pressure monitors are too inaccurate and cannot be relied upon. nine0005

Measurement of blood pressure is best done in a sitting position, and after you have spent about fifteen minutes in this position, in a state of physical and emotional rest, you do not need to talk while measuring blood pressure.

The cuff is worn on the shoulder freed from clothing, its lower edge should be a few centimeters above the elbow. The arm on which blood pressure is measured should be in a relaxed position, the cuff should be located approximately at the level of the heart. Measurement is performed on one arm, measurement on two arms, which was previously required for all pregnant women, is now excluded from all clinical recommendations. nine0005

When measuring with the mechanical blood pressure monitor, the cuff is inflated to the digits, approximately twenty to thirty mm. rt. Art. higher than expected blood pressure. The air from the cuff is released slowly, the appearance of sound marks the numbers of systolic blood pressure, the disappearance of the sound - diastolic. This is not "cardiac" and "renal" pressure, but - systolic and diastolic.

Measurement of blood pressure is carried out at each visit to the obstetrician-gynecologist - office measurement of blood pressure, at home of the pregnant woman herself or her relative - outpatient measurement of blood pressure. If necessary, the doctor may recommend that the patient keep a blood pressure diary - measure blood pressure several times a day for some time, writing down the numbers. Ceteris paribus, more reliable information is obtained from outpatient (at home) measurements. nine0005

If there is doubt about the correctness of the patient's blood pressure measurement or if there is a suspicion of an increase in blood pressure at night, the doctor may prescribe the patient 24-hour blood pressure monitoring (ABPM), in which blood pressure is measured automatically at certain intervals within one day.

In general, during pregnancy, blood pressure in the first trimester is lower than normal for the patient, in the second or third it returns to her usual numbers, by the third trimester it may be slightly higher, but within normal numbers. Blood pressure below 140/9 is considered normal during pregnancy.0 mm. rt. Art.

If the patient is prone to arterial hypotension (low blood pressure), elevated blood pressure is still considered to be blood pressure above 140/90 mm. rt. Art., lower figures do not require any additional examination or treatment, even if they are higher than usual for the patient. None of the clinical guidelines for the treatment of arterial hypertension during pregnancy indicate the need for treatment with higher blood pressure than usual, but not reaching a value of 140/90 mm. rt. Art.

AD 140/90 mm. rt. Art. and above must be recorded 2 or more times with an interval between measurements of at least 4 hours to be considered hypertension.

Causes of high blood pressure

There are three causes of high blood pressure during pregnancy: chronic arterial hypertension, gestational arterial hypertension and preeclampsia.

Chronic arterial hypertension is the general name for all cases of high blood pressure that existed before pregnancy. Chronic arterial hypertension is not divided into primary (due to unknown causes) and secondary (resulting from a disease), in contrast to arterial hypertension detected outside of pregnancy. Also, chronic arterial hypertension includes situations when a woman did not control blood pressure before pregnancy, and for the first time an increase in blood pressure was detected only in the first half (up to 20 weeks) of pregnancy. nine0005

Gestational hypertension occurs from the twentieth week until the end of the term, and is not accompanied by protein excretion in the urine.

Pre-eclampsia, unlike gestational hypertension, also develops after 20 weeks of gestation and is accompanied by protein excretion in the urine (proteinuria). Preeclampsia can also occur after delivery. Signs of an increase in the severity of preeclampsia are the appearance of a headache, dizziness, visual disturbances, pain in the solar plexus and / or in the right hypochondrium, pain under the right shoulder blade, respiratory failure, and some changes in blood tests. These signs require urgent hospitalization. nine0005

The extreme case of preeclampsia - eclampsia - is characterized by the occurrence of convulsions and threatens the life of both the mother and the child, therefore, it requires an emergency delivery, regardless of the gestational age, only in this way it becomes possible to save the life of the mother and child.

Since an increase in blood pressure may occur before proteinuria in pre-eclampsia, it is possible to distinguish gestational arterial hypertension from preeclampsia only in retrospect - if blood pressure increased, and protein did not appear in the daily urine, it can be said with certainty that this increase in blood pressure was due to specifically gestational hypertension. nine0389 Preeclampsia may be associated with chronic arterial hypertension that existed before pregnancy.

Treatment of Hypertensive Disorders

Hypertensive disorders are an important cause of maternal and perinatal death, increase the rate of preterm birth, and are indeed a serious problem and should not be ignored.

The only one to date proven effective in preventing pre-eclampsia drug is acetylsalicylic acid. It is prescribed starting from the 13th week of pregnancy at a low dose and at this dosage does not lead to impaired fetal development, unlike high doses.

Treatment of any arterial hypertension during pregnancy is prescribed only by a doctor.

In case of chronic arterial hypertension uncomplicated by damage to other organs, treatment is started at a blood pressure of 150/90 mm. rt. Art. and more, with gestational arterial hypertension and preeclampsia - with blood pressure 140/90 mm. rt. Art. and more.

BP should be maintained at 130-150/80/95 mmHg during treatment. rt. Art., since a more radical decrease in blood pressure is fraught with impaired blood supply to the fetus and is not recommended.

There are several groups of antihypertensive drugs, the use of which during pregnancy can lead to impaired fetal development or death, so they should not be used during pregnancy. These are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Do not use during pregnancy and diuretics (drugs with a diuretic effect). nine0389 Usually, treatment is started with methyldopa, but it is also possible to use certain drugs from the group of beta-blockers and some drugs from the group of calcium antagonists, which are best studied from the point of view of safety in pregnancy. It is possible to use combinations of these drugs.

Separately, a few words should be said about magnesium sulfate (magnesium sulphate). This drug has practically no antihypertensive effect, and its use during pregnancy is limited only to preeclampsia, which threatens the development of eclampsia. It is needed to prevent the development of seizures (neuroprotective effect). It should not be used to influence elevated blood pressure. nine0005

delivery of hypertension during pregnancy, as a rule, is performed through the birth canal, except in cases of severe preeclampsia, eclampsia and their complications, requiring emergency delivery by caesarean section, regardless of the gestational age for health reasons.