How high blood pressure does a pregnant woman have? When is discharge considered normal?

During pregnancy, you need to check your blood pressure every day for all 9 months: the numbers displayed on the tonometer display largely determine the condition of the expectant mother and her baby.

Hormonal changes in the first months of pregnancy contribute to a decrease in blood pressure (BP) - causing hypotension. Because of this, the expectant mother feels weak, drowsy, dizzy, ringing in the ears, and suffocates when walking. The discomfort usually worsens in the morning.

Some women find out that they are expecting a baby when they are examined for sudden fainting. Doctors consider such an episode to be no less a characteristic sign of pregnancy than an addiction to sour and salty foods and nausea characteristic of early toxicosis. By the way, against this background, hypotension increases. This is unpleasant for the mother, but extremely dangerous for the baby!

With low blood pressure during pregnancy, blood circulation in the placenta is disrupted - placental insufficiency occurs. The baby, lacking nutrients and oxygen, begins to starve and suffocate. This should not be allowed under any circumstances - that is why it is so important to check the tonometer readings from the very beginning of pregnancy!

Your blood pressure should not fall below 100/60 or exceed 140/90. If this happens, consult a doctor!

High blood pressure during pregnancy

In the second half of pregnancy, there is a tendency to high blood pressure. This is partly due to physiological reasons. An additional circle of blood circulation appeared in the body of the expectant mother, due to which the volume of circulating blood increased by half a liter by the 19-20th weeks, and by a whole liter by the 32-36th weeks!

As a result, the load on the heart has increased: it is forced to increase blood output by 40-50% and contract more often. The pulse, measured in a calm state, now reaches 80-90 beats (the norm is 70 0), and when the expectant mother is worried or actively moving, it generally jumps over a hundred. Don’t worry, this is normal, as is an increase in pressure by 5-15 mm compared to the numbers that were displayed on the tonometer display at the beginning of pregnancy.

Is there a bigger difference? Watch out! This happens with toxicosis in the second half of pregnancy. Its essence is that fluid leaves the bloodstream into the tissues: swelling occurs, and the pressure drops. Then the expectant mother’s body turns on the emergency system of arterial stimulation.

But the higher the pressure in the vessels, the more liquid seeps out of them. Trying to normalize it in this way is like carrying water in a sieve: the more you pour, the more it flows out. This is extremely dangerous! An emerging problem needs to be identified as early as possible, before a vicious circle has yet formed.

Special pressure control

Expectant mothers at risk should monitor their blood pressure very carefully. It includes those who have had miscarriages or complications during a previous pregnancy, as well as women suffering from excess weight, hormonal disorders, hypertension, neurocirculatory dystonia, kidney diseases and other internal organs that complicate pregnancy.

In such cases, in addition to daily monitoring of blood pressure at home, the doctor may refer the pregnant woman to daily monitoring of arterial pressure - hourly measurement with a portable device. It detects sudden jumps in this indicator during the day and night. It is recommended to do this check three times: the first time - in the early stages, to identify a tendency to hypotension, the second time - at 24-28 weeks, when the likelihood of gestosis increases, the third time - shortly before childbirth, to make sure that everything is normal, there is nothing to worry about !

Is your pressure lower than it should be?

This sometimes happens at night. The expectant mother is asleep and does not suspect that her blood pressure has dropped below the permissible level, and the baby is suffocating in her tummy. It’s unlikely that anyone would think of measuring blood pressure at 3 a.m. on their own initiative! So it turns out that such hypotension cannot be tracked except with the help of monitoring.

It is no less dangerous if a pregnant woman with a tendency to low blood pressure became agitated at the antenatal clinic, and it jumped. The doctor classifies her as a hypertensive patient and prescribes antihypertensive drugs that reduce her already low blood pressure.

Has your blood pressure exceeded normal?

You need to see how long this condition lasts during the day and what it is connected with. If, based on the total calculation, the rise in blood pressure lasts no more than 5-6 hours a day and is explained by physiological reasons (excitement, physical activity, reaction to stress or a magnetic storm), everything is in order: there is no need for antihypertensive therapy.

Checking blood pressure during pregnancy

To check the blood pressure of the expectant mother every day, you need a modern electronic tonometer that measures pulse and blood pressure automatically, memorizing the indicators.

With old-style devices, firstly, you will suffer, and secondly, without the appropriate experience, you will most likely get the wrong result.

Advice: If you use an electronic tonometer, strictly follow all the instructions. There are compact devices that measure pressure on the wrist and even finger, which you can take on the road. But at home it is better to have a standard tonometer designed for the elbow: the smaller the artery on which blood pressure is determined, the less accurate the result.

• When purchasing a blood pressure monitor, make sure it is adjusted correctly and tested for accuracy. From time to time, compare its readings with the results obtained on other devices used by a doctor, a neighbor, or a pharmacist at a pharmacy.
• Keep in mind: one blood pressure monitor is not enough to monitor blood pressure during pregnancy.

You need a bathroom scale to monitor your weight gain (every pound you gain increases your blood pressure by one) and the ratio of fluids you drink to the amount you excrete (write everything down!). The difference should not exceed 200-300 ml!

How to measure blood pressure

An air-inflated cuff compresses the blood vessels, stopping the movement of blood through them. Then it is slowly lowered. At that moment, when the pressure of blood in the brachial artery slightly exceeds the pressure in the cuff, the first portion will break through the obstacle and hit the walls of the artery below the “dammed” place, producing a characteristic sound (the so-called Korotkoff sound), which can be heard using a phonendoscope.

The pressure in the cuff at this time is equal to systolic (upper). As the air leaves it, larger portions of blood will begin to overcome the “dam”. Eventually, the cuff will no longer compress the brachial artery even during diastole.

When the blood flows through it again in a continuous stream, and the Korotkoff sounds disappear. In this case, the readings on the tonometer display will correspond to diastolic pressure. Always measure your blood pressure at the same time, preferably in the morning after sleep and in the evening. Never do this immediately after eating or physical activity - the results will be unreliable.

Do not try to place the blood pressure monitor on the sofa or on your lap. Sit on the chair to the right of the table. Place the blood pressure cuff on your upper arm and secure it so tightly that only one finger fits between it and the skin. The result is not within the norm? Don't panic - check yourself!

High blood pressure can be obtained with a completely serviceable tonometer, if before the measurement you:

• drank coffee or strong tea. We ate a bar of chocolate and were in a smoky place;
• took breast elixir and other medicines based on licorice root, herbal neurostimulants (schisandra, ginseng and eleutherococcus);
• They were nervous, “replaying” unpleasant episodes in their heads. We waited a long time for our turn to see the doctor;
• walked quickly, afraid of being late for the appointment, carried a heavy bag, climbed the stairs;
• reacted with internal tension to the hospital environment - psychologists call this “white coat syndrome.”

Low pressure will be if you:

• the cuff was poorly inflated and could not completely cut off the blood supply to the brachial artery;
• they let the air out of her too quickly;
• they applied a standard cuff to an arm that was too thin;
• you didn’t sit as usual, but lay down while your blood pressure was measured.

At low and high blood pressure

With high blood pressure

• Press with the pad of the thumb of your right hand on a point located deep in the occipital fossa (at the point where the spine attaches to the head). After counting to 10, stop exposure. Repeat the manipulation 2 times.
• Mentally divide the back of your neck into 3 equal parts horizontally. Now find 3 paired points on the sides of the spine. Simultaneously influence each pair with the pads of the thumbs of both hands - three times in succession, each time slowly counting to 10.
• Find a point located along the midline of the abdomen just below the chest (it corresponds to the solar plexus). Press it simultaneously with the index, middle and ring fingers of both hands, count to 10 and release. Repeat 10 times.
• With your right hand, squeeze firmly and at the same time stretch the middle finger of your left hand, then vice versa.
• Are you excited? Think about the anti-stress point in the center of the inside of your chin. Massage with your index finger 9 times clockwise and 9 times counterclockwise.

At low pressure

• Act on the points in the middle of the groove between the nose and upper lip, in the center of the fold between the chin and lower lip, on the little finger at the root of the nail (immediately behind the periungual fold) on the side of the ring finger, on the index finger, also at the root of the nail on the side of the middle finger. Finally, knead the tip of each finger in turn.

What lowers blood pressure?

Cranberry mousse

Effectively lowers blood pressure. Take 1/3 cup cranberries, rinse and squeeze out the juice. Pour a glass of boiling water over the cakes, leave on the fire for 5 minutes, strain. Pour 1 tbsp into the broth. semolina and cook for 20 minutes, stirring constantly. Then add 3 tbsp. sugar, bring to a boil and cool.

Beat the mixture with a mixer until the mousse is light pink in color and thick, gradually pouring in the cranberry juice removed from the refrigerator.

Hypotensive juices (lower blood pressure)

Drink a glass of birch sap every day, and also reduce blood pressure by taking ¼ - ½ glass of freshly prepared beet juice 2-3 times a day (before drinking, keep it in an open container for 2 hours) 30 minutes before meals.

Pumpkin broth with honey

Take 200 g of pumpkin, cut into pieces, simmer over low heat until soft, place in a sieve and cool, then add honey.

One of the most common symptoms of the development of various pathologies while expecting a child is high blood pressure. Since the expectant mother’s body is very vulnerable during this period, gynecologists carefully monitor blood pressure during regular examinations.

High blood pressure during pregnancy

As a rule, any woman knows her own normal blood pressure (BP). For some it is slightly lower than the generally accepted norm, and for others it is slightly higher. It is not for nothing that women who are going to become mothers have their blood pressure measured at the clinic, because these indicators determine the health status of the pregnant woman and the fetus. Medical norms for blood pressure during pregnancy are 100/60 -140/90. But while expecting a child, these figures can vary up to 15%.

Hypertension during pregnancy is extremely undesirable, since the load on the heart increases, blood output increases, and blood vessels narrow. In this condition, embryo growth slows down due to lack of oxygen. Excessively high blood pressure in pregnant women sometimes causes placental insufficiency and early placental abruption. This can cause fetal death or spontaneous miscarriage.

Blood pressure during early pregnancy

Both a decrease and an increase in blood pressure levels are dangerous in the early stages of pregnancy. Alarming numbers for an expectant mother on a tonometer are from 140/90, especially if they are observed regularly. Increased blood pressure during early pregnancy indicates the presence of gestational or chronic arterial hypertension:

1. Gestational hypertension. An increase in blood pressure causes pregnancy. Pathology in the early stages leads to a narrowing of blood vessels, which reduces the fetus’s consumption of essential nutrients.
2. Chronic hypertension. Deviations are caused by pathological processes that develop in a woman’s body. The most common causes of complications are endocrine disorders or kidney disease.

High blood pressure during late pregnancy

When there is a constant increase in blood pressure during pregnancy, the woman has a high risk of developing preeclampsia. A dangerous disease can develop at any stage, but more often begins in the third trimester. Preeclampsia leads to disruption of the blood flow, vascular system and important organs. Pregnant women with chronic stress, infections or intoxications are at risk.

High blood pressure during late pregnancy can develop due to heredity. If relatives on the female side suffered from hypertension, then the pregnant woman has a high probability of encountering this pathology. What to do if you can’t lower your blood pressure on your own at a later stage? You should definitely contact your doctor, who will refer you to a hospital for examination and observation.

Why does blood pressure increase during pregnancy?

Starting from the second trimester, a pregnant woman’s blood volume increases, but the bloodstream remains the same. This condition causes signs of high blood pressure: tinnitus, headache, heaviness in the lower extremities. Other causes of high blood pressure during pregnancy:

• genetic predisposition;
• alcohol, smoking while expecting a baby;
• regular overexertion, constant stress;
• dysfunction of the adrenal glands and/or thyroid gland;
• obesity;
• diabetes;
• physical inactivity;
• unbalanced diet.

Signs of high blood pressure during pregnancy

An accurate and quick way to find out your blood pressure is to measure it using a tonometer - an electronic device that every pregnant woman needs to have. If there is no such device in your home medicine cabinet, then you can find out about the presence of hypertension if you listen to your condition. The main symptoms of high blood pressure during pregnancy:

• the appearance of red spots or general redness on the chest, face;
• the appearance of “floaters” before the eyes;
• vomiting, nausea;
• stomach ache;
• increased weakness;
• bad feeling.

Why is high blood pressure dangerous during pregnancy?

In most cases, expectant mothers begin to suffer from edema, and this makes life very difficult. The consequences of high blood pressure during pregnancy are arrhythmia, general weakness, and blurred vision. This problem does not require delay in going to the doctor, as it can lead to placental abruption, which is dangerous for the baby. Among other things, high blood pressure may indicate eclampsia, which is characterized by rejection of the fetus by the mother's body. Complications are accompanied by the presence of protein in the urine or severe weight gain.

How to reduce blood pressure during pregnancy

There are several ways to normalize blood pressure during pregnancy. The most common is taking pills. However, pregnant women should not do this on their own, as it can provoke dangerous conditions. The second method is traditional medicine, but this option should also be accompanied by observation from a specialist. If a woman’s blood pressure does not go off scale to prohibitive heights, then it can be reduced by daily walks, lack of stress and a review of the diet. Sweet, salty, spicy and fried foods should be excluded from the menu.

Blood pressure pills during pregnancy

Drug treatment for hypertension is prescribed by a doctor. Before the pills are prescribed, the pregnant woman is sent for laboratory tests, where she needs to undergo extensive urine and blood tests. You may need to additionally undergo an electrocardiogram and an ultrasound of the heart. After this information, the gynecologist will prescribe medications for blood pressure during pregnancy. If blood pressure is slightly elevated, then Papazol tablets are prescribed. You can quickly lower your blood pressure with drugs such as Egilok, Dopegit. If hypertension is severe, then a 10-day course of Nifedipine is prescribed.

Folk remedies for high blood pressure during pregnancy

When using natural medicines before giving birth, a woman must always listen to her body’s reactions. The slightest discomfort in the form of nausea or gastrointestinal upset requires immediate discontinuation of treatment. To reduce blood pressure, fruit and berry juices and drinks made from them are used. The following juices gently relieve hypertension:

• beet;
• carrot-apple;
• lingonberry;
• pumpkin;
• pomegranate;
• cranberry.

Other folk remedies for hypertension in pregnant women:

1. Rose hip decoction. Pour boiling water (0.5 l) over a handful of berries, then cook for 10 minutes. The drink should be cooled and then drunk three times a day until results are obtained.
2. Dill seeds. Grind 2 tbsp. l. seeds, then pour boiling water (0.5 l) in a thermos. After an hour, the drink should be strained and taken before meals 3-5 times a day.
3. Pumpkin with honey. Cut the pumpkin (200 g) into pieces. Cook over low heat until done. Add 2 tbsp. l. honey, consume in equal portions throughout the day.

How to reduce a pregnant woman's blood pressure at home

Some foods help lower blood pressure. These include: low-fat dairy products, vegetable oils, seafood, cereals, fish, bran. In order not to harm the child’s health, it is better to coordinate the daily diet with a specialist. You can reduce blood pressure during pregnancy at home if it suddenly increases with the help of a cushion, which you need to place under your feet while lying down. Next, you need to provide the woman with an influx of fresh air and call an ambulance.

In order to avoid hypertension during pregnancy, you need to do gymnastics as much as you can, move more, and maintain body tone. Preventive measures:

• do not abuse hot baths;
• remove coffee and chocolate from your diet;
• take a cool shower;
• do acupressure on the base of the head;
• Regularly ventilate living rooms.

Video: Arterial hypertension during pregnancy

In the structure of diseases of pregnant women, arterial hypertension makes up 15-20%. Among these 20%, primary hypertension makes up a third, hypertension due to gestosis - about 70% and secondary hypertension due to other diseases - 25%. Arterial hypertension is a serious disease that quietly undermines the body's strength from the inside. The essence of the disease: vasoconstriction occurs under the influence of nerve impulses and certain hormones. At first, arterial hypertension does not manifest itself in any way. The woman does not feel an increase in pressure and performs the same load. However, the internal organs suffer because little blood flows through the narrowed vessels, there is not enough oxygen (hypoxia), and connective tissue begins to grow in the organs (its cells can grow when there is a lack of oxygen). Specialized organ cells cannot live without oxygen, and the organ loses its function. This is when women complain. They can be different: dizziness, headaches, spots flashing before the eyes.

In serious forms of hypertension, there may be a sharp rise in blood pressure - a hypertensive crisis (a complication of hypertension). There is the following classification of hypertensive crises: neurovegetative form, edematous form, convulsive form. During a crisis, a woman’s well-being sharply worsens: sudden onset, agitation, fear, sweating, and pale skin (neurovegetative form). Another form of crisis is edematous: the development is gradual, the woman has drowsiness, lethargy, there is a decrease in activity and poor orientation in space, swelling and puffiness of the face and the whole body increase. With a sudden loss of consciousness and the appearance of convulsions, a convulsive form develops, threatening sudden death as a result of cerebral edema. First aid for a hypertensive crisis in pregnant women should be carried out only by ambulance doctors. If a pregnant woman complains of feeling unwell, an ambulance is immediately called. Arterial hypertension has its own classification, which is based on the levels of pressure increase: optimal pressure is 120 to 80 mm Hg. Art., in pregnant women it is desirable 100-110 and 60-70 mm Hg. Art.

I degree - 140-159 and 90-99 mm Hg. Art.
II degree - 160-179 and 100-109 mm Hg. Art.
III degree - 160-179 and more than 110 mm Hg. Art.

Causes of hypertension during pregnancy

Arterial hypertension during pregnancy occurs quite often if:

• the woman had hypertension before pregnancy;
• a woman suffers from kidney diseases (pyelonephritis, glomerulonephritis, kidney infarction, diabetic nephropathy, etc.) and (or) diseases of the endocrine system (hypothyroidism, hypercortisolism, etc.), which can contribute to the development of hypertension during pregnancy;
• There are mental and (or) neurogenic disorders that can also serve as triggers for increased blood pressure.

Symptoms and signs of hypertension during pregnancy

The main symptom of hypertension is an increase in blood pressure. Increased blood pressure may be asymptomatic, but often a woman may experience the following unpleasant symptoms.

• headache;
• heartbeat;
• sleep disorders;
• fatigue;
• visual impairment;
• noise in ears;
• nosebleeds, etc.

The main difficulty in diagnosing arterial hypertension in pregnant women is the following: young women do not measure their blood pressure, and if they have hypertension, they do not feel it. Due to the characteristics of pregnancy at the beginning, blood pressure decreases in all expectant mothers. In addition, the presence of gestosis, which is also manifested by increased blood pressure, masks hypertension. A diagnosis of “arterial hypertension” can only be made under certain criteria: the presence of the disease in close relatives and increased blood pressure in a woman at least once in her life, in comparison with blood pressure levels in previous pregnancies, if any, complaints from the pregnant woman of frequent headaches, nasal bleeding or pain in the heart, etc. Naturally, the main criterion for hypertension is the fact of increased blood pressure. In the first stage of hypertension, a pregnant woman does not experience any inconvenience. May complain of recurring headaches (often after a stressful situation), tinnitus or nosebleeds. At the same time, there are no changes in other organs; the first to suffer from hypertension are the kidneys, brain and fundus of the eye. In the second stage of arterial hypertension, there are constant headaches, limitation of physical activity and stress due to shortness of breath. Hypertensive crises may occur here. Changes in the fundus of the eye are noted when examined by an ophthalmologist; the wall of the left ventricle of the heart thickens (hypertrophy). With third-degree hypertension, pregnancy and the ability to conceive a child are unlikely due to unfavorable conditions. When a pregnant woman is diagnosed with hypertension, immediate treatment must be started to create conditions for normal growth and maturation of the fetus. First, you need to create a calm environment for the pregnant woman, protect her from stress and anxiety, provide her with sufficient good sleep and rest, and a balanced diet. In case of excessive excitability, sessions of auto-training, hypnosis, and acupuncture can help well. The expectant mother should be under the constant supervision of a general practitioner, who should prescribe certain medications to lower blood pressure. Women should remember: many medications that they took before pregnancy to lower blood pressure are not suitable during pregnancy because they negatively affect the child. Arterial hypertension has an adverse effect on the course of pregnancy, the woman and the child. The child suffers the most. Against the background of hypertension, gestosis develops, accompanied by failure of all organs. The placenta, which nourishes and protects the fetus, and the uteroplacental blood flow suffer. These manifestations lead to a lack of oxygen and nutrients, and the fetus dies. Labor during arterial hypertension is also distorted: labor either lasts slowly or very quickly, which threatens the child with injury or hypoxia. It is important for pregnant women with hypertension to be hospitalized at less than 12 weeks. The clinic determines the severity of the disease, its complications, and the possibility of bearing a child. In the first stage of hypertension, the prognosis for expectant mothers is favorable: if all recommendations are followed and a doctor’s supervision is followed, pregnancy is possible and the child will be born healthy. In the second stage, the possibility of maintaining pregnancy is decided on an individual basis and depends on the severity of complications from other organs. The third stage is a contraindication for pregnancy. The second time the expectant mother is hospitalized at 28-32 weeks to prevent excessive stress on the heart and blood vessels. The third hospitalization is two to three weeks before birth to prepare for childbirth, determine the tactics of childbirth and the necessary methods of pain relief. Often women give birth to a child themselves; a caesarean section is needed only for certain indications. The basis for the course of pregnancy in a woman with arterial hypertension is the correct daily routine, lack of stress, proper nutrition, regular medication intake and supervision by specialists.

Arterial hypertension is dangerous due to its complications during pregnancy, as it can cause:

• placental insufficiency;
• massive bleeding;
• premature birth,
• intrauterine fetal death;
• premature placental abruption, etc.

During pregnancy, the internal organs and vital systems of the child are formed. A lot depends on the woman’s health. What to do if the expectant mother has hypertension?

Of course, the situation should not be dramatized, although it would be unwise to completely ignore the risk.

Arterial hypertension nowadays occurs very often in people of all ages. Therefore, it is difficult to surprise anyone with increased blood pressure. Most people know from personal experience what it is, so they do not think that a pregnant woman with hypertension needs special care. This is a misconception. After all, it is her family and friends who should be primarily interested in her well-being and the successful course of her pregnancy.

The vast majority of women suffering from hypertension tolerate pregnancy well and give birth to healthy babies. But problems, of course, can and often do arise. The modern level of development of medicine allows us to cope with them. However, there is severe stage III hypertension. At this stage of the disease, pregnancy is fatal to the woman’s life. Fortunately, stage III is extremely rare, and stages I and II of arterial hypertension are not a contraindication to pregnancy.

Typically, a woman suffering from hypertension knows about it before pregnancy. Most likely, she already has a certain understanding of the disease, regularly or periodically takes some medications and is observed by a cardiologist.

At the very beginning of pregnancy, a woman diagnosed with hypertension should definitely consult a cardiologist, and then, throughout the entire pregnancy, undergo regular examinations, including blood pressure measurements, urine tests (for protein determination), and an electrocardiogram (ECG). It is very important that a specialist regularly monitors the development of the fetus. Not all medications can be taken during pregnancy. That is why independent choice of medications is unacceptable. Only a doctor prescribes drugs that do not have a teratogenic effect, that is, they will not harm the unborn child. When selecting medications, the individual characteristics of a woman’s body, as well as the presence of concomitant diseases, are very important.

In addition to prescribing medication, the doctor must give the necessary recommendations regarding the lifestyle of a woman suffering from hypertension. During pregnancy, such patients will have to reconsider their lifestyle, pay special attention to their diet, and give up certain foods. Moderate physical activity is very important.

It often happens that in the early stages of pregnancy, blood pressure decreases even in those women who had high blood pressure before pregnancy. In some cases, on the contrary, there is a sharp increase in blood pressure. Sometimes it is during pregnancy that a woman learns about a new diagnosis for herself - arterial hypertension.

The consequence of hypertension in pregnant women can be late toxicosis, which occurs in a severe form.

At the same time, the woman develops severe headaches, sometimes even vision is impaired.

Very dangerous complications of hypertension during pregnancy can be cerebral hemorrhage and retinal detachment. That is why, throughout the entire pregnancy, a woman must undergo regular medical examinations, follow all doctor’s instructions, be sure to measure blood pressure, do an ECG, and take a urine test to determine protein content. Consultation with an ophthalmologist is no less necessary.

During pregnancy, patients with arterial hypertension should visit an antenatal clinic once every 14 days and have a urine test done. After 30 weeks of pregnancy, a urine test must be taken every week.

If the diastolic pressure level rises above 90 mm Hg. Art. in a sitting position, the pregnant woman requires therapy with antihypertensive drugs.

If, despite following all recommendations, a hypertensive crisis occurs during pregnancy, signs of late toxicosis appear, or a woman feels a noticeable deterioration in her condition, it is better for her not to refuse hospitalization.

At least 2 weeks before the expected birth, even with a favorable pregnancy, experts still recommend that the woman go to the hospital. This is due to the risk of unexpected complications in the expectant mother or child. If complications occur, the woman is prescribed special therapy aimed at lowering blood pressure. Doctors carefully monitor the condition of the fetus. Sometimes a woman has a caesarean section. In some cases, they cause premature birth.

High blood pressure during pregnancy can cause fetal mortality and prematurity, premature placental abruption and some other problems. Therefore, timely assistance from a specialist is necessary.

Diagnosis and treatment of arterial hypertension in pregnant women

During each examination, the doctor must measure the pregnant woman’s blood pressure and record its readings in the card. This is necessary to track blood pressure dynamics at different stages of pregnancy.

You can often encounter a situation where blood pressure rises as a reaction to the “white coat”.

For example, a healthy woman’s blood pressure may “jump” noticeably during an appointment with a doctor, while at home this does not happen and the expectant mother feels good. If you know that you have this characteristic, if you are afraid of doctors and react to them this way, warn your doctor in advance about the possibility of receiving incorrect blood pressure numbers at the appointment.

Most often, in this case, the doctor prescribes home blood pressure monitoring. It is good if you measure and record your blood pressure three times a day for a long time, so that the doctor is convinced of your “sensitivity to the medical staff.” In this case, you will have to independently monitor your blood pressure at home throughout your pregnancy.

Treatment for the expectant mother is aimed at stabilizing blood pressure and eliminating complications for the baby (if any have begun). Quite often, a pregnant woman is required to be hospitalized for examination and normalization of her condition.

For hypertension, the expectant mother is advised to:

• consultation with a psychologist to eliminate psycho-emotional negative manifestations (stress, fears, anxiety, etc.);
• diet;
• daily quiet walks in the fresh air, preferably in nature (park or forest area);
• day rest;
• limiting weight gain (avoid excess body weight);
• daily blood pressure measurement at home;
• physiotherapy.

Antihypertensive drugs prescribed and supervised by a doctor must be taken constantly, since skipping medications can cause sudden surges in pressure, which is dangerous for blood vessels.

In the second semester of pregnancy, but sometimes even in the first, blood pressure often decreases. In the third semester, blood pressure becomes the same as usual. In some cases it exceeds the normal value. If, when examining a pregnant woman, a doctor notes high blood pressure, he will definitely recommend a thorough examination so that the nature of hypertension can be clarified, the presence of concomitant diseases can be determined, and the need for antihypertensive treatment can be determined.
Treatment is carried out depending on the degree of risk. If the patient has normal ECG and EchoCG results, there is no protein in the urine, and blood pressure levels are 140-149/90-199 mm Hg. Art., then she belongs to the low-risk group. If the patient has severe arterial hypertension, a poor obstetric history, there are concomitant diseases (collagenosis, diabetes mellitus, kidney disease are especially dangerous) and changes in internal organs, then she is at high risk.

Regardless of the degree of risk for each specific patient, there are general recommendations. They concern the correct regime, lack of overload, mandatory 8-9 hours of sleep. During pregnancy, a woman needs to limit the amount of fats and carbohydrates in her diet. The diet should contain as little table salt as possible, no more than 5 g. This rule is general for people suffering from arterial hypertension, but during pregnancy it is especially important.

If the patient is in a low-risk group, she is often not prescribed special medications. Non-drug therapy is sufficient, which consists of eliminating excessive stress, dieting, exercise, and taking care of your emotional state. Every day she must take as long a walk as possible. It is advisable to take walks not along polluted city streets, but in a forest or park. Autogenic training and relaxation give good results. During this difficult, but very important period for the baby’s health, the expectant mother must learn not to take all worries and troubles to heart. It is very important that relatives provide the woman with psychological support and do not cause trouble.

However, despite various non-drug treatments, blood pressure may increase. If blood pressure rises to 160/100 mm Hg. Art. and above, the patient must be prescribed antihypertensive drugs. Medicines make it possible to control blood pressure levels. But, it must be said, even taking medications is not always a reliable protection against the onset of preeclampsia. That is why, even if a pregnant woman belongs to a low-risk group, she should be screened in a timely manner.

In some cases, in patients with stage I arterial hypertension, the pressure decreases to normal levels. Then it is not necessary to take medications. But it is still necessary to control blood pressure. If a pregnant woman is at high risk, she is usually advised to start antihypertensive therapy immediately. Timely treatment will make it possible to avoid a number of complications. If the blood pressure level is 140/90 mm Hg. Art., the uteroplacental circulation is disrupted, which entails various pathologies of fetal development. The child does not have enough oxygen, since it is the blood that carries it. Due to high pressure, premature placental abruption may begin. There is also a risk of slower fetal development.

Treatment of arterial hypertension in pregnant women is complicated by the fact that not all drugs are harmless to the child. But modern medicine is at a very high level.

Despite the obvious need for treatment, some pregnant women themselves try not to take medications because they are worried about the harmful effects on the fetus. In case of severe arterial hypertension, this is unacceptable. Lack of treatment will cause much more harm.

There are some general rules for pregnant women regarding taking medications.

1. Most experts believe that angiotensin receptor antagonists (for example, valsartan, ibesartan, etc.) should not be used during pregnancy because they have a teratogenic effect.
2. In the first trimester of pregnancy, it is better not to take angiotensin-converting enzyme inhibitors that have a teratogenic effect (for example, quinapril, enalopril).
3. After the eighth week of pregnancy, some medications can have an embryotoxic effect (in particular, a number of antibiotics, antidiabetic, anti-inflammatory drugs). Therefore, the use of a drug that worsens hemodynamics in the mother is considered undesirable, because it also worsens the blood supply to the fetus. A drug that reduces blood clotting in the mother, therefore reducing blood clotting in the fetus.

A number of drugs do not have a harmful effect on either the expectant mother or the unborn child. The first-line drug for the treatment of arterial hypertension during pregnancy is methyldopa (Dopegyt, Aldomet). Many years of research and observations of born children have allowed scientists to claim that methyldopa is absolutely safe. It is usually prescribed in 3-4 doses of 0.75-4 g per day. Taking the drug may cause some people to experience fluid retention in the body. Therefore, if long-term use of the drug is required, it is combined in small doses with diuretics. If the patient has impaired renal or liver function, the medicine should be taken with caution, and the patient should be constantly under the supervision of the attending physician.

Calcium channel blockers are also used to treat hypertension during pregnancy. The dihydropyridine group drug nifedipine is very often used. The doctor sets the dose. The drug is able to quickly stop an impending hypertensive crisis.

The undoubted advantages of beta blockers include a gradual effect on blood pressure. The drugs also stabilize platelet function. It is very important that beta blockers do not have a negative effect on blood plasma volume. Examples of beta blockers include pindolol, atenolol, metoprolol, oxprenolol and some others.

It is important to remember that the choice of necessary medications remains with the doctor, because it is the specialist who must take into account the individual health status of the patient and other factors affecting the course of pregnancy.

The most severe complications of pregnancy with arterial hypertension are preeclampsia and eclampsia. Such complications are very dangerous for the life of a woman and child.

Preeclampsia during pregnancy

Preeclampsia is a condition that occurs late in pregnancy. In this condition, a woman experiences high blood pressure. Protein is found in the urine. The woman's legs and arms swell. The woman feels a headache, vomiting, and visual disturbances. There are also signs of nephropathy.

There is a risk of preeclampsia progressing into the last and most severe phase. In this case, there is a risk of coma or death of both mother and child during or after childbirth if the necessary treatment is not carried out. Severe forms of preeclampsia and eclampsia lead to dysfunction of vital organs, that is, the brain, lungs, kidneys, liver, and heart. The consequences of preeclampsia and eclampsia can affect the rest of your life if appropriate treatment is not carried out in a timely manner. This applies to both mother and child. According to the World Health Organization, preeclampsia is responsible for 15-40% of maternal and 38% of perinatal mortality worldwide.

Preeclampsia most often occurs during the first pregnancy. At risk are the youngest girls and women over 35 years old.

Risk factors are:

• arterial hypertension that was diagnosed before pregnancy;
• obesity;
• multiple pregnancy;
• diabetes;
• rheumatoid arthritis;
• systemic lupus erythematosus;
• cases of preeclampsia that have already been observed in the past in the patient herself;
• cases of preeclampsia in the patient's sister or mother.

Preeclampsia leads to impaired blood flow through the placenta, meaning the baby may be born underdeveloped. In some cases, preeclampsia also causes premature birth. A newborn may have pathologies such as visual and hearing impairment, cerebral palsy, and epilepsy.

Some doctors tend to underestimate the danger of preeclampsia. A simplified view of it is based on the fact that the main problem is high blood pressure, edema and proteinuria (protein excretion in the urine). But such symptoms are only superficial manifestations of the syndrome of multiple organ and multiple system failure. These signs make it possible to make the diagnosis of “preeclampsia”, but are not the cause of the disease.

If we talk about swelling of the arms, legs and face, then such symptoms often accompany normal pregnancy. Also, a clear relationship has not been established between the fact that one or another degree of arterial hypertension is observed and edema is simultaneously present.

Often, edema can occur in women whose blood pressure is normal. The presence of protein in the urine is a later sign of preeclampsia. About 5-10% of pregnant women with preeclampsia first experience seizures, and then proteinuria, that is, protein in the urine. Based on this, it was concluded that if the patient developed preeclampsia, it means that morphological damage to the kidneys is present, for example, pyelonephritis, glumerulonephritis, nephrosclerosis. Before protein appears in the urine, other symptoms occur: the concentration of urea and creatinine in the blood plasma increases.

Preeclampsia also occurs in early pregnancy, up to 20 weeks. In this case, the cause may be a disease of the ovum in a pregnant woman, which is characterized by the growth of the surface layer of the villous membrane (chorion) and swelling of the villous substance (hydatidiform mole).

There are several types of preeclampsia.

• Type I - there is low pressure in the pulmonary artery system, low cardiac output. Total peripheral vascular resistance is high.
• Type II - there is high pressure in the pulmonary artery system, high cardiac output. Overall vascular resistance is high.
• Type III - there is normal pressure in the pulmonary artery system, high cardiac output. Total peripheral resistance is low.
• Type IV - high pressure appears in the pulmonary artery system, and high cardiac output occurs. Plasma volume is normal or increased.

Experts often use the term “mild preeclampsia.” In this case, the outcome is favorable, because the pregnant woman only experiences a one-time increase in blood pressure. There are no other symptoms characteristic of preeclampsia. For mild preeclampsia, no special measures are usually taken. A woman should only limit her activity and take care of her health.

If there is a risk of premature birth, then special treatment is carried out for preeclampsia, which must be prescribed by the attending physician. Sometimes it is better for a woman to stay in a hospital setting to be constantly monitored. At an advanced stage of pregnancy, labor can be forcibly induced.

If a pregnant woman exhibits gestosis (late toxicosis of pregnancy, nephropathy - a complication accompanied by dysfunction of the placenta and the condition of the fetus), this means that there are signs of a critical condition, expressed to varying degrees.

These signs include:

• hypovolemia - a decrease in the volume of blood circulating in the body (it may be associated with limited fluid intake or loss);
• hypoxemia - decrease in gas exchange in goblin, hemoglobin content in the blood;
• circulatory disorders in the kidneys, brain, liver.

Such signs are associated with the fact that the properties of the blood are deteriorating and microthrombosis is present. Possible insufficiency of renal, pulmonary, and myocardial function. The severity of the patient’s condition is aggravated by vascular spasm, disruption of all types of metabolism, and especially water-salt metabolism.

Severe forms of preeclampsia are very dangerous for women during pregnancy. Lack of special treatment could lead to her death. In some cases, other treatment methods are prescribed, such as magnesium sulfate (magnesia). It makes it possible to prevent seizures and lower blood pressure. It is also possible to use various drugs that lower blood pressure. Control of fluid intake is important. The last resort is to immediately induce labor, regardless of the stage of pregnancy.

If a pregnant woman with manifestations of gestosis is observed in a hospital, eclampsia very rarely develops. This is due to the fact that the patient is under the constant supervision of specialists, and a variety of intensive therapy methods are used to improve her condition. Thanks to this, the development of the convulsive stage is prevented.

Eclampsia in pregnant women

The term "eclampsia" comes from the Greek. the words "eklampsis", which means "flare". The main symptom of eclampsia is muscle cramps throughout the body and loss of consciousness.

For specialists, a very important, but at the same time difficult problem is the ability to predict eclampsia, despite the suddenness of its onset. There are certain criteria that allow one or another patient to be considered at risk.

In eclampsia, great importance is given to the study of hereditary factors. This is very important because eclampsia most often develops during the first pregnancy. If the patient's mother had eclampsia, her daughter has a 49% chance of developing it. If the patient's sister had eclampsia, the patient's risk of developing eclampsia increases to 58%. With multiple pregnancies, the likelihood of developing eclampsia increases. There is also a high risk of this condition in pregnant women under the age of 25 and in women after 35 years.

Eclampsia leads to spasm of the respiratory muscles, which disrupts breathing, sinks the tongue, causes hypoxia (oxygen starvation) and hypercapnia.

As a result of hypercapnia, the secretion of the glands increases, and increased secretion of saliva, bronchial secretions, gastric and intestinal juice begins. There is no cough reflex during loss of consciousness. Bronchial secretions and saliva accumulate, and the airways narrow. Their lumen may close completely, which leads to disruption of gas exchange.
With hypercapnia, the excitability of the respiratory center decreases, and the disturbance of gas exchange worsens. The vasomotor center and sinoaortic receptors are irritated, resulting in an increase in blood pressure.

Vasospasm progresses, and excess blood enters the circulatory system from spasmed muscles. As a result, the load on the heart increases significantly. This load is exacerbated by hypoxia and hypercapnia. Therefore, with eclampsia, a disturbance in heart rhythm is observed. (These changes are clearly diagnosed on the ECG.)

Increased load on the heart leads to tachycardia and expansion of the cardiac cavity. Circulatory failure occurs, which only worsens hypoxia and hypercapnia.
Impaired cardiac function in eclampsia is often accompanied by pulmonary edema. As a result, hypoxia and hypercapnia worsen.

There are severe attacks of eclampsia. With them, very strong hypercapnia develops, which affects the peripheral vessels and the vasomotor center. In this case, in addition to central circulatory failure, peripheral failure also occurs.

More than 70% of patients with eclampsia have liver failure, and renal dysfunction also occurs. Various changes in kidney function lead to disruption of the body's filtration. Due to impaired renal function, compensation occurs only as a result of increased ventilation if there is free passage of the respiratory center and there is no brain damage. Otherwise, a mixed form of acidosis may develop and hypoxia and hypercapnia may worsen. At the same time, intracranial pressure increases and attacks become more frequent.

It happens that it is not possible to stop what is happening. Then there is a risk of hemorrhage in the brain, paralysis of the respiratory center, and cardiac arrest. The lungs swell, or respiratory and metabolic acidosis occurs. Death may not occur immediately, but after a few days. Thus, the main cause of death in eclampsia is (70%) cerebral hemorrhage, followed by respiratory failure with pulmonary edema, acute renal failure, postpartum hemorrhage, placental rupture, liver rupture, and septic shock. If the patient suffered eclampsia and survived, she may experience a number of complications in the future. In particular, disorders of the central nervous system, such as paralysis, autonomic disorders, headache, memory impairment, psychosis. Pathologies of other vital organs and systems of the body may also appear.
The development of eclampsia is considered a multiple organ failure syndrome, because in this condition there is failure of a number of systems and organs: respiratory, cardiac, renal, hepatic. There are also pronounced disturbances in the distribution of blood flow, rheological properties of blood, and various types of metabolism.

Complications of severe eclampsia may include:

• disseminated intravascular coagulation with uncontrolled bleeding;
• capillary leak syndrome;
• intrahepatic bleeding;
• heart attacks;
• acute renal failure.

Arterial hypertension associated with the presence of late taxicosis can cause premature placental abruption, miscarriage, hypoxia, developmental delays in the child and even his death.

Against the background of multiple organ failure, convulsive seizures develop. These seizures are not associated with cerebrovascular accident. Convulsive seizures are rare. But a whole series of seizures can occur that follow each other. This phenomenon is called “eclamptic status”. After a seizure, a woman sometimes loses consciousness, that is, an eclamptic coma develops. (Sudden loss of consciousness can occur without a seizure attack.)

Before cramps appear, the head begins to hurt sharply, insomnia occurs, and blood pressure rises. The woman feels very anxious. The seizure lasts from 1 to 2 minutes.

A seizure consists of several stages.

1. Pre-convulsant period. It lasts approximately 30 s. The facial muscles twitch, the corners of the mouth droop, the eyelids close.
2. The period of tonic convulsions. Lasts approximately 30 s. The muscles of the whole body contract, the torso tenses. The face turns blue, breathing stops.
3. Period of clonic convulsions. Lasts 30 s. Twitching of the facial muscles, muscles of the whole body and limbs is observed. The cramps become weaker. Breathing becomes hoarse, foam appears at the mouth with blood.
4. Consciousness gradually returns. The woman does not remember anything that happened to her just a few minutes ago.

The excitability of the central nervous system during eclampsia increases markedly. A new attack can occur from a variety of stimuli, such as light and noise.

Magnesium sulfate is often used to treat eclampsia. This drug is also used for preeclampsia. Magnesium sulfate is administered slowly intravenously or intramuscularly. At the same time, tendon reflexes and breathing rate must be monitored. But if the patient is taking calcium channel blockers, magnesium sulfate is not prescribed, because there is a danger of a sharp drop in blood pressure.

For eclampsia, aminazine or diazoxide is sometimes administered intravenously. It is also possible to administer intravenously and then drip diazepam (Seduxen).

Long-term rehabilitation therapy is very important. It is necessary for women who have suffered preeclampsia and eclampsia. Restorative therapy can reduce blood pressure, improve microcirculation and hemodynamics of the brain.

During the period of rehabilitation therapy, patients are recommended to take Mildronate 1 tablet (125 mg) three times a day in the period after childbirth. Mildronate affects the redistribution of blood flow in the brain, helps eliminate functional disorders of the nervous system, and improves blood supply to the brain.

If the patient has suffered eclampsia or preeclampsia, then even after discharge she should be under the supervision of a cardiologist, urologist, therapist and neurologist. Timely treatment and further observation help to avoid serious consequences that can lead to disability.

Arterial hypertension in pregnant women

The concept of “arterial hypertension in pregnancy” serves to designate various painful conditions.

First of all, we mean the following diseases:

• Hypertension in pregnant women. Hypertension in pregnancy is said to occur if the blood pressure of a pregnant woman is more than 140/90 mm PC and first rises after the 20th week.
• Severe hypertension in pregnant women. If blood pressure readings exceed 160/110 mm PC.
• Preeclampsia. The diagnosis is made when, along with high blood pressure, there is more than 300 mg of protein in the urine per day. Preeclampsia may also be indicated by clinical manifestations such as headaches, double vision and ripples in the eyes, pain in the upper part of the
• Eclampsia. The most severe form of preeclampsia, accompanied by convulsive seizures.

Blood pressure measurement. Important conditions are a wide cuff and rest, otherwise the indicators may be unreliable.

Blood pressure (BP) is the pressure exerted by blood on the walls of the arteries. Its value is indicated as a fraction, in which the first digit characterizes the blood pressure at the moment of contraction of the heart (systole) - systolic, and the second indicates the pressure value at the moment of relaxation of the heart (diastole) - diastolic blood pressure. Blood pressure readings are measured in millimeters of mercury, since pressure was originally measured using mercury tonometers.

This parameter is one of the most important, characterizing the quality of functioning of the body. Often during pregnancy, women for the first time encounter the problem of increased blood pressure, which can pose a danger to both the expectant mother and the fetus.

Symptoms of high blood pressure

If your blood pressure rises, you may experience:

• headache (its strength will be directly proportional to blood pressure level);
• dizziness;
• noise in ears;
• feeling of pressure on the eyes;
• general weakness;
• nausea and vomiting;
• redness of the face and chest area or the appearance of red spots on the face;
• flashing “flies” before the eyes.

The “insidiousness” of high blood pressure during pregnancy is that in some cases, even with high blood pressure numbers, the patient does not feel any pathological symptoms, feels normal, and continues normal daily activities. High blood pressure is detected by chance, during the next visit to the antenatal clinic. The absence of clinical manifestations of high blood pressure does not exclude the development of severe complications that can threaten the life of the mother and the unborn child, therefore it is very important to regularly monitor blood pressure during pregnancy.

How to measure blood pressure?

Currently, there are automatic electronic tonometers on sale that make it easy to measure blood pressure by pressing one button. Their use does not require special skills. From the moment you become pregnant, it is advisable to purchase a tonometer and measure your blood pressure at least 2 times a day. But it is necessary to take into account the fact that electronic tonometers may not be accurate enough, and in order to find out what your pressure is at the moment, it is recommended to measure three times and calculate the average value between the obtained values.

Arterial indicators pressure during pregnancy depend on many factors: the total volume of circulating blood, vascular tone, heart function (for example, heart rate), quality characteristics of the blood (viscosity, etc.), as well as on the level and activity of a number of hormones and biologically active substances produced by the kidneys and adrenal glands, thyroid gland, etc. In addition, a number of external conditions have a great influence on blood pressure: the level of physical activity, psycho-emotional stress, and atmospheric pressure.

Considering that changes occur in the body of the expectant mother regarding the amount of circulating blood, heart function, and changes in hormonal levels, even with a physiological pregnancy, blood pressure changes depending on its duration.

In the first and second trimesters, blood pressure, as a rule, decreases (systolic by 10–15 mm Hg, diastolic by 5–15 mm Hg), which is due to the action of the main pregnancy hormone, progesterone. It has a relaxing effect on blood vessels, which is a necessary condition for favorable growth and development of the fetus. As the duration of pregnancy increases, the load on the cardiovascular system increases, as the volume of circulating blood increases (by about 40?% of the original: 2-2.5? liters more blood circulates in the body of the expectant mother than before pregnancy), the heart rate increases (by an average of 15-20 beats per minute), the production of placental hormones increases, and body weight increases significantly (by the end of pregnancy - normally by 10-12? kg). This leads to a slight increase in arterial blood levels pressure during pregnancy, and it becomes the same as it was before pregnancy.

With the development of pregnancy complications, blood pressure levels can increase significantly, which poses a potential threat to the woman and the unborn child. Therefore, from the moment of registration at the antenatal clinic, careful monitoring of the value and dynamics (changes) of blood pressure is carried out.

Is your blood pressure normal?

It is believed that the average statistical blood pressure, which can be considered optimal (that is, necessary for the life support of the body with a minimal risk of developing cardiovascular complications), is a systolic blood pressure level of 110–120? mm Hg. Art., and diastolic – 70–80? mm Hg. Art. The limit values ​​are 130?/?85 –139?/?89?mmHg. Art. If the value blood pressure is 140?/?90 and above, then this condition is regarded as arterial hypertension (pathologically high blood pressure).

It should be noted that among young women there are often those for whom the usual blood pressure before pregnancy is 90?/?60–100?/?70 mm Hg. Art. In these cases, it is more correct to focus not on the absolute values ​​of blood pressure, but on the increase in indicators: if the values ​​of systolic pressure during pregnancy increased by 30? mmHg. Art., and diastolic - by 15? mm Hg. Art., then the expectant mother has high blood pressure.

To determine a reliable level of blood pressure, the doctor observes a number of fairly simple but important conditions, since expectant mothers quite often experience the “white coat” syndrome: if a woman has been sitting in line for a long time to see a doctor, being under stress from an unfamiliar environment, in tension While waiting for the test result, you can get increased measured pressure values. Blood pressure is measured for all pregnant women at every doctor visit. The doctor measures the pressure in both arms while the woman is sitting; the cuff of the tonometer (a device for measuring pressure) should be at the level of the patient’s heart. Blood pressure is measured using a tonometer, which can be manual (when the doctor listens to heart sounds in the area of ​​the brachial artery in the elbow) and automatic, when the device independently records the blood pressure level using electronics. Manual tonometers allow you to more accurately measure blood pressure levels, but require special skill. The positive aspect of electronic tonometers is their ease of use, but they can produce errors in measurements.

The patient should avoid physical activity an hour before visiting the doctor, and sit in a quiet environment for 5–10 minutes before recording blood pressure. During the measurement, you should relax, lean back in a chair or armchair, and do not cross your legs (this will make venous outflow difficult, and blood pressure values ​​may be too high). To obtain a reliable result, the doctor takes measurements repeatedly, since the first measurement, as a rule, is overestimated.

Since “white coat” syndrome cannot be ruled out, the doctor measures the pressure again 10-15 minutes after meeting the patient, since the pregnant woman’s anxiety decreases significantly after a calm conversation with the doctor.

To establish an accurate diagnosis, it is desirable that each woman knows her usual (as doctors say, working) blood pressure level, which occurred before pregnancy.

As already mentioned, it is impossible to establish a diagnosis of arterial hypertension (pathological increase in pressure) based on only one blood pressure measurement. To do this, the doctor takes repeated measurements; the diagnosis is made when a consistently elevated blood pressure level is recorded at least 2 times in a row. For an accurate diagnosis, the doctor may prescribe daily monitoring of blood pressure levels. It is carried out using a device attached to the patient’s body. In this study, blood pressure is automatically recorded for 24 hours during the patient’s normal rhythm of life. During the measurement, the woman keeps a diary in which she notes hourly the type of activity, duration of sleep, time of meal, etc. With 24-hour blood pressure monitoring, the side effects of external factors (white coat syndrome, stress, etc.) are excluded. therefore, the presence of arterial hypertension is diagnosed or excluded with a high degree of certainty.

High blood pressure in pregnant women

High blood pressure in a pregnant woman is an alarming symptom, as it can lead to serious complications:

If in the vessels of the body pregnant woman's blood pressure rises, this leads to similar changes in the “mother-placenta-fetus” circulatory system. As a result, the vessels of the uterus and placenta narrow, and consequently, the intensity of blood flow decreases and less oxygen and nutrients reach the fetus. These disorders cause fetoplacental insufficiency (complications when the normal functioning of the placenta is disrupted and the delivery of oxygen and nutrients to the fetus is reduced) and intrauterine growth retardation (with a full-term pregnancy, a child is born with low body weight). Also a consequence of placental insufficiency is the threat of termination of pregnancy.

Persistent long-term increase in blood pressure pressure during pregnancy can cause severe disturbances in the functioning of the vital organs of a pregnant woman, leading to acute renal or heart failure, dangerous to the life of the mother and fetus.

Arterial hypertension in a pregnant woman can lead to premature placental abruption due to increased pressure in the space between the wall of the uterus and the placenta (normally, the separation of the placenta occurs after the birth of the fetus). Premature placental abruption leads to bleeding (in severe cases, with quite large blood loss). Since the partially separated placenta cannot perform its function of ensuring the vital activity of the fetus, acute hypoxia (oxygen starvation) develops, which poses a real threat to the health and life of the unborn child.

A significant increase in blood pressure can lead to the development of severe conditions - preeclampsia and eclampsia. These conditions are consequences of gestosis - a complication of pregnancy, manifested by increased blood pressure, the presence of protein in the urine and edema. Preeclampsia is a condition accompanied by high blood pressure (200?/?120 mm Hg and above), headache, flashing “spots” before the eyes, nausea and vomiting, pain in the epigastric region located above the navel. Eclampsia is an attack of muscle spasms throughout the body, accompanied by loss of consciousness and respiratory arrest.

One of the most serious complications of arterial hypertension is cerebral hemorrhage. The risk of this complication increases significantly during the pushing period of labor, therefore, in order to avoid such severe consequences, when blood pressure levels are high, delivery is performed by cesarean section.

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

What is hypertension during pregnancy

Reasons leading to increased arterial blood pressure blood pressure in pregnant women, diverse. Diseases accompanied by increased blood pressure can be divided into two groups.

Group 1 – arterial hypertension that existed before pregnancy. It can be caused by:

• hypertension – this is the name given to high blood pressure, the exact causes of which remain unknown to this day; at the same time, the woman does not have diseases that could cause an increase in blood pressure (endocrine pathology, long-term diseases of internal organs);
• chronic diseases of internal organs accompanied by high blood pressure, for example, kidney diseases (chronic pyelonephritis, glomerulonephritis, polycystic kidney disease, congenital anomalies of kidney development), diseases of the adrenal glands, thyroid gland, diabetes mellitus, pathology of the central nervous system.

As a rule, in the presence of chronic arterial hypertension, elevated blood pressure levels are observed from the early stages of pregnancy.

Group 2 – hypertension that developed during this pregnancy. This group includes preeclampsia and gestational arterial hypertension (a condition in which persistently elevated blood pressure is recorded during pregnancy, not accompanied by clinical signs of preeclampsia and self-limiting after childbirth).

Preeclampsia– a serious complication that develops in the second half of pregnancy (after 20 weeks), characterized by damage to vital organs. In case of severe course or lack of adequate treatment, it poses a danger to the life of the pregnant woman and the fetus. As noted above, gestosis is manifested by a triad of symptoms: edema, the appearance of protein in the urine and increased blood pressure. It should be noted that to establish a diagnosis of gestosis, the presence of two of the listed signs is sufficient.

In rare cases (usually in the absence of observation and treatment of gestosis), dangerous complications such as preeclampsia and eclampsia can develop.

The danger of gestosis is that it can begin with minimal clinical manifestations and develop rapidly, which dictates the need for careful monitoring of pregnant women with high blood pressure.

Risk factors for increased blood pressure during pregnancy are:

• excess body weight;
• multiple pregnancy;
• presence of arterial hypertension in close relatives;
• long-term diseases of internal organs (for example, kidneys);
• diabetes;
• increased blood pressure during previous pregnancies;
• first pregnancy, as well as the age of the first-time mother less than 18 or more than 30 years.

How to reduce blood pressure during pregnancy

If the expectant mother has hypertension or chronic diseases accompanied by increased blood pressure, this pregnancy is managed jointly by an obstetrician-gynecologist and a therapist or cardiologist.

Treatment methods that help lower blood pressure can be divided into non-pharmacological and medicinal.

Non-drug methods include normalizing sleep patterns (duration of sleep at night is at least 9-10 hours, daytime sleep - 1-2 hours), eliminating stressful situations and heavy physical activity. Walking in the fresh air at a calm pace, giving up bad habits (preferably at the stage of pregnancy planning), as well as a diet with reasonable salt consumption (no more than 5 g per day, which corresponds to 1 teaspoon), rich in potassium (it is found in bananas, dried apricots, raisins, seaweed, baked potatoes).

When selecting medications to normalize blood pressure, two conditions must be met: constant monitoring of blood pressure twice a day and the absence of adverse effects of the drug on the fetus, even with long-term use.

With periodic slight increases in blood pressure, treatment begins with the prescription of sedatives based on herbal remedies - VALERIAN, MOONWORN, NOVO PASSIT, PERSENA, PEONY BOTH, etc. In most cases, these drugs are effective in combination with non-drug therapy.

With a stable increase blood pressure The following groups of drugs are usually prescribed:

• DOPEGIT (METHYLDOPA) is recognized as the “drug of choice” (that is, the most accessible, effective and safe), which can be used from the beginning of pregnancy, but the effect of lowering blood pressure is most pronounced for periods up to 28 weeks.
• Calcium channel blockers (NIFEDIPINE, VERAPAMIL, NORMODIPINE) can be used from the second trimester of pregnancy. They are also effective for emergency assistance when blood pressure rises to high levels. Forms with slow release of the drug are available, which allows you to reduce the frequency of administration to 1 time per day.
• β-blockers (ATENOLOL, LABETALOL, NEBIVOLOL) do not have a teratogenic (provoking fetal malformations) effect. They are prescribed from the second trimester of pregnancy. When taking these drugs, the fetal heart rate may decrease, so they are prescribed according to strict indications. While taking the medication, monitoring of the intrauterine condition of the fetus is necessary.

The choice of labor management tactics depends on the severity of hypertension, gestosis, and the intrauterine condition of the fetus. In severe cases, with a persistent increase in blood pressure during treatment, a cesarean section is performed, since the risk of increased blood pressure during childbirth increases.

When managing vaginal birth, planned antihypertensive therapy (using drugs of different mechanisms of action) is prescribed in advance for good blood pressure control, and adequate labor pain relief is provided. The optimal method of pain relief during labor with high blood pressure is epidural anesthesia (an anesthetic drug is injected into the epidural space located between the dura mater and the vertebrae after placing a catheter in the lumbar region), since it not only has a strong anesthetic effect, but also helps reduce pressure.

Preventing high blood pressure

To avoid elevated blood pressure pressure during pregnancy, you need to follow a few simple rules:

• You should ensure normal sleep duration - at least 8-9 hours at night. An afternoon rest of 1–2 hours is advisable.
• It is necessary to avoid emotional and physical overload; if they are possible at work, you need to temporarily reduce the load (switch to easier work).
• Moderate physical activity (hiking in the fresh air, visiting the pool, gymnastics for pregnant women, etc.) helps improve blood supply to the brain and internal organs, and has a beneficial effect on the emotional and physical state of the expectant mother.
• A reasonable approach to organizing nutrition during pregnancy is necessary: ​​in order to prevent an increase in blood pressure, it is necessary to exclude strong tea, coffee, and alcohol in any quantity. You need to give up hot, spicy, fried foods, canned food and smoked foods. Drinking no more than 1.5 liters of liquid and no more than 5 g (1 teaspoon) of table salt per day is an important point in helping to maintain an optimal blood pressure level.
• It is necessary to control body weight gain (during the entire pregnancy it should not be more than 10–12? kg, and with an initial weight deficit - more than 15? kg).
• An important point is to monitor blood pressure levels in both arms at least 2 times a day (morning and evening). In both arms, pressure should be measured because recording different blood pressure values ​​(differing by 5–10 mm Hg) indicates a dysregulation of vascular tone and is one of the early signs of the development of gestosis.

When should you go to the hospital?

If hypertension is diagnosed before pregnancy, I trimester(for up to 12 weeks) hospitalization in the cardiology department is required. In the hospital, the severity of the disease will be clarified, the issue of the possibility of carrying a pregnancy will be resolved, and medications approved for long-term use during pregnancy will be selected. For hypertension, planned hospitalization is carried out, in addition to the first trimester, at 28-32 weeks (the period of greatest increase in circulating blood volume) and 1-2 weeks before birth. Unscheduled hospitalization is indicated when pregnancy complications develop or when hypertension worsens.

When increasing blood pressure, which was first noted in the second half of pregnancy, hospital stay is required for further examination, clarification of the diagnosis and timely detection of gestosis.

Expectant mothers with diseases of the cardiovascular system are sent to the pathology department at 28–32 weeks of pregnancy. This period is considered critical, since at this time the greatest increase in the volume of circulating blood occurs and most often there is a deterioration in the condition of the pregnant woman. Hospitalization helps avoid complications.

Before childbirth (at 38–39 weeks), prenatal hospitalization is indicated to select the optimal method of delivery and prepare for childbirth.

If the condition of the expectant mother worsens (increased blood pressure during treatment, headache, signs of circulatory failure, etc.), urgent hospitalization is carried out regardless of the stage of pregnancy.

High blood pressure values ​​recorded at any stage of pregnancy (even with the woman’s good condition and the absence of clinical symptoms) require hospitalization for examination, identification of the causes of high blood pressure and selection of adequate treatment.

We live in a fast-paced and busy time, which brings us not only the benefits of civilization, but also some “side effects,” for example, a high level of stress. And stress, in turn, also gives us surprises, for example, high blood pressure during pregnancy - after all, the body also perceives pregnancy as a kind of stress...

Therefore, blood pressure control is a mandatory procedure for all expectant mothers. It makes sense to measure your blood pressure once a week, and if any problems begin, do it daily. Of course, for this you need to know the normal values.

Blood pressure during pregnancy: normal and deviations from it

You've probably heard that the first number means systolic and the second diastolic pressure, and that in a healthy person they should be 120/80? However, it is worth focusing on your individual indicators. It is believed that normal blood pressure during pregnancy is no higher than 140/90 and no lower than 90/60.

Quite a large range of values, isn't it? This means that you must know your “working pressure”, the one that you usually experience. 90/60 for a 20-year-old girl weighing 50 kg who has not given birth is absolutely normal, but the notorious 120/80 would already be considered rather high.

Why is high blood pressure dangerous during pregnancy?

Unfortunately, a steady increase in pressure during this period is an alarming symptom. If blood pressure rises during pregnancy, doctors fear the possible development of a dangerous and insidious complication during pregnancy, which consists of disrupting the functioning of vital organs, and primarily the cardiovascular and circulatory systems.

It arises from the fact that the placenta produces substances that cause microholes to form in the vessels. Through them, plasma protein and fluid enter the tissues from the blood, which causes swelling, primarily in the legs and hands. The worst thing is that not only the limbs swell, but also the placenta, and this already causes a lack of oxygen in the fetus.

Even if high blood pressure during pregnancy is not a sign of gestosis, you still can’t give up on it; after all, it’s not for nothing that doctors in the antenatal clinic pay so much attention to monitoring blood pressure in women who are registered as expecting a baby. The fact is that high blood pressure during pregnancy provokes changes in the blood vessels of the placenta and fetus.

Reduced blood circulation between mother and child is called fetoplacental insufficiency. If a child does not have enough oxygen and nutrients, intrauterine growth retardation may begin, and this is very serious.

If blood pressure fluctuates regularly during pregnancy and the readings are quite high (140-150 and above), this can lead to premature placental abruption- a very dangerous complication of the normal course of pregnancy. Hypertension in the mother may well cause a threat of miscarriage or premature birth. Finally, high blood pressure in the mother during childbirth can lead to eclampsia - a convulsive syndrome, which is also not beneficial for either the woman or her child.

Signs of high blood pressure during pregnancy

The most accurate way to find out your blood pressure is to measure it using a special device (tonometer), which it is advisable for every pregnant woman to purchase, and if there are problems with blood pressure, then purchasing it is a must. At home, it is more convenient to use an electronic tonometer, but a regular one is also quite suitable - some doctors even believe that its readings are more accurate, and it costs less.

But a woman can also find out about increased blood pressure by her own feelings: this condition may be accompanied by headaches, sometimes very strong, dizziness.

Also characteristic:

• deterioration of health;
• noise in ears;
• nausea, vomiting;
• the appearance of “flies” before the eyes;
• the appearance of red spots on the skin of the face and chest or general redness of the skin in these areas.

But it also happens that hypertension is asymptomatic, does not bother the pregnant woman and is detected only during the next blood pressure measurement.

Causes of high blood pressure during pregnancy

Why does blood pressure increase during pregnancy? There are several most common reasons for this.

• stress, already mentioned above. The stress on the body is so great that it does not have time to adapt and reacts with pressure surges;
• insufficiency of the compensatory forces of the pregnant woman’s body. The heart, which must pump blood “for two,” cannot cope with the increased volume of circulating blood;
• heredity. If any of your close relatives had high blood pressure, there is a chance that you will have to deal with it too;
• diabetes. It does not increase blood pressure during pregnancy, but diabetes can be an unfavorable factor;
• smoking. In any case, it does not add health, but nicotine is one of the first to affect the cardiovascular system;
• weak physical activity. A trained heart copes with stress much better;
• overweight or obesity. Carefully monitor how much you gain during pregnancy, control this process;
• kidney problems. Oddly enough, there is a direct relationship - often people suffering from kidney diseases (for example, pyelonephritis, glomerulonephritis) have high blood pressure;
• disturbance of hormonal activity of the thyroid gland, adrenal glands, pituitary gland. Often, high blood pressure during pregnancy is the result of these hormonal shocks, because at this time women experience real hormonal storms.

Reduced blood pressure during pregnancy

Many women are interested in how to reduce blood pressure during pregnancy on their own? But just in this case, self-medication is unacceptable. Do not take any blood pressure pills during pregnancy, or drink any herbs until you consult your doctor!

The doctor will examine you and prescribe medication. Strictly adhere to the regimen of medications and their dosage, do not stop taking medications without permission - when it comes to high blood pressure, the result is achieved only by carefully following all recommendations.

You may need to be hospitalized in the pregnancy pathology department of the maternity hospital. There you will not only be treated, but also an individual birth plan will be drawn up, taking into account high blood pressure. Often in this case, epidural anesthesia is prescribed during childbirth,

At the end of pregnancy, closer to childbirth, you will most likely be offered re-hospitalization to correct the pressure before childbirth.

There are also blood pressure lowering products during pregnancy - their use, of course, will not eliminate the problem completely, but can serve as a preventive measure. First of all, these are beets and beet juice, cranberry juice - in addition to lowering blood pressure, it is also a source of vitamins!

A good remedy is pumpkin decoction with honey: boil 200 grams of pumpkin pieces in a small amount of water over low heat, cool, add honey. This salad can also help: mix raw beets, cabbage and carrots in equal proportions and season with vegetable oil.

Don't use coffee, chocolate, strong tea - they are already undesirable during pregnancy, and even more so with high blood pressure. But hibiscus tea or very weak tea with a few slices of lemon, on the contrary, will improve your condition. A sedative such as valerian, motherwort, or a cool shower can also help.

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