Hypertension is a common and frequently-occurring disease worldwide, which seriously threatens human health. While we are concerned about hypertension in the general public, we should pay more attention to gestational hypertension.
Gestational hypertension seriously affects the health of mother and child. According to statistics, the prevalence of gestational hypertension in my country is as high as 5-12%, and the maternal death caused by it accounts for about 10% to 16% of the total number of pregnancy-related deaths. It is the second leading cause of maternal death. If management is not strengthened, pregnant mothers with gestational hypertension may be a member of patients with chronic hypertension after delivery.
First, understand gestational hypertension
Hypertensive disorders of pregnancy are a group of diseases that coexist with pregnancy and elevated blood pressure, with an incidence of about 5-12%. , Chronic hypertension complicated with pregnancy. The disease seriously affects the health of mothers and infants, and is the main cause of increased maternal and perinatal mortality.
The effect of gestational hypertension on mother and child
The basic pathophysiological changes of hypertensive disease during pregnancy are systemic small vascular spasm and vascular endothelial injury, and the perfusion of various organs and systems of the whole body is reduced, which manifests as multiple organ and system damage, causing harm to mother and child, and even death of mother and child.
The impact of gestational hypertension on pregnant mothers
(1) Brain: cerebral arterial spasm, leading to cerebral edema, congestion, ischemia, thrombosis and hemorrhage, etc. Pregnant mothers may experience dizziness, headache, nausea, vomiting and convulsions. In severe cases, coma and vision may occur Symptoms such as decline, blindness, dysesthesia, and confusion.
(2) Kidney: Renal ischemia causes renal damage, which can cause oliguria, proteinuria, and even renal failure in severe cases.
(3) Liver: Liver damage often manifests as elevated serum transaminase levels, and in severe cases, liver hemorrhage forms hematoma, and even liver rupture and hemorrhage endanger the life of the mother and child.
(4) Heart: Peripheral arterial spasm, increased resistance, aggravated heart burden, insufficient coronary blood supply to the heart, impaired myocardial contractility, etc. lead to myocardial ischemia, and in severe cases, heart failure may occur.
Fourth, the impact of gestational hypertension on the fetus
When the pregnant mother suffers from gestational hypertension, the placental blood supply is insufficient and the placental function is decreased, which can cause:
(1) Fetal distress, neonatal asphyxia, etc.;
(2) fetal growth restriction;
(3) The risk of placental abruption is higher than that of non-pregnant women with hypertensive disorders of pregnancy, which can lead to intrauterine stillbirth in severe cases;
(4) Due to disease reasons, the pregnancy had to be terminated early, resulting in premature birth.
The poor outcomes of mother and child bring a heavy burden to patients, families and society.
Five, how to prevent pregnancy-induced hypertension?
1. Do a good job of pre-pregnancy inspection, and take effective preventive measures for high-risk groups:
(1) Women who are obese before pregnancy should control their weight within a reasonable range before pregnancy;
(2) For women with chronic hypertension, control the blood pressure within the normal range, and check the functions of their important organs, such as whether the functions of the heart, liver, lung, kidney and other organs are damaged;
(3) With the adjustment of the fertility policy, the number of mothers who are trying to conceive at an advanced age increases. For those with a history of preeclampsia, chronic hypertension, a body mass index > 35 kg/m2, or a multiple pregnancy interval > 10 years, the blood pressure in early pregnancy is > 130/m2. 80mmHg and other high-risk groups should focus on management.
2. After pregnancy, pregnant mothers must have regular obstetric examinations, monitoring on time, and early detection and early treatment.
3. Proper exercise should be done during pregnancy to control reasonable weight gain during pregnancy.
4. For those predicted to be at high risk, effective preventive measures include:
(1) Moderate exercise: arrange rest reasonably to keep your body healthy;
(2) Reasonable diet: Strict restriction of salt intake is not recommended, nor is it recommended for obese pregnant women to restrict calorie intake;
(3) Calcium supplementation: 1.5-2g of calcium is taken orally every day to prevent high blood pressure;
(4) Aspirin can be used from 11-13+6 weeks of pregnancy, no more than 20 weeks at the latest, and low-dose aspirin 100-150 mg orally before going to bed every night to 36 weeks, or 5-10 days before termination of pregnancy. use.
5. For patients with gestational hypertension, it is necessary to closely monitor blood pressure and the condition of the fetus:
(1) Pay attention to rest: It is advisable to lie on the side to ensure adequate sleep;
(2) Ensure a certain amount of exercise;
(3) Eat a reasonable diet, pay attention to rich and balanced nutrition, and ensure adequate intake of protein and calories. Moderately limit salt intake;
(4) Closely monitor blood pressure: if blood pressure is not well controlled, dizziness, vertigo, blurred vision, nausea, vomiting, abdominal pain, vaginal bleeding, abnormal fetal movement, etc., you should go to the hospital immediately. If hospitalization is required, hospitalization is required;
(5) Regularly maintain contact with obstetrics and cardiologists to formulate individualized management plans.
About the Author
Li Binglin
Chief physician of obstetrics and gynecology, engaged in clinical and teaching work of obstetrics and gynecology for 20 years, has accumulated rich clinical experience, mastered the diagnosis and treatment of common and frequently-occurring diseases in obstetrics and gynecology, and has certain insights and treatment methods for some difficult diseases. Obstetrics has accumulated a lot of clinical experience in dealing with high-risk pregnancy, pregnancy complications, and various dystocia. Be able to undertake and guide subordinate physicians to complete various types of obstetrics and gynecology operations, including minimally invasive operations such as laparoscopy and hysteroscopy. Nearly 30 professional academic papers have been published in national and provincial medical journals, and the cooperative project won the third prize of Shaanxi Provincial Science and Technology Progress Award.
Member of the Standing Committee of the Obstetrics and Gynecology Branch of Xi’an Medical Association
Member of Shaanxi Medical Association Gynecological Oncology Society
Vice Chairman of the Youth Committee of the Shaanxi Provincial Society of Sexuality
Gynecological Oncology of Shaanxi Sexual Society
Member of the Professional Committee of Female Pelvic Floor Diseases of Shaanxi Provincial Health Care Association
Member of Maternal and Infant Health Professional Committee of Shaanxi Provincial Health Society
Source: Li Binglin, Xi’an Central Hospital
Review: Wang Lan
Editor: Wang Xiaoli
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