pregnancy induced hypertension
Introduction
Introduction to pregnancy-induced hypertension Pregnancy-induced hypertension, known as pregnancy toxicosis, pre-eclampsia, etc., is a unique condition for pregnant women, most of which occurs in 20 weeks of gestation and two weeks after delivery, accounting for about 5% of all pregnant women. Some of them are accompanied by proteinuria or edema, which is called pregnancy-induced hypertension syndrome. If the condition is severe, symptoms such as headache, blurred vision, and upper abdominal pain may occur. If not treated properly, it may cause generalized paralysis or even coma. basic knowledge Proportion of disease: 5% of pregnant women Susceptible population: pregnant women Mode of infection: non-infectious Complications: disseminated intravascular coagulation, placental abruption, eclampsia
Cause
Causes of pregnancy induced hypertension
The cause of pregnancy-induced hypertension has not yet been determined and is generally considered to be related to the following factors.
Placental ischemia (30%):
Cervical placenta ischemic multiple pregnancy, excessive amniotic fluid, primipara, excessive uterine enlargement, abdominal wall tension, etc., will increase the pressure of the uterine cavity, reduce or slow down the blood flow of the uterus, causing ischemia and hypoxia, vasospasm and blood pressure Raise. It has also been suggested that after ischemia or hypoxia of the placenta or decidua tissue, a pressurized substance can be produced, causing vasospasm and raising blood pressure.
Prostaglandin deficiency (25%):
Prostaglandins can cause blood vessels to dilate. Generally, the body's pressurized substances and antihypertensive substances are in equilibrium, keeping blood pressure at a certain level. The vasodilator prostaglandin is reduced, and the reactivity of the blood vessel wall to the pressurized substance is increased, so that the blood pressure is increased.
Immunity and heredity (10%):
Clinically, maternal pregnancy-induced hypertension is less common. Women with pregnancy-induced hypertension have more pregnancy-induced hypertension. Some people think that it is related to the recessive gene or recessive immune response gene in pregnant women.
Prevention
Pregnancy-induced hypertension prevention
There are two key points in the prevention of heart failure due to pregnancy-induced hypertension:
1. Early identification of the possibility of this disease: Special attention should be paid to the following situations: 1 severe pregnancy-induced hypertension with severe anemia or weight gain; 2 upper respiratory tract infection, especially in the harsh winter or climate change season; Abuse of improper indications, all of the above are easy to induce pregnancy-induced hypertension heart failure, especially when the above factors coexist more easily to cause this disease; clinicians are highly vigilant, it is important to prevent the disease.
2. Strengthen the management of high-risk pregnant women by the three-level maternal and child health care network.
Prevention of cerebrovascular accident
There are no comprehensive preventive measures at present, but the following points should be noted:
1. Strengthen three levels of maternal and child health care to prevent mild to severe development of pregnancy-induced hypertension.
2, the average arterial pressure 18.7kPa (140mmHg), the cerebral vascular self-regulation function is lost, easy to cause cerebral hemorrhage.
3, sudden occurrence of cortical blindness, should be immediately cesarean section and active treatment, is beneficial to prevent cerebral hemorrhage.
4, any history of subarachnoid hemorrhage, cerebral vascular malformation or congenital cerebral aneurysm, pregnancy, especially after labor, cerebrovascular accidents are more likely to occur, cesarean section should be scheduled, postoperative ergot and oxytocin.
Pregnancy-induced hypertension complicated with prevention of DI
1. Strictly grasp the two principles of expanding and reducing blood pressure on the basis of dissolving and terminating pregnancy in a timely manner. Pregnancy-induced hypertension and DIC will rarely occur.
2, for pregnancy-induced hypertension with intrauterine growth retardation (IUGR), the application of heparin mixture, heparin 25mg plus Danshen injection 16ml, 25% magnesium sulfate 30ml dissolved in 5% dextran-40, once a day, intravenous drip 8 hours, in order to achieve dredge microcirculation, prevent platelet aggregation, have a certain effect on the prevention of DIC, 5 days for a course of treatment, 2 days after the stop, and then according to the condition and test results can be used for the second course of treatment.
Complication
Pregnancy-induced hypertension complications Complications, disseminated intravascular coagulation, placental abruption
1, pregnancy-induced hypertension heart disease
This disease is also known as gestational poisoning heart disease, which is a unique heart disease in the obstetrics field.
2, cerebrovascular accident
Cerebrovascular accidents include cerebral hemorrhage, cerebral thrombosis and subarachnoid hemorrhage, which are rare complications of pregnancy-induced hypertension.
3, HELLP syndrome
In patients with severe pregnancy-induced hypertension, especially blood viscosity, and microcirculation perfusion, HELLP syndrome can be complicated.
4, diffuse intravascular coagulation
The relationship between pregnancy-induced hypertension and disseminated intravascular coagulation (DIC): Pregnancy-induced hypertension, especially in patients with pre-eclampsia and eclampsia, is closely related to DIC.
5, pregnancy-induced hypertension complicated with renal failure
Pregnancy-induced hypertension and acute renal failure (ARF) are rare, but patients with pre-eclampsia or eclampsia with HELLP syndrome, or acute fatty liver, or postpartum hemolytic uremia must pay attention to ARF. Possible happening.
6, postpartum blood circulation failure
Postpartum complicated with circulatory failure in patients with pregnancy-induced hypertension is extremely rare. If it occurs, it is usually within 30 minutes after delivery, and it is not the case after more than 24 hours after delivery.
7, pregnancy-induced hypertension combined with early stripping of the placenta
The typical symptoms and signs of pregnancy-induced hypertension complicated with early exfoliation of the placenta occur clinically. There is no difficulty in diagnosis, but atypical, especially in the 34-35 weeks of pregnancy, if neither amniotic fluid nor twin pregnancy, The uterus tension is high, the contractions are not obvious, clinicians often consider the treatment of magnesium sulfate for the premature birth of pregnancy-induced hypertension, in order to achieve the purpose of relieving spasm and inhibiting contractions; but not considering the early attachment of the placenta to the posterior wall of the uterus Peeling, this point is important, so for patients with moderate or severe pregnancy-induced hypertension, if there is an unexplained uterine tension, B-ultrasound should be used to check whether the placenta is in the posterior wall of the uterus, combined with clinical manifestations, to help correct diagnosis and treatment. .
Symptom
Symptoms of pregnancy-induced hypertension Common symptoms High blood pressure, proteinuria, depression, edema, calf edema, pre-eclampsia, eclampsia, nausea, upper abdominal discomfort, dizziness, coma
First, mild pregnancy-induced hypertension is mainly characterized by mild elevation of blood pressure, may be associated with mild edema and micro-proteinuria, this phase can last for several days to several weeks, can gradually develop or rapidly deteriorate.
1. Edema: It is the earliest symptom of pregnancy-induced hypertension. At the beginning, it only shows weight gain (recessive edema). Later, it gradually develops into clinically visible edema. The edema starts from the ankle and gradually develops upwards. It is four levels and is represented by "+".
(+) Depressed edema below the calf, does not subside after rest;
(++) edema extends to the thigh;
(+++) edema extends to the vulva or abdomen;
(++++) Systemic edema, or even chest and ascites.
2, high blood pressure: blood pressure is not high before 20 weeks of pregnancy, blood pressure increased by 17.3/12KPa (130 / 90mmHg) after 20 weeks of pregnancy, or 4/2KPa (30/15mmHg) compared with the baseline blood pressure.
3, proteinuria: occurs after the increase in blood pressure, no or trace.
Second, moderate pregnancy-induced hypertension blood pressure is further increased, but does not exceed 21.3/14.7KPa (160/110mmHg), increased urine protein, accompanied by edema, may have mild self-conscious symptoms such as dizziness.
Third, severe pregnancy-induced hypertension including pre-eclampsia and eclampsia, blood pressure more than 21.3/14.7KPa (160/110 mmHg), urine protein more than 10 ~ + +, edema degree, headache, smudge and other symptoms, serious Convulsions, coma.
1, in addition to the above three main symptoms of pre-eclampsia, dizziness, headache, visual impairment, upper abdominal discomfort, chest tightness and nausea and vomiting, etc., indicating further development of intracranial lesions, blood pressure at 21.3/147 KPa (160/ Above 110 mmHg), edema is heavier, urinary is less, urine protein is increased, convulsions may occur at any time, and active treatment should be taken to prevent eclampsia.
2, eclampsia on the basis of the above serious symptoms, convulsions, or accompanied by coma, a small number of patients progress quickly, preeclampsia symptoms may not be significant, and suddenly convulsions occur more often in late pregnancy and before delivery A small number of births can also occur within 24 hours after delivery.
Examine
Pregnancy-induced hypertension check
1. Urine examination: urine specific gravity, 1.020 means urine concentration, reflecting insufficient blood volume, blood concentration, focus on urine protein, quantitative 5.0g/24h>++, indicating serious condition, microscopic examination for red blood cells And tube type, if any, indicates serious kidney damage.
2, blood test: conditional units, should be necessary for critically ill patients to perform blood tests, including blood routine, blood viscosity, hematocrit, serum electrolyte K +, Na +, Cl-, Ca + +, CO2 binding, liver and kidney function And coagulation function (platelet count, test tube clotting time, fibrinogen, prothrombin time, FDP, etc.).
3, fundus examination: fundus examination can be used as a window to understand the degree of small body movement, is an important parameter to reflect the severity of pregnancy-induced hypertension, is of great significance for estimating the condition and decision-making, severe patients should be routine emergency examination, can be found Arteriolar spasm, abnormal arteriovenous ratio, retinal edema, exudation, hemorrhage, etc., severe retinal detachment.
4, ECG examination: critically ill patients should be routinely examined to understand the degree of myocardial damage, with or without hypokalemia or hyperkalemia, if necessary, by echocardiography to understand cardiac function.
5, B-ultrasound: First, to understand the development of the fetus, the second is to understand the function of the placenta, an important reference value for the obstetric treatment of patients with pregnancy-induced hypertension, the characteristics of pregnancy-induced hypertension B-ultrasound is maternal maturity, aging, amniotic fluid More common.
6, other examinations: such as cerebral blood flow map, CT examination, whether patients with severe pregnancy-induced hypertension have intracranial hemorrhage, etc., through fetal movement count, fetal heart rate monitoring, fetal maturity and placental function measurement, to understand the impact on the fetus And judge the prognosis.
Diagnosis
Diagnosis and identification of pregnancy induced hypertension
diagnosis
Normal people's blood pressure has a certain fluctuation range under different physiological conditions. When anxiety, tension, stress state or physical activity, blood pressure can be increased. In addition, systolic blood pressure increases with age, so hypertension and normal blood pressure The boundaries are not easy to divide. In 1979, China revised blood pressure measurement methods and diagnostic criteria for hypertension as follows:
1. After 15 minutes of rest, take the seat position and measure the blood pressure of the right arm. It should be measured several times until the blood pressure value is relatively stable. The diastolic pressure is subject to the disappearance of the sound. If the sound does not disappear, the value of the sound change is used. 1 hour, or check again every other day.
2, where systolic blood pressure 21.2kPa (160mmHg) and / or diastolic blood pressure 12.6kPa (95mmHg), can be confirmed by verification, blood pressure 18.7 ~ 21.2 / 12 ~ 12.6kPa (140 ~ 160 / 90 ~ 95mmHg) for clinical hypertension.
3, in the past there is a history of hypertension, not treated for more than 3 months, this check for normal blood pressure, not listed as high blood pressure; such as the usual medication and this check blood pressure is normal, should still be diagnosed as high blood pressure.
Repeated measurement of blood pressure above 18.7/12 kPa (140/90 mmHg) before 20 weeks of gestation, or diagnosis of hypertension before pregnancy, called pregnancy with essential hypertension, about 59% of patients have a family history.
Pregnancy with essential hypertension and blood pressure decreased in the second trimester, or blood pressure lower than 21.2/13.3kPa (160/100mmHg), the fetal survival rate is high; if the blood pressure is higher than 21.2 /13.3kPa (160/100mmHg), the fetus The mortality rate has increased significantly. About 10% to 20% of pregnant women with essential hypertension have pregnancy-induced hypertension syndrome in the third trimester. The baseline blood pressure is >24/14.6kPa (180/110mmHg), and the fetal mortality rate is up to 23%; if additional pregnancy-induced hypertension syndrome, the fetal mortality rate is as high as 41.3%, the earlier the pregnancy-induced hypertension sign, the worse the fetal pre-existence, the pregnancy-induced hypertension syndrome before the 32 weeks of gestation, 75% In the death palace, in addition, in the case of pregnancy-induced hypertension based on essential hypertension, the incidence of early placental exfoliation was 2%, higher than that of patients with pregnancy-induced hypertension.
Differential diagnosis
Should be differentiated from the following diseases: pregnancy with chronic hypertension, pregnancy with nephrotic syndrome, pregnancy with pheochromocytoma, pregnancy with cholelithiasis and cholecystitis, pregnancy with cerebrovascular disease, pregnancy with seizures, pregnancy with hand and foot convulsions , acute fatty liver during pregnancy, peripartum cardiomyopathy, immune thrombocytopenic purpura and so on.
