Pregnant women with hypertension

Pregnant women with hypertension
[Summary]



Essential hypertension is arterial blood pressure increased for the main clinical manifestations of vascular disease. Cause not yet very clear, but morbidity, and the age-related. My information <20 years of age, the incidence rate was 3.11 percent, 20 to 29 years of age was 3.91% for 30 to 39-year-old 4.95%; increased significantly after the age of 40. Therefore, the leather women of childbearing age, hypertension rare.



[Diagnosis]




Normal blood pressure in different physiological circumstances have a certain fluctuation range, when the anxiety and tension, stress or physical activity, blood pressure can be increased. In addition, the growth of systolic blood pressure increased with age, hypertension and normal blood pressure Therefore, the boundary demarcation difficult. 1979 China revised method of measuring blood pressure and hypertension diagnostic criteria are as follows:

1. Rest after 15 minutes, from sitting right arm blood pressure measurement, the measurement should be repeated several times until the blood pressure values relatively stable. DBP to voice disappeared, is continuing disappear such as voice, audio, using numerical variable. With the one hour interval days, or every other day again verified.

2. Where systolic blood pressure ≥ 21.2 kPa (160mmHg) and (or) diastolic blood pressure ≥ 12.6 kPa (95mmHg), the diagnosis can be verified. 18.7 ~ ~ 21.2/12 blood pressure of 12.6 kPa (140 ~ 160/90 ~ 95mmHg) for the clinical hypertension.

3. Past history of hypertension, not for more than three months, the normal blood pressure checks, not as hypertension; such as drug treatment and this has been normal blood pressure checks, should be diagnosed as hypertension.

Women of childbearing age suffering from hypertension most of the first period, the rare vascular complications, and fundus, electrocardiogram, cardiac, renal function test abnormalities often without, it must be diagnosed based on the only arterial hypertension. First visit as in the second trimester, as peripheral expansion, hemodilution and placenta formation arteriovenous short circuit can 40% of the systolic blood pressure in patients with a decline of 2.7 kPa (20mmHg) due to the diagnosis complicated. First visit that is renal dysfunction, it is difficult to identify chronic glomerulonephritis or chronic pyelonephritis caused symptoms of high blood pressure, or hypertension caused by kidney disease.

[Treatment]




1. Vein thrombosis treatment

(1) General addressed: bed rest 1 to 2 weeks to relieve leg pain, in the vein thrombosis visco-tight wall endometrial until the machine, luminal patency. Chigaohuanshi, higher than the level of cardiopulmonary from bed 20 to 30 cm, knee buckling slightly to facilitate a reduction in venous return edema. Maintain patency stool to prevent forced defecation而使thrombosis loss. Get up and wear long elastic stockings EC 6 to 12 weeks to oppression superficial vein, increase return and reduce lower extremity edema.

(2) thrombolytic therapy: apply to three days after the onset of pulmonary embolism, or concurrent.

1) streptokinase: half an hour before, intravenous hydrocortisone 25 ~ 50 mg of dexamethasone or 5 to 10 mg, to prevent adverse reactions. Early dose of streptokinase 500,000 u plus 5% glucose fluid or 100 ml saline, intravenous infusion within 30 minutes End, after 100,000 u / h to maintain until the symptoms disappear, renewable drop 3 to 4 hours. Can also be used streptokinase 600,000 u hydrogenation of cortisone 25 mg (or dexamethasone 25 mg) plus 5% glucose 250 ~ 500 ml intravenously once every six hours. General for 3 ~ 5.

2) UK: adverse reactions small, without application of adrenocortical hormones. Early dose of 3 ~ 50000 u plus 5% glucose solution (or dextran-40) 250 ~ 500 ml, 1 to 2 hours intravenous infusion End, and 2 to 3 times daily. According to the daily maintenance of the determination of fibrinogen or euglobulin dissolution time adjustments can be连用1 ~ 2 weeks.

3) plasmin: 50,000 to 150,000 u 5% glucose solution of 250 ml, within 30 minutes intravenous drip End. After 50,000 u 5% glucose solution intravenously for 2 to 3 times daily, a total of 7.

4) in the plasma (plasminogen) combined with streptokinase: plasma in the original 90 mg or 120 mg and 150 ml saline, intravenous infusion of 4 to 6 hours, following by streptokinase 600,000 u 100 ml normal saline infusion , 30 minutes drops End, once a day, the linked on the 5th.

(3) dextran -70 or -40 500 to 1000ml dextran, intravenous infusion once a day upto 10 to 14 days to clear the blood vessels.

(4) Surgical treatment: thrombosis or more conservative treatment fails, consider the purposes of deep venous thrombosis extraction, and lower extremity venous ligation.

2. Treatment of pulmonary embolism: with pulmonary embolism, were advised to take the following measures.

(1) Oxygen: to improve arterial oxygen pressure.

(2) pain: chest pain, can be 30 to 60 mg of papaverine hydrochloride or pethidine (meperidine) 50 ~ 100 mg, intramuscular injection, or 5 to 10 mg of morphine, subcutaneous injection.

(3) spasm: 0.5 to 1 mg of atropine, intravenous injection, every one to four hours once a continued downturn nerve resistance, prevent or improve the pulmonary blood vessels and coronary artery reflex spasm. Aminophylline 0.25 ~ 0.5 g 5% glucose 100 to 250 ml, intravenous drip to relieve bronchial spasm.

(4) anti-shock: dopamine 20 ~ 40 mg or 40 mg Alameng 20 ~ 5% glucose solution 200 ml, intravenous drip.

(5) Strong Heart: acetyl hair to spend glycosides (West to Portland), or 0.4 to 0.8 mg Mao spent glycoside toxicity K0.25mg plus 50% glucose solution was injected intravenously.


[Clinical]




In the 20 weeks of pregnancy before repeated measurements of blood pressure in the 18.7/12 kPa (140/90mmHg) above, before or during pregnancy is diagnosed with hypertension, known as the pregnancy with essential hypertension. About 59% of patients have family history.

Pregnant women with hypertension and blood pressure in the second trimester decline, or blood pressure lower than the 21.2/13.3 kPa (160/100mmHg), fetal survival rate of high blood pressure than if 21.2/13.3 kPa (160/100mmHg), fetal mortality increased significantly. Of pregnant women suffer from hypertension, about 10% ~ 20% in late pregnancy with pregnancy-induced hypertension. Based on blood pressure> 24/14.6 kPa (180/110mmHg), fetal mortality rate of 23 percent if additional pregnancy-induced hypertension and, fetal mortality rate as high as 41.3%. Levy appeared earlier pregnancy-induced hypertension, fetal-worse, 32 gestational weeks ago with pregnancy-induced hypertension, 75 percent of intrauterine fetal death. In addition, on the basis of essential hypertension in pregnancy-induced hypertension, the incidence of placental abruption rate of 2%, compared with pregnancy-induced hypertension simply higher.