Pregnancy

Hypertension in the pregnancy

Hypertensive pregnancy illnesses are one of the most frequent causes of the mortality in childbirth and the perinatal mortality. You appear in the Federal Republic of Germany with 5-7 % of all pregnant woman. There is a pathological blood pressure increase in the pregnancy if a systolic pressure of 140 mmHg and/or a diastolic pressure of 90 mmHg reaches or is exceeded multiply. The so-called gestation hypertension is generally bound to the 3rd Triminon and usually within 7 days sounds, at the latest within 6 weeks after the delivery again off. It has frequently only minor significance for the pregnancy course, however, also can be the first symptom of a pre-eclampsia developing. It is precursor of an essential hypertension itself manifesting later frequent. However, a chronic hypertension can already be known in front of the pregnancy or manifest itself during its course any time, too. It generally impairs the prognosis when there is a kidney function restriction simultaneously with a serum creatinine value > 1.5 magnesium/dl in which himself can a plug child develop and gestosis the prognosis with aggravation for mother. The blood pressure with pregnant women has to be measured in sitting under the conditions described above (the blood pressure can be lower, e.g. cava compression syndrome at supine position, in the lying.)

Ambulatory therapy:
A close cooperation of internists and gynecologists requires the ambulatory monitoring and therapy of the hypertonus. To the relieved monitoring important is the regular monitoring of body weight and blood pressure values controls results, liver with self measurements in the morning and late in the evening, as well as regular of urine and kidney values as well as the platelets.

The induction of a medicinal duration therapy exclusively should Stationary therapy:
be task of the clinic in which a close cooperation is required between gynecologists and internists since a stationary observation can yield the necessity of a medicinal hypotension first under controlled conditions. Furthermore this remains problematic with regard to the fetal development and > 170/110 mmHg therefore should be started with only at continuous blood pressure values. The general measures like a physical saving (breaks, confinement to bed) and the elimination of stress factors (inability to work) are in the foreground at light progressive forms of the hypertonus in the pregnancy once more. An absolute alcohol and nicotine abstentio is shown. A restriction of the common table salt supply cannot be recommended since this like diuretica can lead to a removal of the plasma volume and with that the uteroplacental perfusion.

Medicines during the pregnancy:
The medicinal medical treatment is, carried out parties don't damage this one this one with medicines. This is covered best for alpha methyldopa and also for some beta blockers. One tries to get by on dosages as low as possible. It that a too strong hypotension is adverse for the fetal growth development so that blood pressure values are tolerated turned out > till it stopping mmHg been 170/110. Alpha Methyldopa: = Means of 1 . choice beta blocker (metoprolol, atenolol): = Means of the 2nd choice because of a possible reinforcement of an intrauterine growth retardation.

Either the other substances like dihydralazine, nifedipin, verapamil, diuretica and ACE inhibitors aren't side effect free either appropriately or not as has been proved for the parties.

A hypertensive emergency in the pregnancy then is, increased blood pressure values with results if strong as encephalopathy (visual defects, dizzinesses, headaches, seizure, reduced consciousnesses, neurological Ausfallserscheinungen) or pulmonary edema walks along e.g. more hypertensively.

Initial treatment of Thely hypertensive emergency in The pregnancy: 5 mg rapid resorption nifedipin p.o. or 5 mg dihydralazine intravenous of 6.25 mg Urapidil intravenous

At spasm readiness magnesium sulfate 4 g intravenous or diazepam 5 -10 mg intravenous

CAVE : magnesium sulfate can placenta the parties lead the effect to an abrupt heavy hypotension of calcium antagonists potentiated and through this with an acute aggravation of the blood flow into womb and and serious follow for! Therefore a cardiotocographic supervision of the child is necessary besides the continuous blood pressure control.

Notice: The only causal therapy of the pregnancy conditional hypertension or the pre-eclampsia is the earliest possible completion of the pregnancy by the delivery!

Medicines during the silent time: Alpha Methyldopa: reaches only in low concentrations the mother's milk . toxic symptoms at the infant weren't watched. It therefore is part of the antihypertensives of the choice at the silent time.

Dihydralazine:
is a match for the hydralazine. It reaches in reduced concentration the mother's milk so that no toxic symptoms were watched at the silent time. Choice also therefore is part of the antihypertensives of 1 at the silent time. Calcium antagonists: Nifedipin, nitrendipin and verapamil reach only low concentrations in the mother's milk so that childlike effects don't have to be expected. You are therefore seen in the choice as calcium antagonists at the silent time.

ACE inhibitor:
Captopril and enalapril change only minimally into the mother's milk so that childlike effects don't have to be expected. You are regarded as means of the 2nd choice if antihypertensives of the first choice aren't effective or not indicated. It is, recommended, however, clinical follow-ups at the infant on indications for a disturbed kidney function (edema, weight course) to carry out.

Beta blocker:
partly high concentrations change into the mother's milk and reach so that blood pressure or heart rate was reporting in individual cases over a waste with the newborn child. The therapy should therefore be carefully supervised. Metoprolol has to be preferred at the silent time by the beta blockers recommended in Germany. Diuretica: can reduce the milk production and you shouldn't use because of side effects appeared occasionally at the silent time.

About the application of other anthypertensive during the silent time only insufficient studies lie and in front of till now so that finding isn't use the lactation period recommended in. Due to the good tolerance of the first-mentioned substances one doesn't have to stop silences due to antihypertensive medicines.


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