Arterial hypotension and pregnancy (low blood pressure during pregnancy). Treatment of complications of gestation by trimesters. Causes and signs of hypotension

Hypotension Hypotension is a drop in blood pressure below normal. This is a condition in which the activity of the heart pumping blood through the arteries is weakened. This is a direct manifestation of the depletion of the vital forces of the body. A patient with chronic hypotension may complain of

Hypotension 329. I want to sleep all the time, I just fall asleep on the go. How many hours a day do you need to sleep? Each person has his own sleep rate. But it is believed that for the average person such a norm is 7-9 hours. Both less and more time

Hypotension A persistent decrease in blood pressure due to a decrease in vascular tone, weakening of the heart and other factors is called hypotension. Hypotension, or low blood pressure, can occur in apparently healthy people during rest,

So, yesterday we talked about pressure in pregnant women, its physiological significance for the body and how to measure and control it. However, we ignored the conditions that are accompanied by low blood pressure in a woman or high blood pressure, when it occurs, how it manifests itself, how dangerous these conditions are and what a pregnant woman and her doctor need to do in order to do so. To treat such a condition.

Reduced blood pressure.
Low blood pressure (arterial hypotension, hypotension) is a condition in which the pressure drops below the working, normal pressure by 10% or more. On average, during pregnancy, the pressure should be 110-120 to 70-80 mm Hg. However, there are special conditions and patterns, during the first trimester of pregnancy, the level of blood pressure in women can often be lowered. Usually the reason for this is the physiological expansion of blood vessels, mostly small ones, which occurs due to the relaxation of muscle elements that react sharply to placental hormones.

If the level of blood pressure in a woman systematically falls below 100 systolic, and below 60 - diastolic pressure, then they begin to talk about arterial hypotension. In this condition, the expectant mother may experience attacks of weakness, constant drowsiness and rapid fatigue, periodic dizziness, usually these signs are more pronounced in the morning, after waking up. Expectant mothers with hypotension may experience lack of air at rest and bouts of shortness of breath even with mild physical exertion, episodes of irritability may occur, insomnia may occur with bouts of sudden drowsiness during the day. Often, headaches that occur after sleep, physical exertion or mental stress can also bother. Sometimes pregnancy and low blood pressure first make themselves felt hypotonic (orthostatic) syncope. Usually women in the first weeks of pregnancy faint and then remember the delay, and learn about their condition.

Why does blood pressure drop during pregnancy?
The body is wise, and lowering the pressure for it is a physiological mechanism to protect the mother and child. With such a slightly reduced vascular tone, quite favorable conditions are created in order to form new vessels and vascular networks in the area of ​​the uterus, placenta and fetal vessels. This ensures the optimal level in the utero-placental system, which helps the baby to fully eat and receive oxygen in the most crucial periods of laying the main organs and systems. However, if hypotension moves from the category of physiology to a pathological level, then adverse consequences may occur for both - both the mother and the unborn baby.

Hypotension is fraught with the development of serious complications that can affect the future health of a woman, and through it, the developing fetus also suffers. At a low level of pressure, it is not always possible to properly provide the necessary level of blood supply and delivery of oxygen and glucose, which will lead to tissue hypoxia, the accumulation of toxic products and metabolites in them. The fetus suffers especially strongly from hypoxia in the first months of life, when its main structures are formed. The first complications of hypotension during pregnancy, when it manifests itself as a pathology, is its spontaneous interruption, as well as the formation of the IUGR syndrome (intrauterine growth retardation).

Also, very often, doctors in the first trimester in pregnant women with low blood pressure note early toxicosis, and at a later date, gestosis can also join (this is a serious complication of pregnancy, when the pressure is already becoming excessively high). When deciding on the treatment of pathological hypotension, the doctor must determine whether hypotension manifests itself as a separate disease - it is also called primary arterial hypotension (hypertension), or hypotension manifests itself as a complication of other diseases - infections, disorders of the thyroid gland, diseases of the adrenal glands, liver or a sign of anemia. This is the so-called secondary arterial hypotension (hypotension), in such cases it is enough to eliminate the underlying causes or cure the disease, and then the pressure level will even out.

What to do when pregnant with low blood pressure.
First of all, you need to clearly organize your daily routine - you need to sleep a sufficient number of hours at night, for a pregnant woman it is at least 9-10 hours of night sleep, if possible, you need to lie down to rest during the day, and it is also important to stay in the air for a long time - walk for at least one or two hours, preferably in the morning and evening. It is important to eat well, try to saturate food with vitamins and minerals, eat at least four times a day, and snack if you are hungry. With hypotension, it is important not to limit salt, as many pregnant women do this in order to exclude edema. It is recommended to do gymnastics, swimming - these procedures increase the tone of blood vessels, which gives an increase in pressure.

Water procedures perfectly increase pressure - contrast showers, dousing with cool water, foot baths with a change of procedures, as well as massages. In the treatment of pathological arterial hypotension, physiotherapy is actively used - the use of electrosleep, mineral baths, as well as baths with coniferous extract, sea salt, and acupuncture. If treatment is necessary or if the disease is severe, medications are already used. For pregnant women with hypotension, therapy based on herbs and extracts is usually prescribed, which increase the tone of the sympathetic nervous system. Apply eleutherococcus, radiola, lemongrass and aralia, as well as preparations with caffeine. Any drugs, even herbal extracts, must be prescribed only by a doctor and control the effects of treatment.

High blood pressure in pregnant women.
With arterial hypertension during pregnancy, the level of blood pressure usually rises to 130-140 and above - systolic, and up to 80-90 - diastolic pressure. At the same time, such pressure figures will have to be recorded with two successive pressure measurements at intervals of three to four hours, or arterial hypertension is recorded with a constant increase in the level of systolic pressure by at least 20-25 mm Hg for systolic, and more than 10-15 mm Hg for diastolic pressure, in comparison with the working pressure figures before pregnancy, but often even with high pressure, a pregnant woman does not show any symptoms for a long time, and then pregnant women do not complain to the doctor. Therefore, women often become aware of their hypertension when they become pregnant. This often greatly complicates the correct diagnosis, and then the treatment is delayed.

In many pregnant women, hypertension is manifested by headache, dizziness and palpitations, while vision is impaired and tinnitus occurs, flies may flash before the eyes. As the fetus grows, from about 28 weeks of pregnancy, even physiologically, the pressure gradually increases due to an increase in the volume of blood that circulates through the vessels. By the third trimester, the volume of blood increases by one to one and a half liters. Therefore, approximately by the third trimester, the pressure gradually comes to the original.

Hypertensive conditions during pregnancy, like hypotension, must be divided into two large groups - primary and secondary. With an increase in pressure from the earliest stages of pregnancy, from 10-20 weeks or earlier, there was an increase in the level of pressure, most likely the woman has primary hypertension or hypertension. If the pressure tends to increase towards the end of the second or beginning of the third trimester, most likely hypertension is of a secondary nature, or is a sign of preeclampsia.

What's wrong with high blood pressure?
The blood presses hard on the walls of the vessels, which are under tension when the pressure rises. In this case, the vessels are injured, swell and swell, while the vessels become smaller inside the lumen, which further increases blood pressure. In early pregnancy, this damages the vessels in the placenta and uterus, which can lead to an abortion. In the second and third trimesters, hypertension leads to placental abruption, chronic hypoxia, and delayed child development. At very high pressure, small vessels in many of the most important organs can be affected, which can lead to micro-hemorrhages in the brain, retina or kidney, liver. With an increase in pressure in the second half of pregnancy, gestosis is almost always diagnosed in a pregnant woman.
The main manifestations of high blood pressure are headache, including throbbing, as well as tinnitus and dizziness, there may be visual impairment. There may be a feeling of lack of air, nausea and even vomiting. However, sometimes the pressure is not felt at all.

Tomorrow we will discuss the treatment of arterial hypertension and the development of gestosis with an increase in pressure.

Pressure and gestosis:

Arterial hypotension is characterized by a decrease in blood pressure ≤100/60 mm Hg. (for women under the age of 25) and ≤105/65 mmHg. (over 30 years of age).

Synonyms

Arterial hypotension, hypotension, neurocirculatory dystonia of the hypotonic type, hypotension.

ICD CODE
I 95 Other and unspecified diseases of the circulatory system (I 95.0–I 95.9).

EPIDEMIOLOGY OF ARTERIAL HYPOTENSION DURING PREGNANCY

The prevalence varies widely - from 0.6% to 29.1%. During pregnancy, arterial hypotension is more often diagnosed at the end of the first trimester, less often at 17–24 weeks. In 7.08% of cases, arterial hypotension during pregnancy occurs without pronounced clinical manifestations, however, a decrease in perfusion of various organs causes a greater number of complications from both the mother and the fetus.

Among the entire population, arterial hypotension is noted in 5–7% of cases, among pregnant women - in 10–12% of cases.

CLASSIFICATION OF ARTERIAL HYPOTENSION DURING PREGNANCY

Primary (essential) arterial hypotension manifests itself in two variants:
● physiological hypotension - constitutional and hereditary regulation of vascular tone and blood pressure (not clinically manifested);
● disease with typical clinical symptoms (neurocirculatory asthenia).

Secondary arterial hypotension occurs with infectious diseases, Addison's disease, peptic ulcer, hypothyroidism, anemia, hypoglycemia, acute and chronic hepatitis, cirrhosis of the liver, under the action of a number of drugs, etc.

If arterial hypotension is manifested only by a decrease in blood pressure, it is referred to as a stable (compensated) stage of the disease. In the unstable (subcompensated) stage, subjective symptoms join, and performance decreases. With decompensated arterial hypotension, the appearance of vegetative paroxysms (a sharp disturbance of well-being, the appearance of sudden weakness, lethargy, nausea, cramping abdominal pain), hypotonic crises, fainting often occurs, sleep is disturbed, acrocyanosis appears, disability is lost and the quality of life of patients is reduced.

Currently, domestic researchers adhere to the classification of hypotension developed by N.S. Molchanov (1962).

● Physiological.
● Pathological.
- Sharp.
- Chronic:
●neurocirculatory;
●symptomatic.

V.S. Rakut (1981) proposed a working classification of hypertension in pregnant women according to several criteria.
● Primary, existing before pregnancy (symptomatic/asymptomatic).
● Secondary, occurring during pregnancy (symptomatic/asymptomatic).

ETIOLOGY OF HYPOTENSION IN PREGNANCY

There are several theories explaining the occurrence of arterial hypotension:

● constitutional-endocrine - arterial hypotension occurs due to insufficiency of the adrenal glands;
● vegetative - arterial hypotension develops due to the predominance of parasympathetic influences on the regulation of the cardiovascular system;
● neurogenic - arterial hypotension occurs under the influence of psychogenic factors.

The etiology and pathogenesis of AH is still not completely clear. It is believed that a factor contributing to the development of arterial hypotension in pregnant women is the emergence of an additional uteroplacental circulatory system.

The placenta produces hormones that suppress the function of the pituitary gland, resulting in a decrease in the production of pressor substances, which contributes to the occurrence of arterial hypotension.

PATHOGENESIS

Low blood pressure may be the result of:

● decrease in the volume of shock and minute ejection of the heart;
● decrease in peripheral vascular resistance;
● BCC deficit;
● Decreased venous return to the heart.

The basis of primary arterial hypotension is an increase in the tone of the parasympathetic division of the autonomic nervous system and a violation of the function of higher centers of vasomotor regulation, leading to a decrease in the total peripheral vascular resistance; compensatory increase in cardiac output is insufficient to normalize blood pressure.

In hypotension of pregnant women, an important role is played by the immune response to antigen of the placenta and fetus, resulting in a reduced or increased release of a number of biological substances, in particular catecholamines, acetylcholine, serotonin, histamine. Acetylcholine is considered as a factor contributing to the reduction of blood pressure. In the genesis of arterial hypotension in pregnant women, a decrease in the concentration of serotonin, a sufficiently active vascular substance, plays a certain role. Some researchers attribute arterial hypotension to toxicosis of pregnancy.

The pathogenesis of complications of gestation

During pregnancy, there are predisposing circumstances for the development of hypotension. This is an increase in the tone of the parasympathetic division of the autonomic nervous system; change in higher autonomic centers of vasomotor regulation; inhibition of all functions that prevail over excitation; decrease in total peripheral vascular resistance; the presence of an additional blood depot (uteroplacental bed); numerous changes in the hormonal and neurotransmitter systems with a predominance of vasodilator effects over vasoconstrictor ones.

Violation of supra-segmental autonomic regulation, a particular manifestation of which is hypotension, serves as an initial background that contributes to the development of early toxicosis of pregnant women.

The main complication of pregnancy in hypertension is spontaneous abortion. Arterial hypotension contributes to the development of intrauterine growth retardation syndrome due to reduced uteroplacental blood flow.

CLINICAL PICTURE OF HYPOTENSION DURING PREGNANCY

Complaints of women with arterial hypotension are unusually varied and numerous: lethargy, apathy, a feeling of weakness and increased fatigue in the morning, decreased performance, a feeling of lack of air at rest and shortness of breath during moderate physical work, pastosity or swelling of the legs and feet in the evening. Most patients note irritable emotional instability, sleep disturbance, decreased libido. There may be complaints from the gastrointestinal tract: heaviness in the epigastric region, bitterness in the mouth, loss of appetite, belching with air, heartburn, flatulence, constipation. Disturbed by headaches and pain in the heart.

Based on the predominance of the localization of the pain syndrome, a predominantly cardiac or cerebral form of primary arterial hypotension is distinguished. Headache - sometimes the only complaint of the patient, often occurs after sleep, physical or mental work. The nature of the pain can be different: dull, constricting, bursting or throbbing pain often captures the frontotemporal or fronto-parietal region and lasts from several hours to 2-3 days. Primary arterial hypotension is characterized by periodic dizziness with increased sensitivity to bright light, noise, loud speech and tactile stimuli, staggering when walking and fainting.

A number of patients experience hypotension of the position (orthostatic hypotension): when moving from a horizontal to a vertical position, postural arterial hypotension develops with a sharp drop in predominantly systolic blood pressure and loss of consciousness.

Syncope (due to reversible generalized cerebral ischemia) is the most severe manifestation of hypotension. Arterial hypotension can occur chronically and acutely (hypotensive crises). Crises occur as collaptoid states lasting several minutes. During a crisis, blood pressure drops to 80/50 mm Hg. and less, headache and dizziness increase, vomiting may occur. Often, patients note a sharp weakness, a feeling of stuffy ears. The skin and mucous membranes turn pale, cold sweat appears.

DIAGNOSTICS OF HYPOTENSION IN PREGNANCY

Anamnesis

It is necessary to collect information about hereditary burden of cardiovascular diseases in the family, analyze the course of pregnancy and childbirth, and special attention should be paid to the value of blood pressure in the mother during pregnancy.

Physical examination

Asthenic physique and pallor of the skin are often detected, the presence of acrocyanosis, hyperhidrosis, low temperature of the skin of the hands and feet is possible. When assessing the state of the autonomic nervous system, attention is paid to red dermographism. Auscultation may reveal a slight systolic murmur at the apex of the heart. With severe hypotension, heart sounds may be slightly muffled. When measuring the value of blood pressure, its decrease is recorded.

Laboratory research

The results of studies in primary arterial hypotension, as a rule, do not go beyond the normal range.

Spend:

• clinical blood test;
• general urine analysis;
• thyroid hormones.

Instrumental Research

Daily monitoring of blood pressure.This study allows you to identify initial deviations in the daily rhythm and blood pressure.

Electrocardiography.With arterial hypotension, sinus bradycardia, migration of the supraventricular pacemaker, atrioventricular blockade of the first degree, early ventricular repolarization syndrome, decreased voltage, and sometimes severe respiratory arrhythmia, extrasystole are often detected.

Echocardiography.The study is carried out to confirm the functional changes in the cardiovascular system.

Electroencephalography.Allows you to register pathological biopotentials of the brain.

Ophthalmoscopy.On examination, the ophthalmologist in 80% of cases reveals changes in the fundus in the form of expansion and plethora of retinal veins.

Ultrasound of the kidneys and adrenal glands.

Complications of pregnancy

Typical complications of arterial hypotension:

● early toxicosis (up to 80%);
● threatening miscarriage;
● FIT (up to 33%);
● preeclampsia (up to 20–25%);
● premature birth (up to 20%).

In childbirth, with a frequency of up to 27%, anomalies of labor activity occur (as a rule, hypotonic dysfunction of the uterus).

In 6.7–25% of cases, early toxicosis and preeclampsia develop. In 7.5% of cases, miscarriage is observed, in 56.5% of cases - spontaneous abortion. The frequency of detection of the IGR syndrome ranges from 8 to 33%. PS and the birth rate of children weighing less than 2500 g are twice as high in women with arterial hypotension than in women with normal blood pressure.

Differential Diagnosis

Primary and secondary arterial hypotension is differentiated, excluding various pathological processes leading to a persistent decrease in blood pressure.

Differential diagnosis is carried out with gastric ulcer, infectious diseases, allergic conditions, hypothyroidism, adrenal insufficiency.

Indications for consulting other specialists

Consultation of specialists is necessary to confirm the presence of secondary arterial hypotension and to resolve the issue of the peculiarities of pregnancy management.

Prevention of consultation of the therapist and endocrinologist is shown.

Diagnosis example

Pregnancy 24 weeks. Primary arterial hypotension (subcompensated).

TREATMENT OF HYPOTENSION IN PREGNANCY

Primary physiological (constitutional) arterial hypotension does not require medical correction. With symptomatic arterial hypotension, it is advisable to carry out a complex of both drug and non-drug methods of correction. Treatment of secondary arterial hypotension requires exposure to the disease, which is its formation.

Treatment Goals

Normalize vascular tone, reduce the frequency of complications of pregnancy and childbirth.

Indications for hospitalization

Decompensated form of arterial hypotension, subcompensated form in case of pregnancy complications.

Non-pharmacological treatment of hypotension during pregnancy

● Optimization of the mode (sleep 9-10 hours/day, daily exposure to fresh air for at least 2 hours).
● Morning exercises followed by water treatments (contrast and fan showers).
● Adequate physical activity (swimming and a complex of restorative gymnastics).
● In the absence of contraindications - general massage, massage of the collar zone, hands and calf muscles, feet.
● Diet with adequate content of vitamins and microelements.
● Physio- and balneotherapy (electrosleep, water procedures - salt-coniferous, sage and mineral baths, Charcot's douche, fan and circular douche).
● Acupuncture.
● Wearing elastic stockings, bandaging the lower extremities to normalize venous return in varicose veins.

Medical treatment of hypotension during pregnancy

In the treatment of arterial hypotension, herbal preparations that affect the autonomic nervous system (pantocrine, eleutherococcus extract, lemongrass tincture, rhodiola extract, aralia tincture, zamanihi tincture) are widely used in the treatment of arterial hypotension. They are prescribed together with herbal preparations with a sedative effect (infusion or decoction of valerian root, motherwort). A positive effect is given by the use of preparations of their Manchurian aralia roots, caffeine (0.05–0.1 g 2–3 r / day).

With headaches, analgesics are ineffective, while when taking caffeine and being in a horizontal position, the pain symptom quickly stops. It is advisable to prescribe drugs that affect the rheological properties of blood (dipyridamole, small doses of acetylsalicylic acid) and the state of the vascular wall (ascorbic acid + rutoside).

To prevent pregnancy complications, a course of drugs with a metabolic effect (inosine, potassium and magnesium asparaginate, actovegin ©) is prescribed. For the treatment of crises, ephedrine (0.5 ml of a 5% solution subcutaneously), caffeine (1.0 ml of a 10% solution intramuscularly) are prescribed.

Prevention and prediction of complications of gestation

Physical therapy is an effective means of treating and preventing arterial hypotension, and morning exercises are very important. Water procedures are useful: shower, dousing, contrast foot baths, massage. Sleep should last 10-12 hours a day. Useful as a night, and 1-2-hour daytime sleep. It worsens the condition of prolonged standing, taking hot baths, prolonged stay in a stuffy and hot room.

Features of the treatment of complications of gestation

Treatment of complications of gestation by trimester

Pregnant women with arterial hypotension are at risk for increased PS and MS.

In the first trimester, pregnancy is accompanied by the threat of abortion. At the same time, sedative, anti-stress, antispasmodic and hormonal therapy are carried out. When an abortion has begun, hemostatic agents are used to stop bleeding.

With the development of early toxicosis in pregnant women, the main components of treatment are diet (food should be taken in small portions every 2-3 hours in a chilled form and in a lying position); therapeutic and protective regime with the elimination of negative emotions; electroanalgesia, acupuncture, psycho- and hypnotherapy. Drug therapy should be complex and include the following drugs: regulating the function of the central nervous system and blocking the gag reflex; infusion agents for rehydration, detoxification and parenteral nutrition; to normalize metabolic disorders.

With the development of FPI in the II and III trimester, therapy is prescribed aimed at normalizing the function of the central nervous system, improving uteroplacental blood flow, affecting the rheological properties of blood, improving the trophic function of the placenta and normalizing metabolic processes. When the IGR syndrome is detected, drugs are used to improve uteroplacental blood flow, activate enzyme systems and metabolic processes in the placenta, eliminate fetal tachycardia, and increase the nonspecific immune defense of the placenta.

With the development of gestosis in the III trimester, pharmacotherapy is carried out: drugs that regulate the function of the central nervous system; diuretics, antihypertensive therapy; drugs that normalize rheological and coagulation parameters of blood; detoxification therapy; drugs that improve uteroplacental blood flow; antioxidants, vitamins, hepatoprotectors; drugs that affect metabolism; immunomodulators.

Treatment of asymptomatic forms of arterial hypotension is not required. With decompensated forms, inpatient treatment is carried out.

Treatment of arterial hypotension in pregnant women begins with the use of non-drug methods: regulation of work and rest, adherence to the daily regimen (night sleep of at least 6 hours, obligatory daytime sleep of 2–3 hours), the appointment of physiotherapy exercises with tonic water procedures, elimination of harmful factors, excessive psycho-emotional and physical stress; full and varied four meals a day with the use of tea or coffee in the morning and afternoon (not at night!); aerotherapy, physiotherapy (ultraviolet irradiation, calcium electrophoresis on the collar zone), psychotherapy, massage and self-massage, electrosleep. Targeted therapy of concomitant diseases and sanitation of foci of infection are very important.

Drug therapy is carried out individually, taking into account the severity of the symptoms of the disease. Assign biogenic stimulants (tincture of ginseng root, magnolia vine, eleutherococcus, etc.) 2 times a day, on an empty stomach or immediately after meals. Perhaps the use of caffeine at 0.05–0.1 g; it can be combined with diphenhydramine (50 mg) or diazepam (5 mg at night).

In hypotensive crises, caffeine, cordiamine injections, as well as ephedrine, 40% glucose solution are used. To improve uteroplacental circulation, dipyridamole, tocopherol, inosine, ascorbic acid, vitamins B1, B6, and pentoxifylline are used. Oxygen therapy and acupuncture, electro- or laser reflexotherapy are effective.

Treatment of complications in childbirth and the postpartum period.

In women in labor with arterial hypotension, a delayed type of development of labor activity can be mistaken for the primary weakness of labor activity. This condition is associated with a significant depletion of the body's energy resources as a result of a slow metabolism, which is typical for women with arterial hypotension. Rhodostimulation in such cases leads to discoordination of tribal forces. To successfully overcome this condition, the woman in labor should be provided with rest and sleep.

Women in labor with arterial hypotension do not tolerate blood loss; note severe collaptoid conditions even with relatively small bleeding.

Management of bleeding in the early postpartum period.

● At a delay in a uterus of parts of a placenta their removal is shown.
● With coagulopathy, their correction is shown depending on the existing changes.
● In violation of uterine contractility in case of blood loss exceeding 0.5% of body weight, use the following methods:

• emptying the bladder with a soft catheter;
• external massage of the uterus;
• cold in the lower abdomen;
• agents that enhance the contraction of the myometrium;
• manual examination of the walls of the cavity of the postpartum uterus;
• terminals for parameters according to Baksheev;
• laparotomy and extirpation of the uterus (with the ineffectiveness of the measures taken).
• hemostatic, blood-substituting and antianemic therapy.

Terms and methods of delivery Even the decompensated stage of arterial hypotension is not an indication for abortion or early delivery. Delivery at full term is carried out through the natural birth canal with the prevention of characteristic complications of the birth act. Early hospitalization is indicated for delivery. Careful analgesia, pharmacological protection of the fetus, and prevention of bleeding are essential in the management of timely delivery. CS is performed according to obstetric indications.

Approximate periods of incapacity for work

They are determined by the severity and form of arterial hypotension, pregnancy complications and the effectiveness of therapeutic measures.

PREVENTION OF HYPOTENSION DURING PREGNANCY

Prevention of arterial hypotension involves the implementation of a number of hygiene measures:

● compliance with the daily routine (night sleep for at least 8 hours, morning and production exercises, water tonic procedures);
● proper organization of labor;
● full and varied four meals a day;
● elimination of psycho-emotional stress.

INFORMATION FOR THE PATIENT

● Arterial hypotension increases the likelihood of complications during pregnancy and may worsen its prognosis.
● With arterial hypotension, self-monitoring of blood pressure should be carried out.
● Regular medical supervision during pregnancy is necessary.
● For all patients with hypotension, it is advisable to recommend preventive measures and carry out a complex of non-drug interventions.
● With arterial hypotension during pregnancy, regular examination, prevention and treatment of disorders of the fetoplacental system is necessary.

FORECAST

The prognosis of the disease depends on the complex treatment, as well as on the regimen of the day. Often, arterial hypotension is observed throughout life as a borderline state between normal health and illness.

All pregnant women have their blood pressure measured at every visit to the doctor. Often, doctors pay attention only to its increase, while expectant mothers suffer from hypotension (low blood pressure) no less severely. The decrease in pressure is associated with hormonal changes, dietary habits and physical activity of a woman, heredity and the initial state of the body. Sometimes a sharp literally exhausts a pregnant woman during the first and partially second half of pregnancy, leading to severe ailments, weakness and metabolic disorders. Why is it dangerous?

Lowering the pressure in pregnant women: norm and pathology

Arterial hypotension (or hypotension) is a decrease in the level of mean arterial pressure, measured on both hands, below normal (average) pressure by 10% or more.

note

It is important to assess the decrease in pressure in a woman not in relation to the average age norms, but in relation to her own "working" pressure for a non-pregnant state. That is, if a woman before pregnancy had a stable blood pressure in the range of 100-110 / 70-80 mm Hg, while her health and performance were quite normal, this pressure is taken as her "working" variant of the individual norm.

On average, during pregnancy, the pressure in the first or second trimester ranges from 100-120 to 70-80 mm Hg. By the third trimester, due to an increase in weight, circulating blood volume, changes in the intensity of metabolic processes and fetal growth, pressure naturally increases. If the pressure limits deviate by more than 15-20 mm Hg for systolic (upper) pressure, and more than 10-15 mm Hg for diastolic (lower) pressure, and at the same time the woman's well-being and her ability to work are disturbed, we are talking about hypotension.

Pregnancy hypotension: when is it suspected?

If, during measurements both at the doctor's office and at home, the level of systolic pressure fluctuates within 100 mm Hg. and below, and diastolic 60 mm Hg and below, doctors suspect pathological hypotension of pregnant women. This condition is usually accompanied by a number of subjective unpleasant symptoms:

All manifestations are especially pronounced in the morning, immediately after waking up. Women hardly get out of bed, cannot “swing” and join in household chores or work. Often, it is from the manifestations of hypotension and the resulting fainting in the early stages of pregnancy that many ladies learn about their new interesting position.

The mechanism of pressure reduction during pregnancy

For the first trimester of pregnancy, a decrease in pressure, if it fluctuates within acceptable, physiological limits, is not considered a pathology. This is due to the physiological mechanisms of the restructuring of the body to new conditions of functioning for itself. Such mechanisms are associated with the protection of the embryo and providing it with optimal development conditions with the supply of a sufficient amount of oxygen and nutrition for full growth and development in the uterine cavity. The cause of hypotension during this period is the expansion of small vessels, into which a sufficiently large volume of blood from the arteries and veins goes. This is necessary so that all the tissues and organs of the expectant mother are saturated with oxygen and nutrients, especially the pelvic organs and the uterus, where the baby will spend the next 9 months of her life. Vascular relaxation occurs under the influence of pregnancy hormones, which are produced by the pituitary gland and ovaries in increasing quantities. Basically, small arterioles and capillaries, as well as venules (small veins in organs) expand. They braid the uterus and ovaries, as well as all the vital organs of the mother's body, with a dense network.

How do hormones affect blood pressure?

Immediately after the release of the egg from the ovary, the corpus luteum, a temporary hormonal organ that produces the hormone progesterone, is formed at its location. During conception in the cavity of the fallopian tubes, due to excretion, conditions are created for the advancement of the embryo into the uterine cavity. Progesterone acts on the smooth muscle elements to relax the tubes and uterus so that they can "carry" the embryo from the site of conception into the uterine cavity, and create optimal conditions for its implantation in the endometrium (the inner lining of the uterus). If, the embryo cannot attach to its wall, and dies, for this purpose progesterone is produced.

But in addition to affecting the uterus, it also affects the smooth muscle elements of blood vessels and internal organs, also relaxing them. As a result, small vessels dilate, a significant amount of blood flows into them, so that relatively low pressure is created in large arteries. As the fetus and placenta grow, the volume of circulating blood in the vessels increases, the hypotension of pregnancy gradually disappears by the end of the first trimester. The pressure returns to normal. If this physiological mechanism is violated, the woman had hypotension even before pregnancy, and there are problems with vascular tone, physiological hypotension becomes a pathology and can harm both the well-being of the future mother herself and the condition of the fetus.

How is pathological hypotension manifested?

If blood pressure is constantly reduced, the body suffers from a lack of oxygen and nutrients due to the fact that less blood flows through the heart and pulmonary (small) circulation, less of it is saturated with oxygen and goes to organs and tissues. This is due to the fact that pathologically dilated small vessels store a lot of blood, which stagnates and inactively returns through the veins to the heart. Insufficient pressure is created inside the arteries, and the heart is forced to work harder and faster in order to pump smaller volumes of blood and saturate the body with oxygen. In this state, the brain receives less oxygen and nutrition, which causes symptoms such as lethargy and drowsiness, weakness and. Against the background of a constant lack of oxygen to the brain, seizures occur at night and severe drowsiness during the daytime, physical activity may be poorly tolerated, shortness of breath occurs against the background of minor physical or mental activity. Headaches occur immediately after waking up or during the day, sometimes, especially in stuffy rooms, fainting occurs as a reaction to neither (oxygen deficiency). In a woman against the background of pathological hypotension, her working capacity, appetite and mood suffer, she becomes irritable, emotional and tearful.

What is the danger of hypotension of pregnant women for the fetus, if it is not treated?

Do not treat the hypotension of pregnant women as a temporary ailment, and leave it unattended. If this is a sharply reduced pressure, it threatens with complications during pregnancy both for the maternal body and for the health of the fetus.

Reduced pressure disrupts the normal process of blood circulation, which means that organs and tissues, including the placenta and fetus, suffer from hypoxia and a deficiency in the supply of glucose, vitamins and minerals. In turn, the metabolic products of the fetus and various compounds dangerous to it are removed worse through the placenta. If the fetus suffers from hypoxia in the first trimester, when organs and systems are being laid, this threatens with malformations, anomalies in the structure and further functioning of organs. The threat of a missed pregnancy also increases and the body stops the development of pregnancy, realizing that the conditions for the life of the fetus are negative.

In later periods, persistent hypotension can lead to the formation of a serious fetal problem - IUGR (intrauterine growth retardation). The fetus grows and gains weight less than normal, it is weakened and prone to various infections, it is difficult to adapt to a new environment after childbirth.

What is the risk of a future mother with hypotension?

Often, doctors against the background of reduced pressure noted early and severe pregnant women with severe and malaise. At a later date, such mothers are threatened, in which the kidneys and heart, blood vessels and blood circulation of the brain are seriously affected. The low pressure is replaced by an increased one, which is difficult to stop and threatens to develop seizures due to circulatory disorders and cerebral edema. In addition, against the background of pathological hypotension, chronic infections can worsen, the general condition decreases and suffers, pregnancy is difficult to carry.

It is important to determine what caused health problems, the so-called hypotension, the initially reduced vascular tone and abnormally low pressure, or certain pathologies and diseases led to such pressure figures. Frequent factors affecting pressure can be various infections, problems in the thyroid gland (), disorders of the liver, impaired production of adrenal hormones, or iron deficiency with development. The tactics of treatment for primary hypotension and in the presence of low pressure against the background of diseases will differ.

What to do with low blood pressure in pregnant women?

If this is pathological hypotension, which significantly threatens pregnancy, doctors in the hospital will treat the expectant mother. If it is hypotension that can be controlled and treated at home, there are a number of recommendations for a woman to help alleviate the condition. A strict daily routine and pedantic observance of it, even on weekends, are important. It is necessary to sleep at least 9-10 hours at night, and also allocate time for daytime rest for 1-2 hours. You need a long stay in the air to saturate the blood with oxygen, at least a couple of hours a day.

It is necessary to develop nutrition that stimulates the body, the full supply of minerals and vitamins to the body, and the prevention of prolonged starvation. Do not limit your diet with salt, it retains water and leads to an increase in pressure.

note

Often, in the presence of hypotension, women have an irresistible craving for pickles and cabbage, you do not need to limit yourself to these products. Useful for vascular tone and increased pressure will be morning exercises, swimming, contrast showers and walks.

Is hypotension treated during pregnancy?

If low pressure interferes with the normal life of the expectant mother and threatens the fetus, doctors select treatment methods that are safe for each specific period. Preference is given to physiotherapy with the use of mineral baths and bathing with coniferous extracts, electrosleep, acupuncture, sea bathing. Only in serious cases can medicines be used, herbal extracts - tinctures are also preferred.

Blood pressure for pregnant women is measured without fail at each scheduled visit to the antenatal clinic. The doctor, as a rule, pays more attention to the fact of its increase. But often experts do not pay attention to hypotension in pregnant women (that is, low blood pressure).

This is due to the fact that it does not cause any particular inconvenience to the expectant mother, unlike hypertension, and it is usually associated with hormonal changes that occur against the background of the development and course of pregnancy, heredity, the characteristics of the woman's body, her physical activity and nutrition.

And yet, it happens that a sharp decrease in blood pressure leads to exorbitant weakness of the whole organism and a deterioration in well-being so that the expectant mother is not able to lead an active lifestyle, which is required for her position. In addition, it can lead to disturbances in metabolic processes, which will also negatively affect pregnancy.

Norm and indicators of hypotension in pregnant women

Hypotension is the term for low blood pressure. To determine this condition, the measurement is carried out on both hands, and the indicator must be below the norm by 10% or more.

The assessment of the pressure of a pregnant woman is carried out on the basis of her so-called "working" pressure before pregnancy, and the average statistical age standard is not taken into account in this case. This means that in the case when the "working" pressure in a woman was kept between 100/70 and 110/80 mm. rt. Art., and at the same time she felt good and cheerful and her working capacity was at a high level, then these same limits are taken as the norm when pregnancy occurs in this individual case.

The average blood pressure during pregnancy is between 100/70 and 150/80 mm. rt. Art. These figures are usually typical for the first two trimesters of this period. Closer to childbirth, when the body weight of the expectant mother, the fetus increases, and at the same time the volume of circulating blood, blood pressure should increase slightly. This is fine. The allowable increase in this case is 15-20 units of systolic pressure and 10-15 units of diastolic pressure. Any excess (or vice versa) of these figures is considered a deviation and is subject to therapeutic correction when making a diagnosis - hypotension or hypertension.

Causes of hypotension in a pregnant woman

A tendency to hypotension during pregnancy is observed and noted, as a rule, in women with reduced body weight and a fragile physique.

The reasons for this condition may be:

• Hormonal changes in the body.
• Chronic diseases of the stomach and the whole digestive tract.
• Allergic reactions (reduced immunity).
• Thyroid dysfunction.
• Functional disorders of the adrenal glands.

Signs in which there is a suspicion of hypotension during pregnancy

Hypotension as a pathology in a woman carrying a child is diagnosed when her blood pressure, when measured, shows figures below the norm, that is, does not reach 100/60 mm. rt. Art.

Suspicion of this type of disease may arise if the condition of the expectant mother is expressed by the following signs:

• Attacks of shortness of breath are noted with slight acceleration during walking, light physical exertion, or even at rest (usually in late pregnancy).
• There are frequent dizziness, sometimes fainting, especially in the morning, while getting out of bed.
• Rapid fatigue is noted, even with low physical exertion, or while walking in the fresh air.
• The feeling of constant lack of sleep, that is, the state of drowsiness accompanies a woman constantly.
• The woman complains of paroxysmal intense weakness.

All these signs, suggesting suspicions of hypotension, as a rule, make themselves felt in the morning, immediately after waking up.

It happens that it is precisely because of a sharp drop in blood pressure and even fainting in the first weeks after the onset of pregnancy that a woman begins to suspect her new status as a “future mother”.

When hypotension begins at the very beginning of pregnancy and blood pressure indicators fluctuate within acceptable physiological norms, doctors do not classify this as a pathology.

Usually, this process of pressure reduction is caused by the mechanism of functional restructuring of many organs and systems of a woman. All these changes in their work are directly related and their purpose is to provide a protective function and healthy conditions for the development and growth of an infant in the womb: the optimal amount of such an important substance as oxygen and various nutrients entering the child's body.

The early periods of the gestation period are distinguished by such a process as the expansion of small vessels that contain a large volume of venous and arterial blood, in order to fully saturate all mother's organs and tissues with oxygen, especially in the small pelvis and uterus.

Actually, this is precisely what becomes the main reason for the development of the hypotonic state of a pregnant woman.

Hormonal effect on blood pressure

The corpus luteum, which is formed after the release of the egg, forms the pregnancy hormone - progesterone. In turn, it creates favorable conditions directly inside the fallopian tube so that the embryo reaches the uterine cavity without hindrance and can strengthen itself there.

How are these conditions created? Progesterone has a relaxing effect on the smooth muscles of the uterus and tubes. This is necessary, because if the muscles of these organs are in a state of tone, the embryo cannot move along them and attach to the wall. And that means he is in for an imminent death.

As a result of this effect of progesterone, the walls of small vessels also relax, which contributes to their expansion, and, accordingly, a decrease in blood pressure.

With the course of the pregnancy itself, as well as fetal development and growth, hypotension disappears. This happens already by the beginning of the second trimester of pregnancy.

If this does not happen, then the doctor defines the hypotonic state as pathological, capable of harming the well-being of the expectant mother and the development of her fetus, and therefore subject to therapeutic correction.

Clinical picture of hypotension in pregnancy

Low blood pressure forces the heart muscle to work more actively, speeding up the heart rate. At the same time, the brain begins to receive less oxygen, which manifests itself through the following clinical picture:

• Constant drowsiness;
• Night sleeplessness;
• Shortness of breath even with little physical exertion;
• Fainting even from the slightest lack of fresh air;
• Low level of performance;
• High level of irritability, tearfulness, emotional sensitivity;
• Low level of concentration;
• weather sensitivity;
• Tinnitus.

The danger of hypotension to the fetus

It is very important to know that hypotension in pregnant women can cause quite serious harm to fetal development, since blood circulation worsens not only in the mother, but also in the placenta, and the child ceases to receive enough nutrition and oxygen for normal development and growth.

Insufficient blood supply, in turn, causes placental insufficiency, fetal preeclampsia, and the threat of normal delivery.

In addition, the mother’s low blood pressure during pregnancy can also have a negative impact after childbirth: the recovery period will be longer and less intense, since the body will not have enough strength for the stress that will inevitably arise in the process of caring for the baby.

Significantly low blood pressure in pregnant women can be very dangerous and cause complications that threaten various pathologies and unhealthy conditions of the fetus.

First of all, hypotension can cause. The very first to suffer are the kidneys, heart and vessels of the brain of the head, and not only the mother's body, but also the baby.

As a rule, hypotension is replaced by hypertension, which is very difficult to stop during pregnancy. Moreover, hypertension causes convulsions and cerebral edema due to impaired blood circulation.

The chronic form of hypotension can cause an exacerbation of chronic infectious diseases (if any in a woman's history), a decrease in immunity, and therefore pregnancy becomes more difficult.

With hypotension in a pregnant woman, labor can be complicated. This complication will be caused by violations of the contractile function of the uterus, due to impaired blood flow and, accordingly, low blood pressure. Often such childbirth is accompanied by heavy bleeding.

Therapy of hypotension in pregnancy

There are several options used to treat hypotension. The special position of a woman, that is, pregnancy in this regard, is no exception. On the contrary, when choosing therapeutic measures in such cases, the doctor examines the patient's condition more carefully and, accordingly, selects methods of treatment and means more carefully. For each specific period of pregnancy and case, therapy is purely individual.

Pathological hypotension, as the disease is also called, with the threat of termination of pregnancy, suggests a stationary regimen. The expectant mother is placed in a specially designed medical facility or hospital department under the close attention of doctors.

Treatment of crises involves the use (subcutaneously) of a 5% solution of ephedrine with a dosage of 0.5 ml. Caffeine is also injected intramuscularly, more precisely 10% of its solution at a dose of 1.0 ml.

With further medical treatment, preference is still given to pharmaceuticals of plant origin. In this regard, extracts or tinctures are used, in particular, an extract of radiola rosea, eleutherococcus, tincture of Schisandra chinensis, zamaniha, aralia, and other plants corresponding to this group of plants.

As a rule, in combination with drugs of the previous group, which have an active effect on the ANS, sedative drugs are prescribed. They are also of vegetable origin. Traditionally, it is recommended to take decoctions of motherwort or valerian.

Pharmacological drugs are also prescribed that affect the properties of the blood, in particular rheological, for example, dipyridamole, as well as acetylsalicylic acid in small doses. Caffeine is recommended for headaches. It is taken per day 2 - 3 times in the amount of 0.05 - 0.1 g (one time).

With a sharp decrease in pressure, fainting occurs. In such a situation, the pregnant woman is allowed to smell ammonia, and when she regains consciousness, some kind of tonic, for example, 35-40 drops of cordiamine.

Physiotherapy is also of great importance in the treatment of hypotension. Acupuncture, coniferous extracts for the bathroom, bathing in mineral baths, sea bathing, electrosleep, all this has a beneficial effect on the body of the expectant mother.

With a degree of hypotension that allows improvement of the condition at home, the pregnant woman is also under medical control, but remotely. Here, mommy herself must unquestioningly follow all the recommendations of the doctor, and not her friends, and clearly adhere to a strict regimen. Moreover, a strict regime provides not only a daily routine, but also nutrition, an emotional state.

Prolonged sleep is highly recommended, approximately 10 hours at night and approximately 2 hours of rest during the day. After waking up, it is better to lie down for a few minutes (5 - 7), and then just get up, moreover, slowly. Getting up suddenly can cause nausea and dizziness. A few hours should also be spent outdoors. Special gymnastics and a contrast shower, as far as possible, are also recommended to be included in the daily routine.

The nutrition of a pregnant woman should be varied mineral and vitamin saturated. If the craving for salt increases, as a rule, it is cabbage or cucumbers, then these products at reduced pressure, if there are no other contraindications, can not be limited. Fasting is unacceptable with hypotension. Broth soups and broths are recommended. It is desirable to introduce a vegetable such as celery into the diet. It is not only able to increase blood pressure, but also has a beneficial effect on hemoglobin levels.

Expectant mothers, whose favorite drink was coffee before pregnancy, are advised to switch to chicory. Natural coffee, but not instant, you can drink only in the form of latte or cappuccino, and then very rarely.