Is it Safe to Use an Antihypertensive in Pregnancy?

Hypertension during pregnancy is a unique and common obstetrical complication that seriously threatens the life of a pregnant woman. It is one of the important reasons leading to adverse birth outcomes such as premature birth, low birth weight, and perinatal death.

Multiple groups: Pregnant woman

Common symptoms: Premature birth, low birth weight, etc.

Causes and common diseases of hypertension during pregnancy

Hypertensive disease of pregnancy is a multi-factorial disease. There can be various maternal basic pathological conditions, and it is also affected by environmental factors during pregnancy. The condition is different during pregnancy, it can show progressive changes and can quickly deteriorate.

Differential diagnosis of hypertension during pregnancy

Diagnosis of hypertension

The measurement of blood pressure, before the measurement of blood pressure, the subject should rest for at least 5min. Measure the sitting or lying position. Note that the limbs are relaxed and the cuff is the right size. The blood pressure of the right upper limb is usually measured, and the cuff should be at the same level as the heart.

Hypertension during pregnancy is defined as systolic blood pressure 140mmHg and / or diastolic blood pressure 90mmHg measured at least twice in the same arm. If the blood pressure is lower than 140 / 90mmHg, but it is 30 / 15mmHg higher than the basic blood pressure, it is necessary to follow up closely although it is not used as a diagnosis basis. For those who first found an increase in blood pressure, the blood pressure should be re-measured at intervals of 4 hours or more. If the two measurements are both systolic blood pressure 140mmHg and / or diastolic blood pressure 90mmHg, it is diagnosed as hypertension. For severe hypertension pregnant women with systolic blood pressure 160mmHg and / or diastolic blood pressure 110mmHg, the diagnosis can be made after repeated measurements at intervals of several minutes.

Hypertension during pregnancy

Hypertension during pregnancy: The following routine examinations and review if necessary: (1) blood routine; (2) urine routine; (3) liver function; (4) renal function; (5) electrocardiogram; (6) obstetrics Ultrasonography. Especially for pregnant women who start prenatal examination after 20 weeks of pregnancy, pay attention to understanding and ruling out basic diseases and chronic hypertension of pregnant women, and check blood lipids, thyroid function, and coagulation function if necessary.

Principles of treating hypertension during pregnancy

General treatment of hypertension during pregnancy

1. Place of treatment: pregnant women with hypertension during pregnancy can be treated at home or in hospital;

2. Rest and diet: Should pay attention to rest, it is advisable to lie in the lateral position; ensure adequate intake of protein and calories; moderately limit salt intake.

3. Sedation: ensure adequate sleep, if necessary, oral diazepam 2.5 ~ 5.0mg before going to bed.

Antihypertensive treatment of hypertension during pregnancy

The purpose of antihypertensive treatment is to prevent serious maternal-fetal complications such as cardio-cerebral vascular accidents and placental abruption. Hypertensive pregnant women with systolic blood pressure 160mmHg and / or diastolic blood pressure 110mmHg should be treated with antihypertensive therapy; hypertensive patients with systolic blood pressure 140mmHg and / or diastolic blood pressure 90mmHg can also use antihypertensive drugs.

Target blood pressure: pregnant women do not have organ function damage, systolic blood pressure should be controlled at 130-155mmHg, diastolic blood pressure should be controlled at 80-105mmHg; pregnant women with organ function damage, systolic blood pressure should be controlled at 130-139mmHg, diastolic blood pressure should be controlled 80-89mmHg. The blood pressure reduction process strives for a stable drop in blood pressure, which must not fluctuate too much, and the blood pressure cannot be lower than 130 / 80mmHg to ensure uterine-placental blood perfusion (-B). When severe hypertension or organ damage such as acute left ventricular failure occurs, it is necessary to urgently lower blood pressure to the target blood pressure range. Note that the magnitude of blood pressure reduction cannot be too large, and 10% to 25% of the average arterial pressure (MAP) is appropriate. It reached stability within 24 48h. Commonly used antihypertensive drugs include adrenergic blockers, calcium ion channel blockers, and central adrenergic blockers. Commonly used oral antihypertensive drugs include labelolol, nifedipine, or nifedipine sustained-release tablets, etc .; if oral blood pressure control is not satisfactory, intravenous medication can be used. Commonly used: labelolol, phentolamine; pregnancy Generally do not use diuretics to lower blood pressure in order to prevent blood concentration, reduced effective circulating blood volume and hypercoagulability. Atenolol and prazosin are not recommended. Magnesium sulfate is not used as a hypotensive drug. The use of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists is prohibited in the second and third trimesters of pregnancy.