Introduction
Gestational hypertension is a common obstetric disease in clinical practice. Mainly due to the increased size of the fetus, which increases the burden on the kidneys, causing symptoms of high blood pressure. Patients usually sleep in a side-lying position to help lower blood pressure. Ensure adequate protein and calorie intake. If the patient’s blood pressure is very high, diazepam can be used to help the environment and control the disease.
Symptoms/Complications
There are three main symptoms of gestational hypertension: high blood pressure, proteinuria, and edema, and there may be other symptoms such as headache, vision Fuzziness, vomiting, abdominal pain, hyperactivity, and decreased urination.
1. Mild gestational hypertension
Mainly manifested as mildly elevated blood pressure, possibly accompanied by mild edema and microalbuminuria. The expectant mother has no obvious discomfort. This stage can last from days to weeks and can develop gradually or worsen rapidly.
Edema can be overt or recessive. Overt edema can be divided into Ⅰ°～Ⅲ° according to its degree; if it is occult edema, it is only manifested in abnormal weight gain (that is, the weight gain of expectant mothers exceeds 0.5 kg per week).
2. Moderate PIH
Moderate PIH develops on the basis of mild, and the degree of blood pressure, proteinuria and edema is aggravated compared with mild , but the mother-to-be still felt no abnormality at this time.
The blood pressure is further increased, but not more than 21.3/14.7KPa (160/110mmHg), the urine protein is increased, accompanied by edema, and mild symptoms such as dizziness may be present.
3. Severe pregnancy-induced hypertension
Severe pregnancy-induced hypertension is the most serious stage, blood pressure rises ≥ 21.3/14.6 kPa, urine protein ++～++++ , The degree of edema of expectant mothers can be mild or severe, severe cases may have ascites, and expectant mothers feel dizziness, headache, blurred vision, right upper quadrant pain, shortness of breath, palpitation, chest tightness, nausea, and vomiting. If not diagnosed and treated in time; expectant mothers may experience convulsions, coma, and loss of consciousness. Convulsions can come back and forth and can cause bites on the lips and tongue, falls or even broken bones. This can happen before, during, and after delivery. The damage to mother and baby is very serious, and the severe case can endanger the life of mother and baby.
Causes
What are the causes of gestational hypertension? The cause of gestational hypertension has not been fully clarified. At present, it is believed that the following factors may lead to the disease in expectant mothers:
1. Genetic factors. Surveys show that 40% of PIH have a family history.
2. The age of primipara is 40 years old.
3. Expectant mothers with a history of chronic hypertension, nephritis, diabetes, and antiphospholipid syndrome.
4. BMI ≥ 35kg/m2 at the first check-up. BMI (body mass index) = weight (kg) / height 2 (m2).
5. Malnourished expectant mothers.
6. The uterine tension of the expectant mother is too high, such as polyhydramnios, twins, diabetic macrosomia, etc.
7. Cold and temperature changes not only bring colds, but also increase the chance of expectant mothers suffering from pregnancy-induced hypertension.
8. The decrease of blood calcium is also one of the factors that are prone to PIH.
Examination
The basic physiological changes of PIH are the pathophysiological changes of brain, kidney, heart, liver and uterine placenta of different degrees caused by spasm of small arteries throughout the body, resulting in corresponding clinical manifestations. With the different severity of pregnancy-induced hypertension syndrome, its coagulation function also changes correspondingly, which can even lead to disseminated intracapillary coagulation (DIC).
1. Basic examination
To know whether the expectant mother has symptoms such as headache, chest tightness, vertigo, and upper abdominal pain. Check blood pressure, blood and urine routine, pay attention to body mass index, urine volume, fetal movement.
(1) Hypertension: blood pressure >130/90mmHg, or compared with basal blood pressure, systolic blood pressure >30mmHg, diastolic blood pressure >15mmHg.
(2) Edema: The edema does not subside after 6-8 hours of clinical rest;
(3) Weight: The weekly weight gain exceeds 1 kg.
(4) Urine protein: urine routine has protein or urine proteinuria quantitative> 0.3g/24 hours.
2. Special examination for expectant mothers
Including reflex test, fundus examination, coagulation index, heart, liver and kidney function, blood lipids, blood uric acid and electrolytes.
3. Special fetal examination
Including fetal development, B-ultrasound and fetal heart monitoring and umbilical artery blood flow. Pregnancy-induced hypertension can cause fetal distress, growth restriction and other effects on the fetus, so it is necessary to check the fetal development.
Treatment
1. Rational drug use. The patient should use the medicine rationally under the guidance of the doctor, and the doctor should also take into account the health of the pregnant woman and the fetus as well as the patient’s condition, and choose the best treatment plan. The central antihypertensive drug, methyldopa is recommended by the British Hypertension Society for the treatment of chronic hypertension in pregnancy. It is still the first-line drug for gestational hypertension. A vasodilator, hydralazine is a direct vasodilator drug, which has obvious dilation effect on small arteries, obvious effect on reducing diastolic blood pressure, does not affect the uterus and placental circulation, and has no adverse effect on the fetus. Intravenous medication is the drug of choice for severe pregnancy-induced hypertension in foreign countries.
2. Closely observe the changes of the condition. Doctors should regularly check the patient’s condition changes, including listening to the fetal heart rate, measuring blood pressure, etc., but also pay more attention to the patient’s subjective symptoms. The patient also needs to actively cooperate with the doctor. If serious adverse symptoms occur, the doctor should be notified in time for rescue measures.
3. Peace of mind. Patients need to maintain a good attitude during the treatment process, do not be negative and pessimistic, you must know that the baby can feel the emotions of adults, which is very bad for the development of the baby.
Nursing
1. Antispasmodic drugs. Magnesium sulfate is the drug of choice for the treatment of preeclampsia and eclampsia.
2. Antihypertensive drugs. For high blood pressure, the preferred antihypertensive drug is hydralazine.
3. Volume expansion drugs. For pregnant women with hemoconcentration, it can improve tissue blood perfusion and correct hypoxia. Expansion must be done on the basis of antispasmodic. Commonly used volume expanders are albumin, whole blood, plasma, and dextran.
4. Diuretic drugs if necessary. Reduce anxiety, reduce edema, prevent complications, closely observe vital signs, pay attention to control sodium intake, pay attention to rest and strengthen nutrition.
Diet taboos
Expectant mothers with gestational hypertension should pay special attention to their diet, and should abide by the dietary rules of three highs and one low, namely high protein, high calcium, high potassium and low sodium diet. Helps prevent pregnancy-induced hypertension. Expectant mothers should eat more fish, meat, eggs, milk and fresh vegetables, and eat less salty food.
1. Quit alcohol and spicy food: Pregnancy hypertension is often complicated by kidney disease, so it is necessary to limit the consumption of food that stimulates the parenchymal cells of the kidney, such as various beverages containing alcohol (do not use alcohol as an accompaniment in dishes). ingredients), spicy condiments, and various vegetables containing volatile oil, capsaicin, and oxalic acid.
2. Drink less thick soup: too thick chicken soup, broth, and fish soup can produce too much uric acid after metabolism, which will also increase the burden on the kidneys. Therefore, the above soup should be light and not thick.
3. It is advisable to eat fresh vegetables and fruits: Green leafy vegetables and fruits contain more vitamin C, especially tomatoes, oranges, fresh dates, etc., which can be eaten in moderation.
4. It is advisable to eat some bowel-relaxing food. The enlarged uterus compresses the bowel after pregnancy. In addition, due to poor health, constipation is particularly common during pregnancy.
Prevention
1. Improve the three-level maternal and child health care network, and carry out peri-pregnancy and perinatal health care.
2. Regular obstetric examination: strengthen health education, so that expectant mothers can master the basic knowledge of hygiene during pregnancy and conduct prenatal examinations consciously.
3. Instruct expectant mothers to eat reasonably and rest.
(1) Moderate exercise: During pregnancy, moderate exercise and reasonable rest should be arranged to maintain a healthy body during pregnancy and avoid excessive weight gain or excessive weight loss.
(2) Reasonable diet: expectant mothers should eat foods rich in protein, vitamins, iron, calcium, calcium, calcium, and other trace elements and fresh fruits and vegetables, reduce animal fat and excessive salt intake, but not Limit salt and fluid intake.
(3) Keep enough rest and a happy mood, and insist on the left lateral position to increase the blood supply of the placental villi.
(4) Calcium supplementation: low calcium diet (intake
