OVERVIEW
Overview
Puerperal hypotension is defined as a state of low blood pressure in the upper extremity arteries below 12/8 kPa (90/60 mmHg) during the 6 weeks postpartum due to insufficient blood perfusion to organs and tissues. Low blood pressure can be called a hypotensive state as long as it is not accompanied by symptoms related to insufficient blood supply to the brain, heart, and kidneys, but it cannot be considered a pathologic state.
Hazards
When hypotension occurs, patients may have various symptoms such as dizziness, limb weakness, blackness before the eyes, cold sweat, chest discomfort, etc. In severe cases, fainting may also occur. The cause of the disease should be clarified as soon as possible, so as to prevent complications and serious development of the disease.
Examination
Physical examination, arterial blood pressure measurement, upright tilt test, blood routine, blood glucose test, glycosylated hemoglobin test, thyroid function test, adrenal cortex function test, adrenal medulla function test, pituitary function test, etc.
Diagnosis
The diagnosis of hypotension is mainly based on the arterial blood pressure measurement up to the standard of hypotension, and at the same time, detailed inquiries should be made about the history of the disease, the characteristics of the occurrence of symptoms, and the combination of physical signs and auxiliary examinations for diagnosis and differential diagnosis.
Causes
Causes
1. Physiological hypotension: some healthy people’s blood pressure measurements have reached the standard of low blood pressure, but without any conscious symptoms, after long-term follow-up, except for low blood pressure, there is no abnormality of ischemia and hypoxia in various systems and organs of the human body, and it does not affect the life expectancy.
2. Pathological hypotension: besides the lowering of blood pressure, it is often accompanied by different degrees of symptoms and certain diseases.
(1) Primary hypotension: refers to the state of low blood pressure without obvious reasons, such as physiological low blood pressure (somatic hypotension), which is mostly seen in the elderly and women with weak physique.
(2) Secondary hypotensive disease: refers to the lowering of blood pressure caused by the disease of a certain organ or system of the body, such as hemorrhage, acute myocardial infarction, severe trauma, infection, allergy and other causes of a sharp decrease in blood pressure.
Symptoms and Diagnosis
Typical Symptoms
According to the onset of hypotension, it is divided into two categories: acute and chronic.
1. Acute hypotension: the patient’s blood pressure suddenly drops from normal or high level, and due to ischemia of brain, heart, kidney and other important organs, symptoms such as dizziness, limb weakness, black eyes, cold sweat, palpitation, oliguria and so on, and in serious cases, it is fainting or shock.
2. Chronic hypotension:The state in which the patient’s blood pressure is persistently below the normal range.
(1) Somatic hypotension: mostly seen in women aged 20 to 50 and the elderly, the mild cases may not have any symptom, while the severe cases may have mental fatigue, dizziness, headache, or even fainting, and the performance will be more obvious when the temperature is higher in summer.
(2) Postural hypotension: within 3 minutes of changing the patient’s position to upright, dizziness, lightheadedness, blurred vision, fatigue, nausea, cognitive dysfunction, palpitation, and neck and back pain occur.
(3) Secondary hypotension: certain diseases or medications can cause hypotension, with symptoms such as dizziness, weakness and blurred vision.
Diagnostic basis
1. Constitutional hypotension (primary hypotension): the patient’s arterial blood pressure in the upper limb is lower than 12/8 kPa (90/60mmHg), mostly without conscious symptoms, while some patients have symptoms similar to cardiac neurosis, such as mental fatigue, amnesia, dizziness, headache, fainting, chest tightness, palpitations, etc. There is no organic disease or malnutrition, so that other causes of hypotension can be ruled out.
2. Postural hypotension: When the patient suddenly changes from the lying position or squatting position to the upright position, or when standing for a long time, the arterial blood pressure of the upper limbs is lower than 12/8 kPa (90/60 mmHg), or the systolic blood pressure decreases by more than 30 mmHg and diastolic blood pressure decreases by more than 20 mmHg, and there are such symptoms as dizziness, lightheadedness, blurred vision, fatigue, nausea, cognitive dysfunction, palpitation, and pain in the back of the neck, and so on. If the patient takes the lying position, the blood pressure will rise and the symptoms will disappear, and the disease can be diagnosed after excluding other causes.
3. Secondary hypotension: The disease can be diagnosed when the patient’s arterial pressure in the upper limb is lower than 12/8 kPa (90/60 mmHg) and there are other diseases, such as hemorrhage, acute myocardial infarction, severe trauma, infection, allergy and other causes.
Treatment
Treatment guidelines
After clarifying the cause of the disease, actively carry out etiologic treatment, appropriately strengthen exercise and adjust the dietary structure.
Drug treatment
For disease-induced hypotension, the primary disease should be actively treated, and the drug treatment program should follow the guidance of specialists.
Drug-induced hypotension should be discontinued or the dosage adjusted under the guidance of the doctor.
Radiotherapy
For disease-induced hypotension, the radiotherapy program should follow the instruction of the specialist.
Surgery
For disease-induced hypotension, the surgical treatment plan should follow the guidance of the specialist.
Other treatments
For hypotension caused by physical weakness, nutrition should be strengthened.
For hypotension caused by change in body position, care should be taken not to overdo it when standing up from a lying position, and handholds should be used to prevent falls.
Prognosis
The prognosis of hypotension is related to the cause of the disease, the primary disease, and the manifestation of symptoms. If the cause of hypotension, the primary disease is easy to cure and the symptoms are mild, the patient’s prognosis is good; if the cause of hypotension, the primary disease is more difficult to cure or the treatment period is long, and the symptoms are severe, the patient’s prognosis is unsatisfactory.
Nursing care
Daily care
1. Changing position in daily life should be done slowly, not too violently, and should be supported by hand to prevent falling.
2. Life should be regular, pay attention to rest, and prevent excessive fatigue.
3. Choose suitable exercise programs to improve physical fitness as long as your body can tolerate them.
Diet regulation
1. Enhance nutrition, eat more food rich in high quality protein and dietary fiber, drink more warm boiled water, avoid spicy, stimulating, greasy food, avoid smoking and alcohol.
2. You should not eat too much at each meal to avoid returning relatively less blood to the heart.