Various physiological changes will occur in the kidneys, blood pressure and related aspects during pregnancy, such as enlarged kidneys and dilated urinary tract, increased glomerular filtration rate, decreased blood creatinine and urea-uric acid levels, decreased blood pressure, sodium and water retention, and swelling of the lower extremities, mainly to accommodate the growth and development of the fetus and to ensure maternal health. However, pregnant women can also develop diseases that are unique to them, such as pre-eclampsia. Pregnant women are also prone to urinary tract infections and acute renal failure, both of which are treated in the relevant chapters, and the choice of antimicrobial agents is mentioned in this chapter on self-care. This chapter focuses on preeclampsia, which is the most common comorbidity in pregnant women and is characterized by renal damage with proteinuria and edema in addition to hypertension, hence the previous name of nephropathy of pregnancy.
I. Disease profile.
1, the incidence of pre-eclampsia in pregnant women is 3% – 4%, often occurring in primigravida and older multiparous women.
2. Pre-eclampsia symptoms are most typical in the eighth and ninth trimester and develop further until delivery. In some patients, however, these symptoms begin in the fifth or sixth month of pregnancy, while in other women they do not start until the time of delivery or after delivery.
3. During the onset of pre-eclampsia, renal pathology suggests significant glomerular changes, and these characteristic pathological changes rapidly subside and return to normal 2-4 weeks after delivery.
4, Some underlying diseases such as: primary hypertension, diabetes mellitus or renal disease can increase the risk of pre-eclampsia occurrence.
5. The long-term prognosis of pre-eclampsia is related to the severity of the acute phase.
Pre-eclampsia in primigravida is usually self-limiting, with blood pressure returning to normal soon afterwards, and the incidence of hypertension and renal disease is essentially the same as in the general population.
7. Patients with severe preeclampsia in primigravida, especially in the fourth to sixth months of pregnancy, have a poor prognosis, a high rate of disease recurrence in subsequent pregnancies, and are prone to late onset hypertension.
II. Symptomatology.
1. The clinical onset of pre-eclampsia is usually insidious and is not accompanied by obvious symptoms.
2. Headache, blurred vision, abdominal pain, and apprehension may occur.
3. Rapid weight gain, facial and extremity edema.
4.High blood pressure: The diastolic blood pressure is most obviously elevated, while the systolic blood pressure is usually below 160 mmHg.
5.Proteinuria: It rarely appears before hypertension. The amount of urinary protein can range from a small amount (500mg/24h) to nephrotic syndrome levels (>3.5g/24h). It usually does not cause hematuria.
6. pulmonary edema: a common complication of pre-eclampsia, usually caused by left heart failure.
7. Renal hypofunction: see (renal failure).
8, Other systemic lesions.
(1) Platelets may be significantly reduced.
(2) Anemia with hemolysis: severe jaundice may occur with hemolysis.
(3) Acute pancreatitis: there is abdominal pain and increased serum amylase level.
(4) Acute fatty liver: manifested by weakness, discomfort, nausea or vomiting, etc.; abdominal pain is usually severe, and laboratory tests may reveal signs of liver failure.
Third, how to treat.
1. Pre-eclampsia can only be cured after delivery.
2. Severe persistent hypertension (diastolic blood pressure higher than 110 mmHg), headache, blurred vision, and decreased renal function indicate a serious condition, and the fetus must be delivered quickly.
3, If the blood pressure is mildly or moderately elevated, liver function is stable, and there are no coagulopathy or fetal distress symptoms, conservative treatment can be considered.
(1) Asymptomatic patients usually do not need to take antihypertensive drugs.
(2) Patients with diastolic blood pressure higher than 110 mmHg and at risk of cerebral hemorrhage should be treated with antihypertensive drugs, usually orally, or intravenously if necessary.
IV. Precautions.
1. Pre-eclampsia may also appear after delivery, i.e. hypertension and convulsions 24-48 hours after delivery.
2. Pregnant women with pre-eclampsia should preferably be hospitalized in order to monitor the fetus.
3. The primary problem in treating pre-eclampsia is to prevent its occurrence. Proper prenatal monitoring, avoiding sudden weight gain, and careful monitoring of blood pressure and proteinuria are beneficial in reducing the occurrence and severity of preeclampsia.
Another measure to prevent complications of hypertension in pregnancy is calcium supplementation.
5. Seek medical attention in the following cases:
(1) Headache, blurred vision, or even convulsions during pregnancy.
(2) Those who do not have hypertension but have increased blood pressure during pregnancy.
(3) No kidney disease, but swelling, foamy urine and proteinuria in urine examination during pregnancy.
(4) Those who develop jaundice in the course of pregnancy.
6. The selection of anti-infective drugs during pregnancy should take into account the safety of the mother and the effect on the fetus.
(1) Drugs that can be applied: penicillins and cephalosporins, erythromycin, lincomycin.
(2) drugs that are cautious or restricted: aminoglycosides such as gentamicin and dinka, ototoxic and nephrotoxic; quinolones such as haloperidol and ciprofloxacin, which can inhibit the growth of embryonic bone limb buds; furantin, taken near delivery can cause neonatal hemolysis; sulfonamides, which can cause postnatal hyperbilirubinemia in the fetus, and are avoided in late pregnancy.
(3) Drugs that should be prohibited: tetracyclines and chloramphenicol.
Tips
1, not all antihypertensive drugs can treat hypertension in pregnancy, some antihypertensive drugs can cause serious adverse reactions, so they should be used under the guidance of a doctor.
2, whether to continue the pregnancy depends on the changes in the condition of the pregnant woman, a strong conservative treatment can lead to serious complications for the mother.