Gestational hypertension is one of the common diseases in obstetrics and gynecology, and is the second leading cause of maternal death, with an incidence of 5%-10% in pregnant women, posing a serious threat to the health of mother and child, and should be given clinical attention.
I. Common causes
Gestational hypertension is a disease specific to pregnancy. There are many factors that cause gestational hypertension in patients, not only related to abnormal trophoblast invasion, excessive oxidative stress, endothelial cell activation and genetic factors, but also related to the physical quality, nutritional status and genetic factors of pregnant women.
II. Clinical manifestations
In mild cases, gestational hypertension may have no obvious symptoms or manifest as dizziness, mildly elevated blood pressure, accompanied by edema or mild proteinuria; in severe cases, it may manifest as headache, blurred vision, nausea, vomiting, persistent right upper abdominal pain, etc., as well as markedly elevated blood pressure, increased proteinuria, marked edema, and even coma and convulsions.
Auxiliary tests for gestational hypertension
1. Blood tests.
Measurement of hemoglobin, hematocrit, plasma viscosity ratio, whole blood viscosity ratio, etc., to understand whether the blood is concentrated.
2, liver and kidney function measurement.
Glutathione transaminase, blood urea nitrogen, blood creatinine and uric acid measurement, comprehensive judgment of liver and kidney function.
3.Measurement of blood electrolytes and CO2 binding capacity.
To understand the presence of electrolyte disorders and acidosis.
4.Eye fundus examination.
Can see retinal small artery spasm, arteriovenous diameter ratio from 2:3 to 1:2-1:4, in severe cases, retinal edema, retinal detachment, cotton wool exudate and hemorrhage, blurred vision or sudden blindness, most of which can be recovered after delivery.
5. Other examinations.
Including electrocardiogram, echocardiogram, placental function, fetal maturity check, etc., need to depend on the condition.
IV. Treatment
1.General treatment.
Rest, close monitoring of maternal and child status, intermittent oxygenation, diet including protein and calories supplementation, and appropriate salt restriction for patients with generalized edema.
2, antispasmodic treatment.
Magnesium sulfate is the drug of choice for the treatment of hyperemesis gravidarum combined with eclampsia or preeclampsia, and should be applied under the guidance of a physician.
3, antihypertensive treatment.
According to the condition of different antihypertensive drugs can be used, such as labetalol, methyldopa, nifedipine, etc.; and captopril, coxsartan and other drugs are contraindicated in pregnancy.
4.Sedation therapy.
For patients with tension, anxiety or poor sleep, appropriate amount of sedative can be given.
V. Prevention
The health care during pregnancy especially emphasizes the monitoring of blood pressure, and the blood pressure should be recorded at every maternity checkup. Pregnant women with symptoms of gestational hypertension should be systematically managed and have regular maternity checkups. In addition, the diet and rest of pregnant women should be ensured, and they should not be in a state of prolonged exertion, and they should eat fruits and vegetables in moderation during pregnancy to help prevent gestational hypertension.
References
[1] Duan T, Ying H. Early prevention of hypertensive disorders in pregnancy [J]. Chinese Journal of Practical Gynecology and Obstetrics,2004,20(10):584-586.