ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Hypertension In Pregnancy
Dr. Gültaç ÖZBAYa
aKardiyoloji AD, Trakya Üniversitesi Tıp Fakültesi, Emekli, EDİRNE
The incidence of hypertension (HT) in pregnancy was reported as 8%-15% in all gestations in developed countries. HT during pregnancy is categorized as Preeclampsia (PE)/Eclampsia, Gestatational HT, Chronic HT and Superimposition of PE on Chronic HT according to NHBEP Working Group on High Blood Pressure in Pregnancy. PE that occurs after 20 th week of gestation is defined by the de novo apperance of HT (systolic blood pressure >140 or diastolic blood pressure >90 mmHg) accompanied to new onset proteinuria (>300 mg per 24 hours). It is a multysistem disorder and a maternal-paternal maladaptation syndrom. PE is a major cause of maternal mortality (15-20% in developed countries) and morbidities (perinatal deaths, preterm birth and intrauterine growth restriction). Eclampsia occurs when PE progress to a life threatening convulsions.The diagnostic criteria of it remain unclair with no known biomarkers. Traetment is prenatal care, timely diagnosis, some antihypertensive drugs in severe cases, antioxydants, corticosteroids, treatment of its complications such as cardiac, renal and hepatic failure and timely delivery. There are similar findings in PE and atherosclerotic cardiovascular diseases. PE is charecterized by a dyslipidemia identical to that predisposing to cardiovascular diseases. İt is accepted today women who have had PE predispose to cardiovascular disease in later life.
Gestational HT is defined as de novo HT arising after mid-pregnancy and is distinguised from PE by the absence of proteinuria. Blood pressure normalızes in post partum period. İt is named transient HT if high blood pressure decreases to normal level after delivery.
Chronic HT refers to an elevated blood pressure in mother that predated the pregnancy, or HT diagnosed in early pregnancy than twenty week of gestation or persistence of high blood pressure levels at six weeks after delivery. Women with chronic HT are at risk of superimposed PE, preterm delivery, fetal growth restriction, still births, abruptio placenta and complications of HT such as heart or renal failure. The main objectives of treatment of HT in pregnant women are eliminating or lowering of maternal, fetal mortality and morbidity and prolongation of gestation in order to reach the fetal maturation. Therapeutic approaches are the termination of gestation depending on the severity and complications of HT, antihypertensive, anticonvulsive, antiaggregants and supplemental drugs. Angitensin converting enzym inhibitors and angitensine receptör blockers should not be given for hypertension in pregnancies because they cause to developmental abnormalities of urogenital system of fetus, also B blockers, especially atenolol cause to intrauterin growth restriction. Follow-up after delivery is of great importance.Keywords: Pregnancy, chronic HT, preeclampsia, eclampsia, gestastational HTTurkiye Klinikleri J Int Med Sci 2005, 1(50):45-53
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