Hypertension, connected with pregnancy. Treatment, labor

methods. Rendering urgent help.

Ziyashva G.I.

Department of obstetrics and gynecology

Prophylaxis

• Is ungrounded:• the restriction of the feeding the women for reduction of

the strong increase of the weight of the body.• statement that consumption of the full-fledged food in

sufficient amount will safely protect from preeclampsia recommendation about consumption of the food additives with microelements or restriction of the consumption to salts and liquids

Weak or moderate hypertension at period of pregnancy

• Hypotension facility reduce risk of the development serious hypertension in 2 times

HOWEVER

• Do Not change risk of the development preeclampsia [OR 0,99 (from 0,84 before 1,18)]

• Do Not render well-marked influence upon perinatal death-rate, premature birth or on children with low weight for given gestation age

Cochrane Review (2001)

Hypotension treatment• Does Not prevent progressive disease before

heavy complications• Does Not perfect upshots to pregnancy• It Is Considered that treatment follows to

conduct at level of the arterial pressure 160-170/110 mm. and above, basically, for the reason preventions intrauterine hemorrhages

• Strong reduction of the arterial pressure can bring about breach uterine-placental perfusion and cause disstress of fetus

Treatment of preeclampsia• Increase the volume shelters there is it is not

enough proof to efficiency risk developments of the edema light and cerebrum

• Diuretics• Aggravate hypovolemia can cause dangerous side

effects

• Anticoagulants and antitrombocyts facility any other treatment are absent proof to efficiency

Using facilities on preeclampsia

• Preparations for symptomatic treatment:• do not influence upon progressive disease and

only to some degree prevent dangerous for life of the complication beside women can mask threatening symptoms

• Single efficient way of the treatment is an interruption to pregnancy immediately at appearance of the threat to life's full-grown and/or child

When can café pregnancy?

• Extension to pregnancy for increasing of probability of the survival of the fetus only

• Wait-and-see tactics can be motivated at period of pregnancy less 34-36 weeks

Obligatory is careful controlled conditions full-grown and fetus

Indication to the labor on preeclampsia

• In term pregnancy

• Breaches of the able fetus

• Development serious preeclampsia

Serious preeclampsia• Heavy hypertension plus proteinuria OR

• Gipertenziya any degree plus proteinuria plus one of aggravating симптомов:

- hyperreflexes, headache, oligouria

- pain in higher part of the abdomen, retching edema light

- trombocytipenia, microangiopatic anemia breach to functions liver breach to functions bud delay of the growing of the fetus

Treatment of serious preeclampsia (1)

• Checking the arterial pressure

• Preventive maintenance of the cricks

• Usually recommended to serious hypertension plus proteinuria OR

• Hypertension any degree plus proteinuria plus one of aggravating symptoms

Treatment of serious preeclampsia (2)

• Prolonged pregnancy (if required) for -entering corticosteroids

-translation in medical higher-level institution

Prophylaxis of convulsions(1) Eclampsia

• Sulphate magnesium is a preparation of the choice at treatment eclampsia (for prevention of the repeated cricks).

• He is an effective diasepam on 50 % in respect of reductions of maternal death-rate (3,8% and 6,4%, accordingly) and frequencies repeated fit cricks (10% and 23%).

• Vastly below neonatal complication

Prophylaxis of convulsions(2) MAGPI

• Risk of the development eclampsia beside patient with heavy preeclampsia formed 0,8 % when use the sulfate magnesium and 1,9% in checking group (placebo)

- 11 prevented events of the development eclampsia on 1000 patients

- trend to reduction of maternal death-rate reduction

- frequencies separation placentas (OR = 0,67; 99% DI 0,45-0,89).

Lancet (2002)

Average arterial pressure (GARDEN) and pressure in pulmonary artery during intubation / extubation

САД

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Аспирация и экстубация

Время (минуты)

ДЛА

ДЗЛ

Average arterial pressure (AAP) and pressure in pulmonary artery at epidural anaesthesias

САД

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ДЛАДЗЛ

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перерыв

Emergency Caesarean section

• For patients with expressed preeclampsia immediate birth by way of the caesarean section have no advantage under caesarean section more often develop pulmonary complications both beside full-grown, and beside newborn labor reduction of the frequency of some complications does not be accompanied by means of caesarean section

Postoperation complications

• Eclampsia (44 % from all events)

• Coagulo breaches, bleedings

• Edema light (70-80% - after labor), caused mobilization intersticial liquids increasing of the pressure of the filling in heart raised by permeability pulmonary capillary by reduction colloidal osmotic pressures

• (44 % cases)