- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
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Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Hypertension is defined as systolic blood pressure (SBP) above 140 mmHg or diastolic blood pressure (DBP) above 90 mmHg. In order to accurately diagnose arterial hypertension (AH), blood pressure (BP) must be elevated in at least two measurements taken at least 6 hours apart.
Pre-eclampsia is defined as the combination of hypertension during pregnancy and proteinuria (more than 300 mg of protein in a 24-hour urine sample).
Preeclampsia can present in a mild or severe form.
Sometimes, high blood pressure is present before pregnancy. In other cases, high blood pressure develops during pregnancy.
Gestational hypertension: Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. There is no excess protein in the urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia.
Chronic hypertension: Chronic hypertension is high blood pressure that existed before pregnancy, or that appears before 20 weeks of pregnancy. But because high blood pressure usually has no symptoms, it can be difficult to determine when it started.
Chronic hypertension with superimposed preeclampsia: This condition occurs in women who had chronic hypertension before pregnancy and then develop worsening high blood pressure and protein in the urine, or other complications related to blood pressure, during pregnancy.
Pre-eclampsia: Preeclampsia occurs when high blood pressure develops after 20 weeks of pregnancy and is accompanied by signs of damage to various organs, including the kidneys, liver, blood, or brain. Without treatment, preeclampsia can lead to serious — even life-threatening — complications for both the mother and the baby, such as the development of seizures (eclampsia).
Reduced blood flow to the placenta. If the placenta does not receive enough blood, your baby may get less oxygen and fewer nutrients. This can lead to slow growth (intrauterine growth restriction), low birth weight, or premature birth. Premature delivery may result in breathing problems, an increased risk of infection, and other complications for the baby.
Placental abruption. Preeclampsia increases the risk of this condition, in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding and may be life-threatening for both you and your baby.
Limitation of intrauterine growth. Hypertension can lead to slowed or reduced growth of your baby.
Changes in your other organs. Poorly controlled hypertension can lead to lesions of the brain, heart, lungs, kidneys, liver and other major organs. In severe cases it can be life-threatening and then premature delivery is necessary.
Future cardiovascular disease. Pre-eclampsia can increase the risk of future heart and blood vessel disease (cardiovascular). Your risk of future cardiovascular disease is higher if you have had preeclampsia more than once or had a premature delivery due to high blood pressure during pregnancy.
The goal of treatment is to maintain blood pressure at very good levels throughout the pregnancy, combined with continuous and thorough laboratory monitoring.
To manage high blood pressure in general, outside of pregnancy, antihypertensive medications are prescribed. Antihypertensive therapy is necessary in cases of severe hypertension, mainly to prevent cerebrovascular events.
Treating preeclampsia requires special caution, since aggressive management during pregnancy (e.g., sudden and uncontrolled decrease in blood pressure, early use of medication) may lead to maternal or fetal complications (e.g., stroke, myocardial ischemia, sudden intrauterine fetal death).
Pregnant women must be informed promptly by their obstetrician about the signs and symptoms of preeclampsia and report them immediately if they appear. They should also contact their doctor right away in cases of vaginal bleeding, severe abdominal pain, reduced fetal movements, or symptoms of threatened preterm labor.
Limiting physical activity may help, to some extent, prevent the worsening of high blood pressure.
The preventive administration of acetylsalicylic acid (160 mg of aspirin or salospir) from the early stages of pregnancy in women at moderate or high risk for preeclampsia always has a protective effect.
Systematic monitoring of the pregnant woman with hypertensive disease is essential and should take place at intervals of approximately every 2 weeks, and in some cases every week.
At each visit, Blood Pressure must be measured, fetal growth must be assessed via ultrasound, and a urine dipstick test performed.
Laboratory testing in hypertensive disease during pregnancy must be performed very regularly and includes:
In hypertensive disorders of pregnancy, daily monitoring of fetal movements is recommended. Ultrasound assessment of fetal growth is performed every 1–2 weeks.
Fetal development is monitored using a biophysical profile Doppler evaluation of uterine artery blood flow, ultrasound assessment of amniotic fluid volume, and cardiotocography. Fetal surveillance tests are repeated at least weekly, or much more frequently if indicated. Doppler evaluation is essential for assessing fetuses with intrauterine growth restriction.
Η administration of corticosteroids (betamethasone -CELESTONE CHRONODOSE) for enhancing fetal lung maturity before 34 weeks of gestation is mandatory in cases of mild or severe preeclampsia, as well as in cases of severe hypertension.
The definitive treatment for preeclampsia is the completion — termination — of the pregnancy.
When determining the timing of delivery, the risks to the mother and fetus, the gestational age, and the severity of the hypertensive disease are taken into consideration.
In cases of mild hypertension or preeclampsia without additional complications, delivery may be planned at a gestational age beyond 37 weeks.
In any case, delivery should not be delayed beyond 40 weeks. For severe hypertension or preeclampsia, delivery may be planned at 34 weeks of gestation, or earlier if clinically indicated.
Hypertensive disease in pregnancy — especially when the cervix is favorable — is not a contraindication to vaginal delivery, as long as the condition of the mother and fetus allows it and there are no other obstetric indications for cesarean section.
Prolonged labour should be avoided, especially in severe hypertension or preeclampsia.
In women with hypertensive disorders of pregnancy undergoing labor, we monitor at least every hour: vital signs, urine output/proteinuria, and any signs or symptoms of severe preeclampsia.
Routine laboratory tests are repeated at least every 6 hours.
Η Epidural and spinal anesthesia appear to be advantageous, provided there is no thrombocytopenia.
