High blood pressure during pregnancy is one of the biggest red flags that preeclampsia may be developing. And even if it's not a symptom of preeclampsia, it can still be a sign of a problem. During pregnancy, a rise in the lower number diastolic of 15 degrees or more, or a rise in the upper number systolic of 30 degrees or more can also be a cause for concern. Know your blood pressure prior to pregnancy, especially if it's normally considered low. Ask, "What is my blood pressure?
Keep a log of your blood pressure, taken at the same time each day and in the same position. Share your log with your healthcare provider at each visit and notify her immediately if you find any significant rise between visits.
You can buy your own blood pressure monitor at most pharmacies, and some of these stores have a monitor available for your use, though they aren't always reliable.
For accuracy, blood pressure readings should be taken in the sitting position, with the cuff positioned on the left arm at the level of the heart. Please note that home monitors are not always as accurate as those used in clinics or hospitals.
Home readings should never replace prenatal visits, nor should a "normal" reading mean you can ignore other symptoms of preeclampsia.
Some healthcare providers will recommend bed rest for you, even though evidence has not shown it to make a difference in outcomes. Some believe this helps limit potential stressors that could contribute to elevated blood pressures. During late pregnancy, you may be advised to lie on your left side to prevent restriction on certain veins which could also contribute to elevated blood pressure.
Healthcare providers do not always agree on the benefits of lying on your side, but there is no evidence of harm. You may consider seeing or consulting with a specialist in high risk pregnancies.
This Physician Locator may help. Proteinuria, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into your urine. A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria, though other methods may be used in clinics and medical offices such as a Protein:Creatinine Ratio PCR or a timed urine collection.
During each prenatal visit, ask your health care provider for the results of your urine test. A nurse will have dipped a reagent strip into a sample of your urine. A reading of trace protein is relatively common and is usually not a cause for concern. If you are concerned, or have had preeclampsia before, you can buy reagent strips at some pharmacies or online. Sometimes healthcare providers will have you collect your urine for 12 or 24 hours to determine the exact quantity of protein in the urine.
In the case of a protein-creatinine ratio another way to measure proteinuria , 0. A certain amount of swelling is normal during pregnancy. Unless you're one of a lucky few, you may notice a little extra puffiness in your feet good luck fitting into your pre-pregnancy shoes!
Edema, on the other hand, is the accumulation of excess fluid, and can be a concern when it occurs in your face, around your eyes, or in your hands. If you think your face is getting excessively puffy, find a picture of yourself from just before pregnancy to share with your healthcare provider.
This decreases pressure on several major blood vessels and increases the desire to urinate. Regular urination improves the quality of the circulating blood. It is recommended to drink plenty of liquids.
Salt intake should not be reduced — while this is a good idea for chronic high blood pressure, salt is needed during pregnancy. Medications normally used to control high blood pressure are not used to treat preeclampsia.
Instead, magnesium sulphate is injected. This reduces hyperreflexia and reduces the chance of seizures. It also lowers blood pressure at the same time.
The same medication is given for full-blown eclampsia. Magnesium sulphate helps to control the symptoms and reduces the risk of fatal complications, but the only thing that will pull mother and baby out of the danger zone is to deliver as quickly as possible. Even if the baby is premature, its chances are better "on the outside.
If the baby is big enough, and the mother's condition has been stabilized with magnesium sulphate, the doctor will usually give medications to stimulate labour. If for any reason a normal birth poses problems, a caesarean section will be recommended. This operation is very common in Canada. The mother should be re-evaluated within one week after she has delivered the baby and been discharged from the hospital.
Pre-eclampsia part 2: prediction, prevention and management. Nat Rev Nephrol ;10 9 In addition to the immediate risks and complications for both mother and fetus, gestations that include fetal exposure to preeclampsia appear to elevate the risk of cerebrovascular and neuroanatomical changes during development.
Such changes during fetal life may explain the postnatal findings of elevated risks for stroke and specific deviations of cognitive functioning, including visual spatial processing and memory, as shown in an initial pilot study by a group of researchers at Queen's University, published in this issue.
Impacts of Preeclampsia on the Brain of the Offspring. Rev Bras Ginecol Obstet Although we have presented a review of the epidemiology, physiopathology, clinical features, diagnosis and treatment of hypertensive disease of pregnancy, we believe that the main goal should be to identify patients without a previous history of preeclampsia but with potential risk factors. In this situation, we should apply predictive tests to these patients in order to determine the risk and to administer low doses of calcium and aspirin if necessary.
Obstet Gynecol ; 5 43 However, the available predictive tests are useless. Furthermore, many biomarkers have been suggested, 50 Early prediction of preeclampsia. Obstet Gynecol Int ; but none has been demonstrated to be sufficiently predictive. The combination of three interventions, that is, risk factors questionnaire, uterine artery flowmetry and some biomarkers, such as serum pregnancy-associated plasma protein-Av PAPP-A , sFlt-1 and PlGF, 50 Obstet Gynecol Int ; performed during the first or second trimester may allow us to predict the possibility of the disease and to reduce the risk preeclampsia complications.
Obstet Gynecol ; 5 7 7. Mol Aspects Med ;28 2 : 51 Papageorghiou AT, Campbell S. First trimester screening for preeclampsia. Curr Opin Obstet Gynecol ;18 6 52 Competing risks model in screening for preeclampsia by maternal factors and biomarkers at weeks gestation.
Am J Obstet Gynecol ; 1 Calcium administered at a daily dose of 1. Am J Obstet Gynecol ; 1 :S1-S22 or with risk factors or positive predictive tests for the disease.
At these doses, calcium reduces the release of the parathyroid hormone, thus reducing cytosolic calcium and vascular hyperresponsiveness. Lancet ; Low aspirin doses of 80 to mg have produced a modest drop of the disease in patients with risk factors.
Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol ;29 7 54 Early administration of lowdose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther ;31 3 The mechanism of the drug is mediated by the irreversible blocking of platelet cyclooxygenase 1 and 2, inhibiting the aggregation and the release of thromboxane.
Lancet ; Other drugs, such as low molecular weight heparins added to aspirin, have been suggested, but their efficacy still needs to be demonstrated.
Prevention of pre-eclampsia by low-molecular-weight heparin in addition to aspirin: a meta-analysis. Ultrasound Obstet Gynecol ;47 5 In view of the aforementioned considerations, we can see that progress is being made in the understanding of the pathophysiology of preeclampsia that allows us to explore new fields of scientific research, seeking therapeutic interventions to achieve success in the management of the disease.
Rev Bras Ginecol Obstet Additionally, the advance of knowledge about the disease prediction should substantially contribute to the better understanding of the prevention of preeclampsia and consequently the reduction of maternal and perinatal morbidity and mortality. Abrir menu Brasil. Abrir menu. Lancet ; Preeclampsia is a multifactorial disease caused by environmental factors that act over a genetic base, permitting the occurrence of this disorder.
Arch Latinoam Nutr ;58 1 The interaction of risk factors and multiple polymorphic genes induces the synthesis of several proteins with effects differing from their original function, leading to the impairment of placental perfusion and the consequent production of mediators that damage the endothelium. J Perinat Med ;36 1 Group I — vasoactive and vascular remodeling proteins: nitric oxide synthase; renin; type I and II angiotensin receptors; angiotensin converting enzyme; polycarboxypeptidase; endothelin-1; alpha and beta estrogen receptors; endoglin; tyrosine-kinase fms-like receptor-1; placental growth factor; and vascular endothelial growth factor.
J Perinat Med ;36 1 Group III — oxidative stress, lipid metabolism, endothelial injury: epoxide hydrolase; glutathione transferase; superoxide dismutase; cytochrome P 1A1; lipoprotein lipase; apolipoprotein E; and long-chain 3-hydroxyacyl-CoA dehydrogenase.
J Perinat Med ;36 1 Group IV — immunogenetic: human leukocyte antigen; interleukins 1 and 10; and tumor necrosis factor. J Perinat Med ;36 1 Physiologically, in order to promote vascular remodeling, the changes of the decidua also occur in the inner area of the myometrium. Placenta ;28 Suppl A :SS56 The intervillous blood flow seems to begin by the 7th to 8th week of pregnancy, by connections between spiral arteries and lakes formed in the wall of the implanted blastocyst.
Ultrasound Obstet Gynecol ;30 5 Superoxide ion, hydroxyls and hydrogen peroxide damage the lipid bilayer through peroxidation, destroying endothelial cells and exposing the subendothelium 28 Ultrasound Obstet Gynecol ;30 5 Placental hypoxia generates the production of soluble fms-like tyrosine kinase receptor-1 sFlt-1 , which binds to the vascular endothelial growth factor VEGF and placental growth factor PlGF that are responsible for the maintenance of endothelial integrity.
Hypertension ;61 6 The pathophysiology of other signs and symptoms, such as headache, tinnitus, scotoma, vomiting, nausea, epigastric and right upper quadrant pain, oliguria, hyperreflexia, and convulsions 31 Acta Obstet Gynecol Scand ;86 6 It is important to note that in the brain there is a significant increase in the production of excitatory amino acids such as glutamate, which binds to the N-methyl D-aspartate NMDA receptor, allowing the opening of calcium channels in the cell membrane, with calcium entry into hypoxic cells triggering the typical tonic-clonic convulsions of eclampsia.
Lancet ; The classification of hypertensive diseases has been changing, currently comprising preeclampsia-eclampsia, gestational hypertension, chronic hypertension and chronic hypertension plus superimposed preeclampsia, as well as the complication represented by the HELLP H: hemolysis, EL: elevated liver enzymes, LP: low platelet count syndrome.
Am J Obstet Gynecol ; 1 :S1-S22 Once the diagnosis is made and based on the proposed vascular pathophysiological mechanisms, the therapeutic approach can be focused on four objectives: to prevent and treat seizures; 35 CMAJ ; 9 The determination of the gestational age at which to end pregnancy depends on the presence of complications such as HELLP syndrome, eclampsia and uncontrolled arterial pressure.
Lancet ; An important factor to consider in the management of preeclampsia is fluid therapy. Cochrane Database Syst Rev ;4 2 :CD Finally, in order to fulfill the objective of diagnosing maternal and fetal complications, we should determine perinatal comorbidities such as oligohydramnios, intrauterine growth restriction and abruption.
Amsterdam:Academic Press, Elsevier; Checking fetal movements daily, using a non-stressful test twice a week, determining fluid volume weekly and fetal growth every two weeks are helpful for the assessment of fetal wellbeing. Rev Bras Ginecol Obstet Although we have presented a review of the epidemiology, physiopathology, clinical features, diagnosis and treatment of hypertensive disease of pregnancy, we believe that the main goal should be to identify patients without a previous history of preeclampsia but with potential risk factors.
Lancet ; However, the available predictive tests are useless. Ultrasound Obstet Gynecol ;47 5 In view of the aforementioned considerations, we can see that progress is being made in the understanding of the pathophysiology of preeclampsia that allows us to explore new fields of scientific research, seeking therapeutic interventions to achieve success in the management of the disease.
References 1 Duley L. Semin Perinatol ;33 3 Obstet Gynecol ; 5 Complications of preeclampsia. In: Critical Care Obstetrics. Malden, Mass. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Drugs for treatment of very high blood pressure during pregnancy.
Churchill D, Duley L. Interventionist versus expectant care for severe preeclampsia before term. Aggressive or expectant management for patients with severe preeclampsia between 28—34 weeks' gestation: a randomized controlled trial. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Magee L, Sadeghi S. Prevention and treatment of postpartum hypertension. Mattar F, Sibai BM. Risk factors for maternal morbidity.
Late postpartum eclampsia: a preventable disease? Eclampsia: morbidity, mortality, and management. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial [published correction appears in Lancet. Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Magnesium sulphate versus diazepam for eclampsia. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions.
Read the Issue. Sign Up Now. Next: Pruritic Acral Rash in a Child. Jul 1, Issue. Hypertensive Disorders of Pregnancy. B 27 For women with mild preeclampsia, delivery is generally not indicated until 37 to 38 weeks of gestation and should occur by 40 weeks. A 42 Intravenous labetalol or hydralazine may be used to treat severe hypertension in pregnancy because neither agent has demonstrated superior effectiveness.
Table 1 Preeclampsia: Etiology and Risk Factors Theories of pathogenesis Abnormal placental implantation defects in trophoblasts and spiral arterioles 13 , 14 Angiogenic factors increased sFlt-1, decreased placental growth factor levels 15 , 16 Cardiovascular maladaptation and vasoconstriction Genetic predisposition maternal, paternal, thrombophilias 17 — 20 Immunologic intolerance between fetoplacental and maternal tissue 7 Platelet activation Vascular endothelial damage or dysfunction 7 Risk factors 7 , 12 Antiphospholipid antibody syndrome Chronic hypertension Chronic renal disease Elevated body mass index Maternal age older than 40 years Multiple gestation Nulliparity Preeclampsia in a previous pregnancy particularly if severe or before 32 weeks of gestation Pregestational diabetes mellitus note : Previously, young maternal age was considered a risk factor, but this was not supported by a systematic review.
Recommended management of mild gestational hypertension or preeclampsia. Recommended management of severe preeclampsia. Management of Severe Preeclampsia Figure 2. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue.
Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Theories of pathogenesis. Cardiovascular maladaptation and vasoconstriction. Antiphospholipid antibody syndrome. Chronic renal disease. Elevated body mass index. Maternal age older than 40 years.
Pregestational diabetes mellitus. Any of the following associated signs and symptoms:. Elevated liver enzymes. Maternal monitoring. Measure blood pressure twice weekly. Fetal monitoring.
0コメント