Pregnancy and Arterial Hypotension

It is generally accepted to speak about arterial hypotension in case of decrease of arterial blood pressure down to 100/60 mmHg. Arterial hypotension can be the basic manifestation of illness or one of the signs of other disease. Therefore primary and symptomatic hypotension is distinguished.

Primary arterial hypotension is a vascular neurosis, neurocirculatory dystonia of a hypotonic type.

Compensated and subcompensated stages of primary arterial hypotension are distinguished.

Compensated arterial hypotension includes cases manifested only by decrease of blood pressure.

To subcompensated stage the cases refer, manifested by various subjective and objective symptoms, apart from decrease of blood pressure. Patients with decompensated arterial hypotension complain of headache, dizziness, general asthenia, weak heartbeats, sweating, sleep disturbance, decrease of working capacity, memory impairment. Chill of hands and feet is marked. Hypotonic crises, syncopes are frequent. A characteristic objective sign is acrocyanosis. In connection with a bad general state of health, irritability, emotional lability, apathy, depressions often develop.

Hypotensive crises proceed as collaptoid states, the arterial blood pressure decreases up to 80/50 mmHg. Bad headaches, nausea, vomiting, sharp weakness are possible. The asthenic body-build is characteristic of women with arterial hypotension. Anemia, varicosity are often concomitant diseases in such cases.

Effect of Arterial Hypotension on Course of Pregnancy. EPH-gestosis is one of the most often complications of pregnancy in patients with arterial hypotension. The incidence of gestosis in pregnant with hypotension is about 25%. The diagnostics is very difficult, because on a background of hypotension the absolute level of blood pressure in cases with preeclampsia is not so significant — 130/90 mm Hg, but it is accompanied with a typical symptomatology. Besides it exceeds the initial level of arterial pressure by 30 mm and over, and is considered to be a manifestation of preeclampsia.

More often than in healthy pregnants, early forms of gestoses are observed proceeding severely particularly in patients with vegetoasthenic syndrome. Miscarriages and premature labor are observed in patients with arterial hypotension by 3-5 times more often than in group of healthy women. The disturbances of blood circulation in the uteroplacental system connected with hypotension, pathology of veins are accompanied by development of intrauterine fetal hypoxia and hypotrophy, development of syndrome of arrested development of fetus. The rate of perinatal mortality and birth of children with hypotrophy in such patients is 2 times higher than in those with a normal blood pressure.

Labor in pregnant women with arterial hypotension is complicated by anomalies of labor pains, premature rupture of amniotic membranes, asphyxia and hypoxia of the fetus, disturbances of contractile activity of uterus in the 3^rd stage of labor and in early puerperal period. Hypotonic bleedings, as well as bleedings connected with decrease of blood coagulation, are of particular danger in such cases. In puerpera with arterial hypotension the signs of shock develop faster; decompensation occurs more often and quicker, and yields to treatment with difficultly.

Effect of Pregnancy on Course of Arterial Hypotension. The effect of pregnancy on course of arterial hypotension is more often marked by decrease of systolic and diastolic pressure. In the majority of patients the worsening of the course of arterial hypotension is observed from the first trimester of pregnancy, the frequency of vegetovascular disturbances being increased in the late terms of gestation.

Management of Pregnancy and Labor at Arterial Hypotension. The arterial hypotension, even decompensated, is not a contraindication for carrying of a pregnancy and labor. All women with arterial hypotension should be regularly checked up in maternity welfare clinic. Three preventive hospitalizations (at non-complicated course of pregnancy and arterial hypotension) are recommended: in term before 12 weeks, at 22-26 weeks of pregnancy and 37-38 weeks, i.e. two weeks prior to labor.

At preventive hospitalization a restorative, sedative, metabolic therapy, as well as treatment aimed at improvement of uteroplacental circulation and prophylaxis of intrauterine growth retardation, hypoxia and asphyxia of the fetus and newborn are administered. Ultrasound examination of pregnant is made in term of 9-11, 16-21 and 32-36 weeks of pregnancy. In term of 32-34 wk cardiotocography of the fetus, radio-Doppler examination by indication are made.

At compensated hypotension any special treatment is usually not required. At subcompensated stage of primary arterial hypotension out-patient treatment is indicated and in the absence of effect — treatment at the in-patient department. Non-drug treatment, i.e. curative gymnastics, hydrotherapeutic procedures, massage is effective. Normalization of sleep with the help of sedative preparations, antihistamine drugs is necessary. The diet rich in vitamins, microelements is administered.

With the purpose of increase of vascular wall tone, β-adrenoceptor agonist fetanol (0.005 g 2-3 times a day for 2 weeks) should be administered. Its efficiency is based on expulsion of blood deposited in the liver into the bloodstream. On decrease of arterial pressure and reduction of cardiac output izadrin is usually administered in a dose of 0.005 g under the tongue 3 times a day during 10-14 days.

At hypotonic crises 0.5 ml of 5 % ephedrin solution subcutaneously, and then 1 ml of 10 % solution of caffeine or 1-2 ml of cordiamin should be administered. At collapse some pregnant may be administered prednisolone (30 ml intramuscularly or intravenously).

Labor in patients with arterial hypotension is conducted through maternal passages in the presence of neonatologist in accordance with a developing obstetrical situation. Prophylaxis of anomaly of labor pains, intrauterine hypoxia of the fetus, hypo- and atonic hemorrhage should be carried out. The third stage of labor should be conducted with a needle in the vein and obstetrical hands ready to enter the uterine cavity.