Diagnosis
Indications of pregnancy hypertension can be given by measuring the blood pressure in the doctor’s office during examinations as part of prenatal care. The blood pressure values are entered in the maternity record, so that a comparison with values determined during pregnancy is possible. However, since 20% of pregnant women tend to have higher blood pressure values in the doctor’s office than at home in their familiar surroundings, a 24-hour blood pressure measurement can be carried out during the doctor’s visit if the blood pressure values are high, which shows the course of the blood pressure values in the everyday life of the pregnant woman.
Another way of making a diagnosis is for the pregnant woman to measure her blood pressure herself: With the help of an electronic blood pressure monitor, the patient determines her blood pressure values daily and records them. If the values are also elevated during these measurements, the suspicion of pregnancy hypertension is confirmed and appropriate therapy is started. With the help of urine test strips, the urine of pregnant women is also examined for proteins as part of the preventive medical checkups. If there is a suspicion of pre-eclampsia, a blood test is usually performed to check the function of the organ systems.
Therapy
Long-term treatment of hypertension in pregnancy should only be given if repeated high blood pressure values of more than 160-170/100 mmHg occur. These drugs include alpha-methyldopa (e.g. Presinol®), certain beta-blockers such as atenolol (e.g.
Atebeta ®) and the calcium antagonist nifedipine (e.g. Adalat®). Alpha-methyldopa is the drug of choice for the treatment of gestational hypertension because it is very effective, has few side effects and is therefore well tolerated. For patients suffering from gestational hypertension, the treatment of choice is drug therapy with antihypertensives.
If pre-eclampsia is present, the therapy is extended: In addition to the antihypertensive treatment with the appropriate medication, a muscle-relaxing therapy with magnesium sulfate is performed to prevent seizures. Frequently, additional infusions must be administered to keep the patient’s fluid balance stable and thus ensure good care for the child. The benefit of a prophylactic administration of vitamin C and E has been proven in recent studies: Taking vitamin C and E during pregnancy can reduce the risk of pre-eclampsia.
For HELLP syndrome, the following basic therapy procedure applies: First of all, consistent treatment with medication to lower blood pressure and relax the muscles is necessary. However, the only causal therapy for HELLP syndrome is the delivery of the child in order not to endanger the lives of mother and child and to protect both from consequential damage. The delivery of the child can be delayed under the following conditions: If the mother is still in the course of pregnancy before the 34th week of pregnancy and both mother and child are in a stable situation, it is possible to delay delivery.
The child’s lung maturation can be promoted by the administration of the drug dexamethasone, so that the child is prepared for delivery in the best possible way. However, if the HELLP syndrome continues to progress or and leads to an unstable condition in the mother or child, immediate delivery, usually by caesarean section, is recommended. After the 34th week of pregnancy, a delivery should always be attempted if HELLP syndrome is detected.
