Hypertension during Pregnancy: Therapy

Hypertensive pregnancy disease requires presentation to the clinic under the following indications:

  • Hypertension High blood pressure; (≥ 160 mmHg systolic or ≥ 110 mmHg diastolic).
  • Proteinuria (increased excretion of protein in urine) and severe weight gain in the 3rd trimester (third trimester) ≥ 1 kg/week).
  • Clinical suspicion of HELLP syndrome (persistent upper abdominal pain).
  • Impending preeclampsia (e.g., severe headache or upper abdominal pain; neurologic and visual disturbances).
  • Manifest preeclampsia
  • Eclampsia
  • Hypertension or proteinuria and other risk factors such as:
    • Pre-existing maternal conditions such as diabetes mellitus.
    • Multiple pregnancy (multiple pregnancy).
    • Early gestational age (< 34th SSW/week of pregnancy).
  • Indication of fetal (child) threat:
    • Suspicious/pathological CTG (cardiotocography) – a procedure for simultaneous (simultaneous) registration and recording of the heart rate of the unborn child and labor activity (Greek tokos) in the expectant mother.
    • Suspicious pathological Doppler sonogram (e.g., zero flow/reverse flow in the umbilical arteries).
    • Intrauterine growth retardation (< 10th percentile) [fetal growth restriction].

Indications for termination of pregnancy

In preeclampsia and eclampsia, delivery is the only causal therapy.It should be performed immediately in patients after the completion of 37 weeks of pregnancy. In patients between 34 and 37 weeks of gestation, delivery should be completed as soon as possible after discussion of possible benefits from prolonged pregnancy Note: Maintaining pregnancy for a prolonged period of time in the setting of preeclampsia are low: there was no more than 5 days between the group with immediate induction and the group in which pregnancy maintenance was sought. In patients between 24 and 34 weeks’ gestation, conservative therapy should be considered primarily to preserve the benefits to the child of prolonged pregnancy. However, in the following situations, there is an indication for delivery:

  • Fetal indications (indications based on the fetal situation), e.g., reverse flow in the umbilical artery; intrauterine hypoxia (CTG) [decreased oxygen supply to the unborn in utero].
  • Severe hypertension that cannot be controlled with medication.
  • Renal insufficiency (kidney weakness), which is not controllable with medication.
  • Acute pulmonary edema – accumulation of water in the lungs.
  • Evidence of disseminated intravascular coagulation (DIC) [e.g., progressive decrease in platelets and increase in D-dimers] – severe coagulation disorder due to excessive activation of clotting factors in severe disease and trauma, which can lead to bleeding and concomitant thrombosis
  • Severe persistent upper abdominal discomfort.
  • Severe neurological symptoms (impending eclampsia).
  • Eclampsia
  • Maternal/child complications (e.g., suspected cerebral hemorrhage (brain bleeds); abruptio placentae (premature placental abruption), etc.).

The form of delivery sought depends on the condition of the mother and baby.

General measures

  • Physical rest, frequent rest.
  • Observance of the general hygiene measures!
  • Nicotine restriction (refrain from tobacco use).
  • Alcohol restriction (abstaining from alcohol)
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program after pregnancy.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Avoidance of psychosocial conflict situations:
    • Stress

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account pregnancy. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.