Normal value of pregnancy-induced hypertension risk index

Preeclampsia generally refers to the problem of high blood pressure in women during pregnancy. If this situation is not treated and controlled in time, it will directly affect the life safety of women and will also affect the development of the fetus. Therefore, when it comes to the problem of pregnancy-induced hypertension in clinical practice, we must be clear about the blood pressure data and control the surge in blood pressure. So what is the normal value of the pregnancy-induced hypertension risk index for women?

What is the risk index for pregnancy-induced hypertension?

1. Carry out prenatal examinations and provide good health care during pregnancy. Blood pressure should be measured once in early pregnancy as a baseline blood pressure during pregnancy, and then checked regularly thereafter, especially after 36 weeks of pregnancy. Changes in blood pressure and weight, and the presence of proteinuria, dizziness and other subjective symptoms should be observed every week.

2. Strengthen nutrition and rest during pregnancy. Strengthening nutrition during the second and third trimesters of pregnancy, especially supplementing with protein, multiple vitamins, folic acid, and iron, can play a certain role in preventing pregnancy-induced hypertension[1]. The incidence of pregnancy-induced hypertension increases in women with maternal nutritional deficiencies, hypoproteinemia or severe anemia.

3. Pay attention to the inducing factors and treat the primary disease. Think carefully about the family history and whether the pregnant woman's grandmother, mother or aunt has ever suffered from pregnancy-induced hypertension. If so, genetic factors should be considered. Pregnant women who have suffered from essential hypertension, chronic nephritis and diabetes before pregnancy are prone to gestational hypertension. If pregnancy occurs in a cold winter, prenatal examinations should be strengthened and treatment should be carried out early.

The key to preventing the occurrence of pregnancy-induced hypertension is to do a good job of prenatal care and understand blood pressure levels (blood pressure levels before pregnancy and during early pregnancy). In addition to measuring blood pressure, each prenatal check-up should also measure weight and check for protein in the urine. Special attention should be paid to pregnant women with a family history of pregnancy-induced hypertension, a history of chronic persistent hypertension, kidney disease, diabetes, multiple pregnancies, and polyhydramnios. Taking 50 to 150 mg of aspirin orally every day during the second and third trimesters of pregnancy can reduce the risk of gestational hypertension by 65%.

Women who take oral contraceptives should have their blood pressure monitored to detect high blood pressure in a timely manner. If blood pressure rises, you should stop taking the medication and use other contraceptive methods to prevent the occurrence of high blood pressure. At the same time, a physical examination should be carried out. Blood pressure, weight, breast, liver, kidney and gynecological examinations must be carried out before taking contraceptives as a control level before taking the medicine. If it is found that oral contraceptives cannot be taken, then do not use them, and pay attention to measuring blood pressure regularly. Generally, blood pressure should be checked once every three months in the first year, and once every six months thereafter.

Three typical symptoms of pregnancy-induced hypertension

1. Mild hypertension: The main clinical manifestation is mild increase in blood pressure, which may be accompanied by mild proteinuria and (or) edema. This stage may last for several days to several weeks, and may develop gradually or deteriorate rapidly.

(1) Hypertension: Before pregnancy or before 20 weeks of pregnancy, the blood pressure (basal blood pressure) of pregnant women is not high. However, after 20 weeks of pregnancy, the blood pressure begins to rise to ≥18.7/12 kPa (140/90 mmHg), or the systolic blood pressure exceeds the original basal blood pressure by 4 kPa (30 mmHg), and the diastolic blood pressure exceeds the original basal blood pressure by 2 kPa (150 mmHg).

(2) Proteinuria: The onset of proteinuria is often slightly later than the increase in blood pressure. The amount of proteinuria is very small and may be absent at the beginning.

(3) Edema: It may initially manifest as an abnormal increase in weight (hidden edema), exceeding 0.5 kg per week. If there is too much fluid accumulation in the body, it will lead to clinically visible edema. Edema often starts from the ankles and gradually extends to the hind legs, thighs, vulva, and abdomen. When pressed, the area becomes concave, which is called pitting edema. Obvious pitting edema in the ankles and calves that does not subside after rest is indicated by a “+”; edema extending to the thighs is indicated by a “++”; “+++” means edema extending to the vulva and abdomen; “+++” means systemic edema or ascites.

2. Moderate gestational hypertension: blood pressure exceeds that of mild gestational hypertension, but does not exceed 21.3/14.6 kPa (160/110 mmHg); urine protein (+) indicates that the amount of protein in the urine exceeds 0.5 g within 24 hours; there are no subjective symptoms.

3. Severe pregnancy-induced hypertension: further development of the disease. Blood pressure may be as high as 21.3/14.6 kPa (160/110 mmHg) or higher; the amount of protein in the 24-hour urine may reach or exceed 5 g; there may be varying degrees of edema and a series of subjective symptoms. This stage can be divided into pre-eclampsia and eclampsia.

(1) Preeclampsia: In addition to hypertension and proteinuria, patients experience symptoms such as headache, dizziness, nausea, stomach pain and vomiting. These symptoms indicate that the disease is further deteriorating, especially the further development of intracranial lesions, which indicates that convulsions are about to occur, so it is called preeclampsia.

(2) Eclampsia: Eclampsia is a condition in which convulsions or coma occur in addition to pre-eclampsia. In a few cases, the disease progresses rapidly, with no obvious signs of preeclampsia and sudden convulsions. The typical course of eclampsia is first characterized by fixed eyeballs and dilated pupils, followed by a momentary twisting of the head to one side and clenched jaws, followed by tremors in the corners of the mouth and facial muscles. After a few seconds, the disease develops into rigidity of the whole body and limbs, with the hands clenched and the arms bent, followed by rapid and intense twitching. During convulsions, breathing stops and the face turns blue. After about a minute, the convulsion weakens in intensity, the muscles of the whole body relax, and then you take a deep breath, snore and resume breathing. The patient loses consciousness before and during the convulsion. Those with few convulsions and long intervals between them can wake up shortly after the convulsion; those with frequent convulsions and long duration often fall into a deep coma. Various traumas are likely to occur during convulsions. Bites on the lips and tongue, falls, or even broken bones, or vomiting during coma can cause suffocation or aspiration pneumonia.

Eclampsia often occurs in late pregnancy or before delivery, which is called antepartum eclampsia; a few occur during delivery, which is called intrapartum eclampsia; some occur within 24 hours after delivery, which is called postpartum eclampsia.