Hipertensão arterial na grávida: o atual estado da arte

Abstract

Hypertension complicates 6-8% of pregnancies and includes the following four conditions: hypertension preceding pregnancy or documented before the 20th week of gestation; pre-eclampsia (PE)/eclampsia; chronic hypertension with superimposed pre-eclampsia; and gestational hypertension. The latter is defined as a significant rise in blood pressure after the 20th week of pregnancy in previously normotensive women, to over 140/90 mmHg. When blood pressure remains above 160/110 mmHg, it is considered severe. PE is defined as the presence of proteinuria (> or = 300 mg/24 h) in pregnant women with hypertension. The hypertensive syndromes of pregnancy are among the leading causes of maternal and fetal morbidity and mortality and anti-hypertensive treatment is part of the therapeutic arsenal used to prevent serious complications. Although the role of utero-placental insufficiency due to deficient migration of trophoblasts to the spiral arteries is universally accepted, the pathophysiology of PE remains largely unknown and is the subject of debate. No effective ways of predicting or preventing PE have been found, which highlights the need for further research in this field. This review aims primarily to evaluate recent advances in our understanding of the pathophysiology of gestational hypertension and especially PE, and new ways of predicting PE. Additionally, we present a brief review on the diagnosis, prevention and treatment of PE.

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

“…Parturient with HDP includes gestational hypertension and preeclampsia; and the severity of HDP of patients was diagnosed by obstetricians accordingly. [ 3 8 ] All the parturient were followed up for 12 weeks following delivery and confirmed the diagnosis by obstetricians. Inclusion criteria were term parturient with late onset stable HDP.…”

“…[ 2 ] Elevated blood pressure (BP) is considered to compensate the reduced maternal-fetal blood flow due to systematic arteriole spasm. [ 3 ] Major maternal complications associated with HDP are placental abruption, hemolysis, elevated liver enzymes, low platelets syndrome, disseminated intravascular coagulation, neurologic deficits, pulmonary edema and acute renal failure. [ 4 ] Widespread endothelial dysfunction can also occur in the placenta that ultimately leads to placental ischemic injury or even infarction.…”

Nursing care for women with pre-eclampsia and/or eclampsia: integrative review

“…Therefore, the recommendations are: measurement of DBP in the fifth phase of Korotkoff; clamp cover at least three quarters of the circumference of the forearm and right arm; performing at least two measurements at intervals longer than six hours between measurements (6) . Noteworthy that in a study on the current state of the art, looking as references the guidelines of the WHO, the American College of Obstetricians and Gynaecologists (ACOG), RCOG and publications from the journal The Lancet, it was determined that the measurement should be always carried out with the patient sitting and arm at heart level; the cuff should present appropriate dimensions; DBP should be measured in the fifth Korotkoff phase and, in any situation, manual sphygmomanometer with mercury column should be used, since it found an underestimation of 5-15 mmHg in both SBP and DBP when the measurement was made with automatic measurement apparatus (32) .…”

Evolução ponderal na gravidez, preditores e consequências: Estudo retrospetivo

“…De facto verificou-se uma baixa incidência de síndromes hipertensivos (2% HTA gestacional e 0,8% de pré-eclâmpsia) em relação aos 8% descritos na literatura. 13 Esta limitação poderá ter comprometido os resultados do nosso estudo, nomeadamente no objetivo de avaliar associação entre aumento de peso na gravidez e complicações obstétricas.…”