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"Emergency medicine" 2 (57) 2014

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The Correction of Hypertension in Patients with Severe Preeclampsia

Authors: V.Cherniy, V.Kostenko, E.Bernadiner, T. Kabanko, V.Stetsyk — Donetsk National Medical University of Maxim Gorky, Department of Anesthesiology, Intensive Care, Critical Medicine and Cardiovascular Surgery; Donetsk Clinical Territorial Medical Association

Categories: Medicine of emergency

Sections: Specialist manual

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Preeclampsia and eclampsia are leading complications of gestational period, despite the obvious advances in the development of the new methods of diagnosis and intensive care. The frequency of the preeclampsia in pregnant women is ranges from 2,3 to 16,6% over the past 10 years. Preeclampsia occupies one of the top places in the structure of maternal complications. It is the cause of the onset of preterm labor, the development of abruptio placenta, the placental dysfunction, the fetal growth retardation, birth of children with low weight.

High frequency of maternal (12.9%) and perinatal (9,5–30,0%) losses are makes preeclampsia into an important medical and social problem of our time. Despite numerous studies of the etiology, pathogenesis, diagnosis and principles of intensive care of preeclampsia, not in all cases it is possible to correct hypertension during pregnancy in patients with preeclampsia. It remains the most common cause of maternal and perinatal mortality.

The international literary sources were analyzed.

Numerous experimental and clinical studies have focused on the study of the causes of hypertension in pregnant and postpartum women with preeclampsia. At the same time, a holistic theory of the pathogenesis of hypertensive syndrome in preeclampsia has not been formulated. So far, the main role in the development of hypertension in preeclampsia was given to the changes in the central and peripheral hemodynamics. However, one of the pathogenetic mechanisms of high blood pressure is a disorder of the autonomic regulation.

The majority of research in this area are reflect to a dynamic process of maturation of regulatory systems of the fetus. However, the regulatory mechanisms of neural control of blood pressure in preeclampsia are described only in a few studies. Therefore, the role of autonomic disorders in the pathogenesis of hypertension in preeclampsia has not been finalized. The study of the pathophysiological mechanisms of autonomic regulation in hypertensive syndrome in preeclampsia is of great interest. This will find the best methods to reduce of maternal and perinatal complications.

It is important into the pharmacotherapy of hypertension during pregnancy not only the selection of the drug, but also the start time of therapy. The task is complicated by the need to account both the interests of the two patients — the mother and fetus, which do not always coincide. It should be noted that almost all antihypertensive drugs are cross until the placenta and may potentially have an adverse effect on the fetus/newborn.

Ideal medicine for the control of the blood pressure in pregnant women with hypertension is a drug that is safe for both mother and fetus; it may occur rather quickly antihypertensive effect, but does not cause a critical reduction of the blood pressure. It may be easy in usage too. It should be noted that many modern medicines with proven efficacy are contraindicated in pregnant women. And some drugs commonly used for the treatment of hypertension in pregnant women in several countries, are not registered in our country.

In the absence of the 'ideal' hypotensive drug for pregnant and postpartum women with severe preeclampsia, as well as increases in the frequency of this complication of pregnancy, the incorporation of a new antihypertensive agents into the complex of intensive care for this category of patients is an important task of modern obstetric anesthesiology and intensive care.



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