The Successful Clinical Case Of A Severe Arterial Hypertension Management During Preconception And Pregnancy

Abstract

A timely diagnosis and rational management of arterial hypertension (AH) in pregnancy are of the great importance among the practicing doctors. According to the World Health Organization (WHO), different types of hypertension in pregnancy took the 2nd place in maternal mortality structure in 2014 causing at least 76 thousand of maternal and 500 thousand of fetal deaths annually [3, 11]. Over the past decade, the 4th place of mortality rate in fetus is caused by hypertension and its complications. The maximum rate of fetal mortality was indicated at women 35 years of age or older. Perinatal mortality rates and the frequency of preterm births (10–12%) in AH patients prevail greatly over the corresponding values in relatively healthy pregnant women. AH increases the risk of the premature detachment of a normally positioned placenta, can cause cerebral circulation disorder, retinal detachment, pre-eclampsia, eclampsia, massive coagulopathic bleeding, placental insufficiency, and, in severe cases, asphyxia and fetal death [5,6]. The long-term prognosis for such patients is also unfavorable: the frequency of obesity, coronary heart disease, diabetes mellitus and stroke increases; and children born to such mothers suffer from metabolic, cardiovascular and hormonal diseases. A limited number of antihypertensive medications meet the safety criterion for the fetus and, thus, could be used in pregnancy. In case of monotherapy failure, combination therapy is administered to the patient.