Ladder Diagnosis And Treatment Of Chronic Hypertension Complicated With Pregnancy

Objective Chronic hypertension during pregnancy is referred to hypertension occurring before 20 th week of gestation or after 20 th week of gestation but lasting for some period of time post-delivery.Pregnant women with chronic hypertension are at higher risk for complications than other ordinary pregnant women.The chronic hypertension may further develop into more severe situation such as pre-eclampsia,eclampsia,placental abruption,angiocardiopathy etc.Chronic hypertension is also associated with several other adverse pregnancy outcomes,such as HELLP,premature birth,fetal growth restriction,fetal demise,and cesarean delivery.Chronic hypertension during pregnancy pose sever risk to both pregnant women and their fetus for their lives and health.So antihypertensive treatment is a viable option for them although specific treatment requires cautious trials and assessment.But there is no guideline on how to assess the risk and criteria on antihypertensive results at national level.This study focuses on investigating how to assess different risk levels for Chronic hypertension during pregnancy and propose different treatments for each risk level,targeting to provide a new perspective on standardization and treatment for Chronic hypertension during pregnancy.Methods This study closely followed 68 pregnant women with chronic hypertensive,who were enrolled at the 1st People’s Hospital of Kunshan from March 2011 to June 2013.They were broken down into 2 groups: high risk level group and low risk level group.Criteria adopted to define as low risk is: a systolic blood pressure ≥140mm Hg but ≤ 150 mm Hg or a diastolic blood pressure ≥90mm Hg but ≤95mm Hg while there is complication detected[9].The treatment for this group is 50 mg Aspirin P.O.and closely monitoring blood pressure during pregnancy.In case any obvious blood pressure increase,urine protein positive,headache or dizziness per patients own complaints,antihypertensive treatment will be taken.Criteria adopted to define as high risk is: a systolic blood pressure ≥150mm Hg or a diastolic blood pressure ≥95mm Hg,or blood pressure fall into the same range as low risk level group while there is a complication detected such as: urine protein positive,renal ultrasound indicate chronic hypertension changes,or while the ST portion or T curve of electrocardiogram changes,other abnormal symptom associated with hypertension appears,echocardiogram indicates the hypertrophy of atrium or ventricle,other abnormal symptom associated with hypertension appear,fundus arteriole spasm or arteriolar arteriosclerosis,hyperglycemia,or renal dysfunction appears,or hematocrit increases.High risk level group are given prescription for 30 mg P.O of Amlodipine Besylate Tablets(Norvasc)on top of 50 mg P.O aspirin until the delivery.Follow-up monitoring of post-delivery pressure will decide whether to keep same anti-hypertensive treatment until for another 3 months.Results(1)The average ages for two groups are 30.4±5.4 years old.There were 34 multipara while another 34 primipara.No difference was found between the high risk level group and low level group(2)No educational background difference was found between high risk level group and low level group(57.58% vs 56.25).(3)The 1st week for two groups(High and low)to set up book of perinatal health care are without statistical difference(16.0±4.0 vs13.8±5.1).(4)The 1stsystolic blood pressure measured at clinical for high risk level group and low level group show some statistical difference(P value=0.01),but the systolic blood pressure during delivery for two groups shows no statistical difference(P value = 0.108).In contrast,the diastolic pressure shows statistical difference at both 1stclinical measurement and delivery(P value are 0.01 for both statistics).The value for low risk level group is slightly lower than that of high risk level group.Comparison within each group show no any statistical significance.(5)The results at delivery: 13 preeclampsia occurred in high risk level(39.4%)while 5 preeclampsia occurred in low risk level(39.4%).But no severe complication developed such as eclampsia,HELLP symptom,placental abruption,cerebral hemorrhage,cerebral ischemic stroke etc.(6)The average sustaining gestational weeks until delivery: there was no obvious statistical difference between high risk level group and low risk level risk group.But there was premature delivery rate difference from statistical perspective: 10 cases(30.3%)from high risk level group but 3 cases(9.4%)from lower risk level group.(7)The way of deliveries: cesarean rate shows obvious statistical difference(84.8% vs 56.3%)between high risk level group and low risk level group.(8)Neonatal outcomes: average neonatal weight greater than 2500 g for high risk level group is 78.8% while the average number for low risk level group is as high as 90.6%.(9)Apgar scoring on the average for all neonatal infants at 8 to 10 for both groups.There were 5 cases for fetal growth restriction for high risk level group.There were zero cases death for neonatal infants.Conclusions(1)Although the antihypertensive treatment has reduced the morbidity of preeclampsia,but the treatment did not prevent eclampsia from further deteriorating into more severe status such as placental abruption,eclampsia,and HELLP etc.(2)Antihypertensive treatment has effectively reduced blood pressure,but no visible impact on neonatal outcome.(3)Standardized pregnant women’s profile,strengthen prenatal regular check,proactive treatment of preeclampsia,and abortion at correct stage could avoid eclampsia occurrence(4)Early intervention treatment may impact fetus growth,increase chance of fetus deformation and abortion.