Pregnancy-induced hypertension

We will find that women are very happy during pregnancy because they are taken care of by their families in various ways, they can also get maternity leave, have a good rest at home, and receive special treatment from the company. In fact, you should also be careful about some problems during pregnancy. For example, gestational hypertension is a disease that is generally not hereditary, but it is very harmful and requires attention.

Diagnostic tests

Based on the medical history and typical clinical manifestations, the diagnosis is not difficult. However, it is difficult to estimate the condition and differentiate certain diseases with similar clinical manifestations. Therefore, a comprehensive analysis of medical history, predisposing factors, physical examination, and auxiliary examinations is necessary in order to make a correct diagnosis. The diagnosis includes the severity of the disease, classification, and the presence or absence of complications, so as to formulate the correct treatment strategy.

1. Medical history: ask the patient in detail about her pregnancy and pregnancy

Whether there were signs of hypertension, proteinuria and/or edema and convulsions before 20 weeks of pregnancy; whether there was primary hypertension, chronic nephritis and diabetes in the past medical history; whether there was a family history. The time when abnormal phenomena occurred during this pregnancy.

2. Main clinical manifestations (1) Hypertension: If the initial blood pressure measurement is high, it is necessary to rest for 6 hours before measuring again to accurately reflect the blood pressure condition. A diagnosis can be made when blood pressure reaches 140/90 mmHg. Find out if possible his basal blood pressure and compare it with the measured blood pressure. If the measured blood pressure is 1w/m2, it does not meet the diagnostic criteria for hypertension. However, if the basal blood pressure is 4/60m4 and its increase exceeds 1/15m4, it should be considered to meet the diagnostic criteria. (1) Proteinuria: Midstream urine should be collected for examination. If the 24-hour urine protein quantity is > 0. 5g is abnormal. The presence and amount of proteinuria reflects the degree of tubular cell hypoxia and functional damage caused by renal arteriole spasm, and should be taken seriously. (3) Edema: In addition to pregnancy-induced hypertension, edema in late pregnancy can also be caused by compression of the inferior vena cava by the enlarged uterus, which obstructs blood return, nutritional hypoproteinemia, and anemia. Therefore, the severity of edema does not necessarily reflect the severity of the disease. Patients with mild edema may rapidly develop eclampsia. In addition, if edema is not obvious but weight gain is >0.9kg within 1 week, it should also be taken seriously. (4) Subjective symptoms: Once diagnosed with gestational hypertension, you should always pay attention to symptoms such as headache, dizziness, chest tightness, nausea and vomiting. The emergence of these subjective symptoms indicates that the disease has entered the stage of pre-eclampsia and should be examined and treated in a timely manner. (5) Convulsions and coma: Convulsions and coma are manifestations of the disease when it develops to a serious stage. Pay attention to the mental state, frequency, duration and interval.

3. Testing

(1) Blood test: Hemoglobin, hematocrit, plasma viscosity, and whole blood viscosity should be measured to determine whether the blood is concentrated. For critically ill patients, platelet count and coagulation time should be measured. If necessary, prothrombin time, fibrinogen and protamine paracoagulation test (3P test) should be measured to determine whether there is any abnormality in coagulation function.

(2) Liver and kidney function tests: such as alanine aminotransferase, blood urea nitrogen, creatinine and uric acid. If necessary, repeat the measurement or perform other related tests to comprehensively judge the liver and kidney function. In addition, measurements of blood electrolytes and carbon dioxide binding capacity are also very important in order to promptly understand whether there is electrolyte imbalance and acidosis.

(3) Fundus examination: Retinal arterioles can reflect the condition of arterioles in major organs in the body. Therefore, fundus changes are an important sign reflecting the severity of pregnancy-induced hypertension, and are of great significance for estimating the condition and deciding on treatment. The main change in the fundus is spasm of retinal arterioles, and the ratio of arteriovenous diameters may change from the normal 2:3 to 1:2 or even 1:4. In severe cases, retinal edema and retinal detachment may occur. Or there may be cotton-like discharge and bleeding, and the patient may experience blurred vision or sudden blindness. These conditions can gradually recover after delivery.

(4) Other tests: such as electrocardiogram, echocardiogram, placental function, fetal maturity examination, etc., depending on the patient's condition.