Hypotension during pregnancy, causes, symptoms, how to treat

Low blood pressure in pregnant women: norm and pathology

Arterial hypotension (or hypotension) is a decrease in the level of mean arterial pressure, measured in both arms, below normal (average) pressure by 10% or more.

note

It is important to assess a woman’s blood pressure reduction not in relation to average age norms, but in relation to her own “working” pressure for a non-pregnant state. That is, if a woman before pregnancy had a stable blood pressure within the range of 100-110/70-80 mmHg, while her health and performance were quite normal, this pressure is taken as her “working” pressure, a version of the individual norm.

On average, during pregnancy, pressure in the first and second trimester fluctuates between 100-120 per 70-80 mmHg. By the third trimester, due to an increase in weight, circulating blood volume, changes in the intensity of metabolic processes and fetal growth, pressure naturally increases. If the pressure limits deviate by more than 15-20 mmHg for systolic (upper) pressure, and by more than 10-15 mmHg for diastolic (lower) pressure, and the woman’s well-being is disturbed and her ability to work, we are talking about hypotension.

Hypotension in pregnant women: when is it suspected?

If, when taking measurements both at a doctor’s appointment and at home, the level of systolic pressure fluctuates within 100 mmHg. and below, and diastolic 60 mmHg and below, doctors suspect pathological hypotension in pregnant women. This condition is usually accompanied by a number of subjective unpleasant symptoms:

Frequent or constant attacks of severe weakness, up to the inability to get out of bed normally;
Severe drowsiness during the day and evening, in the morning and a feeling of constant lack of sleep;
Fatigue even with light physical activity;
Attacks of dizziness, even fainting, when changing position, when getting out of bed or from a chair;
Attacks of shortness of breath with light exertion or a quick step, and as pregnancy increases, even at rest.

All manifestations are especially pronounced in the morning, immediately after waking up. Women have difficulty getting out of bed, cannot “swing” and get involved in household chores or work. Often, it is with the manifestations of hypotension and fainting that occurs in the early stages of pregnancy that many ladies learn about their new interesting situation.

Complications

Hypotension during pregnancy can lead to a number of complications:

Early appearance of toxicosis.
Problems with labor.
Preeclampsia.
Early onset of toxicosis.
Delay in fetal development.

During pregnancy, you should be sensitive to your health, because the woman’s responsibility now also lies with the child in the womb. If symptoms inherent in hypotension occur, you cannot tolerate them in silence, you should immediately go to the doctor. The problem can be prevented by maintaining the proper level of physical activity and self-monitoring of blood pressure.

lethargy;
apathy;
increased fatigue;
weakness;
decreased performance;
feeling of lack of air;
headache;
sleep disturbance;
irritability;
dizziness;

pain in the heart area;
increased sensitivity to loud speech, noise and bright light;
mood swings;
nausea;
pallor;
thermoregulation disorder;
periodic pain in muscles and joints;
mood swings;
fainting;
varicose veins;
rare pulse.

Some of these symptoms, such as headache, fainting, weakness and dizziness, may especially occur if a pregnant woman is in a stuffy room for a long time, is hungry, or takes a hot bath. Probably the most unpleasant symptom of hypotension is orthostatic hypotension.

miscarriage;
gestosis;
early toxicosis;
intrauterine growth restriction of the baby;
anomalies of labor;
premature birth.

In this regard, it is very important to diagnose the disease in time and begin to treat it.

The mechanism of lowering blood pressure during pregnancy

For the first trimester of pregnancy, a decrease in pressure, if it fluctuates within acceptable, physiological limits, is not considered a pathology . This is due to the physiological mechanisms of the body’s restructuring to new operating conditions. Such mechanisms are associated with protecting the embryo and providing it with optimal development conditions with the supply of sufficient oxygen and nutrition for full growth and development in the uterine cavity. The cause of hypotension during this period is the expansion of small vessels into which a fairly large volume of blood from the arteries and veins goes. This is necessary to ensure that all the tissues and organs of the expectant mother are saturated with oxygen and nutrients, especially the pelvic organs and the uterus, where the baby will spend the next 9 months of her life.
Relaxation of blood vessels occurs under the influence of pregnancy hormones, which are produced by the pituitary gland and ovaries in increasing quantities. Basically, small arterioles and capillaries, as well as venules (small veins in organs), dilate. They weave a thick network around the uterus and ovaries, as well as all the vital organs of the mother’s body.

How do hormones affect blood pressure?

Immediately after the release of the egg from the ovary, the corpus luteum, a temporary hormonal organ that produces the hormone progesterone, is formed at its location. During conception in the cavity of the fallopian tubes, due to the release of progesterone, conditions are created for the advancement of the embryo into the uterine cavity. Progesterone acts on smooth muscle elements, relaxing the tubes and uterus so that they can “carry” the embryo from the site of conception into the uterine cavity, and create optimal conditions for its implantation into the endometrium (inner lining of the uterus). If the tone of the uterus is increased, the embryo cannot attach to its wall and will die; progesterone is produced for this purpose.

But in addition to its effect on the uterus, it also affects the smooth muscle elements of blood vessels and internal organs, also relaxing them. As a result, small vessels dilate, a significant volume of blood flows into them, so that a relatively low pressure is created in large arteries. As the fetus and placenta grow and the volume of circulating blood in the vessels increases, pregnancy hypotension gradually disappears by the end of the first trimester. The pressure returns to normal . If this physiological mechanism is disrupted, the woman had hypotension before pregnancy, and there are problems with vascular tone, physiological hypotension becomes a pathology and can harm both the well-being of the expectant mother and the condition of the fetus.

Therapeutic measures

Hypotension during pregnancy is treated only under the condition of observation by a cardiologist. Even if these are mild forms of the disease, you must follow all its recommendations so that the condition does not worsen.

Lifestyle changes resolve most cases of low blood pressure. If you correct it, you will be able to avoid most complications. Typically, the doctor’s recommendations on this matter are as follows:

Maintaining physical activity. This is not necessarily heavy physical activity; walking, swimming in the pool, and daily exercises are enough. In addition, it will help the baby's development and an easier birth.
Nutrition rich in protein components and vitamins. To avoid heaviness, it is better to divide meals into 6 times.
If you need more sleep than before, don't force yourself to stay awake. You can modify your daily routine by adding a nap during the day.
It is better to drink coffee and strong teas in the morning.
To avoid triggering an attack, avoid standing up suddenly. By rising slowly, you will protect yourself from fainting.

Any pregnant woman knows that it is better not to get carried away with taking all kinds of medications, especially choosing them yourself. If you faint, it is important to take the following list of actions:

lay the body so that the head is level with the heart;
bring ammonia to your nose;
open the windows or turn on the air conditioning;
brew tea with lemongrass, eleutherococcus, ginseng, hawthorn (this remedy will help to tone);
if the condition does not improve, the woman is given sweet tea and an ambulance is called.

They try not to prescribe medications. The doctor may recommend drinking teas and decoctions of herbs that help tonify blood vessels - Rhodiola rosea, hawthorn, Leuzea, etc. The greatest attention during therapy is given to physiotherapy methods. For example, electrosleep, mineral baths, acupuncture, Charcot's shower are indicated.

If the symptoms are painful, doctors suggest drinking strong tea or coffee and lying down - this helps relieve the headache better than painkillers. In case of stress, sedatives based on herbal components help normalize the condition. Medicines with metabolic effects help minimize the negative impact of low blood pressure on the fetus. During a crisis, it is recommended to take caffeine or ephedrine.

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They try not to prescribe medications. The doctor may recommend drinking teas and decoctions of herbs that help tonify blood vessels - Rhodiola rosea, hawthorn, Leuzea, etc. The greatest attention during therapy is given to physiotherapy methods. For example, electrosleep, mineral baths, acupuncture, Charcot's shower are indicated.

It is important to make a correct diagnosis in time to eliminate negative consequences.

To make a correct diagnosis, a pregnant woman needs to contact various specialists:

therapist;
ophthalmologist;
neurologist;
cardiologist;
endocrinologist.

To determine the cause of the pathology, check the health of the pregnant woman and the condition of the fetus, the following diagnostic measures are prescribed:

physical examinations;
electroencephalogram;
laboratory blood and urine tests (general and biochemical);
echocardiography;
ophthalmoscopy;
ultrasound examination of the kidneys, adrenal glands, fetus;
thyroid hormones;
heart electrocardiogram;
differential studies;
24-hour blood pressure monitoring.

How does pathological hypotension manifest?

If blood pressure is constantly reduced, the body suffers from a deficiency of oxygen and nutrients due to the fact that less blood flows through the heart and pulmonary (pulmonary) circulation, less of it is saturated with oxygen and goes to organs and tissues. This is due to the fact that pathologically dilated small vessels store a lot of blood, which stagnates and inactively returns through the veins to the heart. Insufficient pressure is created inside the arteries, and the heart is forced to work harder and faster in order to pump smaller volumes of blood and saturate the body with oxygen. In this condition, the brain receives less oxygen and nutrition, which causes symptoms such as lethargy and drowsiness, weakness and headaches. Against the background of a constant lack of oxygen in the brain, attacks of insomnia occur at night and severe drowsiness during the day, physical activity may be poorly tolerated, and shortness of breath occurs due to minor physical or mental activity .
Headaches occur immediately after waking up or throughout the day; sometimes, especially in stuffy rooms, fainting occurs as a reaction to hypoxia (oxygen deficiency). Against the background of pathological hypotension, a woman’s performance, appetite and mood suffer, she becomes irritable, emotional and tearful.

Childbirth during illness

Hypotension in pregnant women is often accompanied by the following symptoms:

drowsiness;
lethargy;
pale skin;
dizziness;
fast fatiguability;
noise in ears;
weakness and shortness of breath when walking;
depressed mood;
lack of appetite;
nausea;
vomit;
headache.

Pregnant women with arterial hypotension due to poor blood supply to the uterus often experience untimely discharge of amniotic fluid and placental abruption. This slows down uterine contractions, which leads to a decrease in the labor process, perineal ruptures, and bleeding. Doctors in such cases resort to caesarean section. If there is no threat to the child, then the woman can give birth without surgery.

If there is a pregnancy with a large fetus, multiple pregnancy or a large amount of amniotic fluid, the prenatal period and childbirth should proceed strictly under the supervision of specialists. For successful delivery, a woman is hospitalized in the 3rd trimester. Before childbirth, prenatal preparation is carried out by making intravenous infusions of a 5% solution of glucose, calcium, and ascorbic acid.

How dangerous is hypotension in pregnancy for the fetus if it is not treated?

Important

You should not treat hypotension in pregnant women as a temporary ailment and ignore it. If this is a sharply reduced pressure, it threatens complications during pregnancy for both the mother’s body and the health of the fetus.

Reduced pressure disrupts the normal blood circulation process, which means that organs and tissues, including the placenta and fetus, suffer from hypoxia and a deficiency in the supply of glucose, vitamins and minerals. In turn, fetal metabolic products and various compounds dangerous to the fetus are less efficiently removed through the placenta. If the fetus suffers from hypoxia in the first trimester, when the formation of organs and systems occurs, this threatens developmental defects, anomalies in the structure and further functioning of the organs. also increases; the body stops the development of pregnancy, realizing that the conditions for the life of the fetus are negative .

At a later date, persistent hypotension can lead to the formation of a serious fetal problem - IUGR (intrauterine growth retardation). The fetus grows and gains weight less than normal, it is weakened and susceptible to various infections, and it is difficult to adapt to the new environment after birth.

Preventive recommendations

The best preventive measure is planning a pregnancy. To prevent hypotension you should:

normalize sleep patterns;
take a walk in the fresh air every day;
engage in moderate physical activity;
eat a balanced and regular diet;
drink sweet tea and coffee in moderation;
don’t be nervous, don’t overwork;
independently monitor blood pressure;
take essential vitamins and minerals.

During pregnancy, you should be more attentive to your well-being and monitor any changes. If low blood pressure causes discomfort, is accompanied by a pathological clinical picture and causes concern, you should immediately consult a doctor and undergo the necessary diagnostic measures.

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What risks does the expectant mother have with hypotension?

Often, doctors note early and severe toxicosis of pregnant women with severe vomiting and malaise against the background of low blood pressure. In a later period, such mothers are threatened with gestosis, in which the kidneys and heart, blood vessels and blood circulation of the brain are seriously affected. Low blood pressure is replaced by high blood pressure, which is difficult to control and threatens the development of seizures due to impaired blood circulation and cerebral edema. In addition, against the background of pathological hypotension, chronic infections can worsen, immunity decreases and the general condition suffers, pregnancy is difficult to bear.

It is important to determine what caused the health problems, the so-called hypotension, the initially existing decreased vascular tone and abnormally low pressure, or whether certain pathologies and diseases led to such pressure figures . Frequent factors affecting blood pressure can be various infections, problems with the thyroid gland (hypothyroidism), liver disorders, impaired production of adrenal hormones, or iron deficiency with the development of anemia. Treatment tactics for primary hypotension and in the presence of low blood pressure due to illness will differ.

Causes of low blood pressure

The reasons for this phenomenon are not fully understood. There is an opinion that the disease develops due to the fact that the activity of the neurohumoral apparatus, which regulates vascular tone, is disrupted.

Pathological hypotension can be chronic or acute. The latter can develop due to vascular and heart failure. Pregnant women may experience fainting and collapse with sudden movements or prolonged standing. Hypotonic syndrome due to acute vascular insufficiency sometimes manifests itself in the supine position. This only happens to expectant mothers. The reason for this is inferior vena cava compression syndrome. Most often, the presence of such a syndrome is detected in late pregnancy.

Today, there is no consensus on whether hypotension is considered an independent disease or whether it is a consequence of some pathology. However, it is clear that blood circulation slows down and the tone of the venous vessels decreases, which affects the overall tone of the body. Therefore, hypotensive people are sensitive to changes in atmospheric pressure, they suffer from headaches, and they quickly get tired. Clearly, this makes life even more difficult for pregnant women than for other people. Now is the time to pay more attention to the symptoms of hypotension, which is clearly manifested during pregnancy.

What to do with low blood pressure in pregnant women?

If this is pathological hypotension, which significantly threatens pregnancy, doctors in the hospital will treat the expectant mother. If this is hypotension, which can be controlled and treated at home, there are a number of recommendations for a woman that will help alleviate the condition. A strict daily routine and meticulous adherence to it, even on weekends, are important. It is necessary to sleep at least 9-10 hours at night, and also allocate time for daytime rest for 1-2 hours. You need a long stay in the air to saturate the blood with oxygen, at least a couple of hours a day.

It is necessary to develop a diet that stimulates the body, a complete supply of minerals and vitamins to the body, and avoiding prolonged fasting. You should not limit salt in your diet, it retains water and leads to increased blood pressure.

note

Often, in the presence of hypotension, women have an irresistible attraction to pickles and cabbage; there is no need to limit yourself to these products. Morning exercises, swimming, contrast showers and walks will be useful for vascular tone and increasing blood pressure.

How is the treatment carried out?

Drug therapy

The medicine is used for low blood pressure.
For hypotension in pregnant women, medications are prescribed quite rarely. However, if it is not possible to normalize the blood pressure with the help of general recommendations and traditional medicine, they begin drug treatment. It consists of taking herbal-based medications that strengthen the nervous system of the expectant mother. Pantocrine, lemongrass tincture, radiola, and aralia are often prescribed. Doctors recommend using them together with a decoction of motherwort and valerian root, which have sedative properties. For headaches, take Dipyridamole, as well as Acetylsalicylic acid in small doses. To prevent complications of hypotension, the doctor prescribes Actovegin and Inosine. If a pregnant woman is in crisis, then 0.5 ml of a 5% ephedrine solution is injected subcutaneously and 1 milliliter of a 10% caffeine solution intravenously.

General recommendations

To normalize blood pressure, a pregnant woman will need to adhere to the following principles:

Daily walks in the fresh air for at least 2 hours.
Balanced diet.
Full sleep. You need to sleep 9-10 at night and at least 2 hours during the day.
Morning exercises.
Massage of hands, feet, collar area.
Taking sage, pine, salt and mineral baths.
Bandaging the legs with an elastic bandage.

ethnoscience

Healers recommend using the following infusions of medicinal preparations:

Traditional medicine can help overcome low blood pressure.

You will need 1 tablespoon each of calamus root and juniper fruit, 2 tbsp. l. plantain leaves, mint, 3 tablespoons of fireweed herb and rose hips. The ingredients are mixed and then poured with 2 cups of boiling water. Send to infuse overnight, then drink 3 times a day for 4 weeks.
Strawberry, mint, currant and birch leaves are taken in the amount of 1 tablespoon. Add 6 tbsp. l. rose hips, 1 spoon of chopped calamus root. Add 1 liter of boiling water to them and leave for 6 hours. Take half a glass 4 times a day. The course of treatment is 4-5 weeks.

Is hypotension treated during pregnancy?

If low blood pressure interferes with the normal life of the expectant mother and threatens the fetus, doctors select treatment methods that are safe for each specific period. Preference is given to physiotherapy using mineral baths and bathing with pine extracts, electrosleep, acupuncture, and sea bathing. Only in serious cases can medications be used; plant extracts are also preferred - tinctures of Eleutherococcus, generic radiola, aralia or Chinese magnolia vine. Caffeine-containing drugs are indicated in limited quantities. All medications are prescribed only by a doctor and monitor their tolerability during gestation. You should not take any pills without a doctor’s permission, on the advice of friends or articles from the Internet, they can harm the baby.

Alena Paretskaya, pediatrician

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