Gebelikte Hipertansiyon
Özet
Gebelikte hipertansif hastalıklar preeklampsi, gestasyonel hipertansiyon, kronik hipertansiyon ve süperempoze preeklampsi olarak dört gruba ayrılır. Preeklampsi, gebeliğin 20. haftasından sonra proteinüri veya end organ disfonksiyonu ile birlikte sistolik kan basıncının ≥140 mmHg ya da diyastolik kan basıncının ≥90 mmHg olmasıyla saptanan multisistemik bir hastalıktır. Patofizyolojisinde anormal spiral arter remodelingi ve trofoblastik invazyon defektinin yol açtığı plasental hipoperfüzyon ile endotel disfonksiyonu kritik rol oynar. Nulliparlık, çoğul gebelik, ileri anne yaşı, diyabet ve kronik hipertansiyon önemli risk faktörleridir. Hastalığın kesin tedavisi doğumdur. Önlemede 75-150 mg/gün düşük doz aspirin kullanımının, özellikle 16. gebelik haftasından önce başlandığında, risk altındaki gebelerde preeklampsi oranını %10-20 azalttığı kanıtlanmıştır. Ağır preeklampsi yönetiminde maternal ve fetal stabilizasyon sağlanarak ≥34. haftalarda doğum planlanırken, daha erken haftalarda kortikosteroid uygulaması ve magnezyum sülfat ile nöbet profilaksisi eşliğinde beklenti yaklaşımı uygulanabilir. Doğum eylemi esnasında ve sonrasında nöbetlerin önlenmesinde magnezyum sülfat; akut şiddetli hipertansiyonun kontrolünde ise labetalol, hidralazin ve nifedipin tercih edilen antihipertansif ajanlardır. Preeklampsi öyküsü olan kadınların sonraki yaşamlarında kardiyovasküler ve renal hastalık riski artış göstermektedir.
Hypertensive disorders in pregnancy are categorized into four groups: preeclampsia, gestational hypertension, chronic hypertension, and superimposed preeclampsia. Preeclampsia is a multisystemic disorder characterized by a systolic blood pressure of ≥140 mmHg or a diastolic blood pressure of ≥90 mmHg, accompanied by proteinuria or end-organ dysfunction after the 20th week of gestation in previously normotensive women. Placental hypoperfusion and endothelial dysfunction caused by abnormal spiral artery remodeling and defective trophoblastic invasion play a critical role in its pathophysiology. Major risk factors include nulliparity, multiple gestations, advanced maternal age, diabetes, and chronic hypertension. The definitive treatment for the disease is delivery. For prevention, the use of low-dose aspirin (75-150 mg/day) has been proven to reduce the risk of preeclampsia by 10-20% in high-risk pregnancies, particularly when initiated before the 16th gestational week. In the management of severe preeclampsia, delivery is indicated at ≥34 weeks once maternal and fetal stabilization is achieved, whereas expectant management can be pursued at earlier weeks alongside corticosteroid administration and seizure prophylaxis with magnesium sulfate. Magnesium sulfate is the agent of choice for seizure prophylaxis during and after labor, while labetalol, hydralazine, and nifedipin are the preferred antihypertensive agents for controlling acute severe hypertension. Women with a history of preeclampsia exhibit an increased risk of cardiovascular and renal diseases later in life.
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