Causes and treatment of hypotensive syndrome. Hypotensive syndrome during pregnancy Hypotensive syndrome in the mother: what it is and how it manifests itself

According to statistics, hypertensive syndrome in pregnant women leads to complications and mortality in childbirth more often than any other diseases - per 100 births with complications of approximately 20-30 cases.

Hypertensive syndrome is the main cause of the risk of placental abruption and massive coagulopathic bleeding, can disrupt cerebral circulation, and hypertension can also result in retinal detachment, eclampsia and HELLP syndrome.

Please note that hypertension can be controlled at the very beginning and during pregnancy the woman will not feel any discomfort associated with it, but usually the treatment does not affect the outcome of the birth itself.

How to identify hypertensive syndrome

First, an increase in blood pressure compared to blood pressure before pregnancy or blood pressure in the first trimester of pregnancy can indicate hypertension:

- systolic by 30 mm Hg or more.

- diastolic by 15 mm Hg or more.

Secondly, if a hypertensive syndrome is suspected, it is necessary to systematically measure blood pressure in a pregnant woman for 6 hours. BP above 140/90 mm. rt. Art., confirmed by several measurements in a row, will indicate that the pregnant woman still has hypertension.

Thirdly, by the calculation method, when the average blood pressure is equal to or more than 105 mm Hg, and the jumps in diastolic blood pressure exceed 90 mm Hg. Art.

Feel

The sensations are the same as those of hypertensive patients, only complicated by pregnancy. So from the most unpleasant can be called:

Breathing while walking

Flushing of the face, fever

Nocturnal spikes in blood pressure cause stomach cramps similar to hunger symptoms

Even sitting in a chair in front of the TV, you can feel how suddenly the heart, for no reason at all, goes astray

Lying on your back feeling short of breath

Headache often occurs, which seems to be nothing to provoke

In later periods, the child begins to beat too hard from a lack of oxygen and the very condition of the mother.

Consequences for you

Depending on the form and severity of the hypertensive syndrome, the frequency of pressure surges, hypertension can lead to preeclampsia and eclampsia in childbirth. Also by the end of the term may be observed:

hyperreflexia

Headache that does not go away after taking conventional analgesics

visual impairment, double vision

Yellowness of the skin

Pulmonary edema

Decreased diuresis and sudden swelling of the extremities.

After delivery, the hypertensive syndrome requires continued diagnosis and treatment so that hypertension does not become a chronic disease for the mother. Having missed such a moment, the doctor will put the woman at risk of being face to face with this unpleasant disease in subsequent births.

Consequences for the child

The main thing is preterm birth, when the baby has not yet gained enough body weight, and the lungs are not open enough. There is a high possibility of intrauterine death of the fetus, impaired blood supply to the brain, accelerated heartbeat, underdevelopment of the central nervous system, and so on.

Therefore, it is best to diagnose hypertension early in pregnancy and treat its moderate to severe forms during the subsequent trimesters. This will enable the child to feel comfortable in the womb and avoid some of the serious consequences of this syndrome, and will also allow prolonging the gestational age to the required 38-40 weeks.

In the early stages, the doctor prescribes treatment depending on the severity of hypertension; in mild forms, it is sufficient to observe bed rest. In more severe forms, preeclampsia, magnesium therapy (intravenously or intramuscularly) is prescribed, as well as antihypertensive drugs. In the last trimester - hospitalization with constant bed rest; the choice of metaprolol, hydralazine, nifedipine, methyldopa - dopegyt, labetalol or nitroprusside; reduced sodium intake; use of diuretics, etc.

Dopegyt is usually prescribed as an antihypertensive drug, but a stronger drug may be prescribed at the discretion of the doctor.

In each individual case, the obstetrician-gynecologist develops an individual scheme for dealing with hypertensive syndrome. Delivery is considered the best treatment, but, nevertheless, the doctor should try to delay this moment as close as possible to the normal delivery time - at 38-40 weeks.

To be or not to be?

Knowing in advance about the presence of a hypertensive syndrome, it is difficult for a woman to make a decision about conception and a fully-term pregnancy. And even more so, such a decision is difficult to make the second, third time, when the first attempt was not particularly successful - the difficult first birth, especially with eclampsia, leaves its mark. In this case, consultations with a specialist are required, who will be able not only to prescribe treatment and manage the pregnancy, but also to support the woman morally during pregnancy, anticipating her fears.

The symptom complex, which displays a persistent decrease in intracranial pressure, is called hypotensive syndrome in the mother. It is characterized by a combination of severe, constrictive headaches, fatigue, retching, and mood lability. Such a diagnosis is made only to women. There is such a syndrome during pregnancy in women aged 25 to 29 years. The existence of this syndrome leads to a decrease in the quality of life, therefore, if such a symptom complex appears, you need to consult a doctor and start treatment.

Causes of the disease

The syndrome has various causes. The main ones are:

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  • decrease in intracranial pressure;
  • head injury;
  • the outflow of cerebrospinal fluid due to ruptures in the membranes of the brain and fractures of the bones of the skull;
  • decrease in the secretory function of the vascular plexuses in the brain;
  • severe medical dehydration of patients;
  • sustained pressure drop.

Symptoms of the hypotensive syndrome

The disease is manifested by such symptoms:

  • the appearance of a strong, sudden, squeezing, like a "hoop", headache;
  • increased pain in a sitting position and when lifting the head;
  • decrease in pain if the head is lowered;
  • the appearance of nausea and urge to vomit;
  • labile mood;
  • prostration;
  • the appearance of drowsiness.

Diagnosis of hypotensive syndrome during pregnancy

At the first symptoms of the disease, you should consult a doctor for help.

If the patient has the first manifestations of such a disease, you need to contact a neurologist, neurosurgeon and obstetrician-gynecologist. They will collect all complaints, conduct an objective examination, as well as conduct a differential diagnosis with other diseases and make a preliminary diagnosis. Diagnostic measures include:

  • general blood analysis;
  • general urine analysis;
  • blood chemistry;
  • spinal puncture;
  • skull radiograph;
  • MRI of the brain.

Features of the treatment of the disease

When the first symptoms of hypotensive syndrome appear in the mother, you should not try to cure it yourself, but you need to contact specialists. Doctors will take a medical history and examine the patient. And also they will carry out diagnostic measures and prescribe special treatment. As treatment, medical and surgical therapy is prescribed.

Medical treatment

Treatment of hypotensive syndrome is carried out with the help of medications presented in the table:

Symptomatic treatment is carried out as follows:

  • In the presence of a decrease in heart contraction, drugs are prescribed that improve the trophism of the heart - "Riboxin", "Aevit".
  • If there are pronounced microcirculation disorders, Reopoliglyukin is used.
  • With a pronounced violation of cerebral circulation, Cinnarizine is prescribed.

Hypotensive syndrome during pregnancy, what is this pathology and how can it threaten the expectant mother and baby? Some women experience persistent low blood pressure during pregnancy. Hypotension is associated with headaches that are spasmodic in nature.

A woman gets tired very quickly, feels weak. Vomiting joins the attacks of headache. Against this background, a change of mood occurs very often. A similar complex of symptoms is observed in pregnant women between the ages of twenty-five and twenty-nine. There are many reasons for such a disease.

The reasons

With the appearance of this syndrome, the woman's condition, accompanied by toxicosis in the first trimester, is even more aggravated. Most often, these symptoms occur due to a drop in intracranial pressure. Head injuries can lead to such problems.

Less often, the pressure level decreases due to the outflow of cerebrospinal fluid. Cerebrospinal fluid loss can be caused by rupture of the meninges or fracture of the bones that form the skull.

There are special vascular plexuses in the brain. Their main task is the synthesis of cerebrospinal fluid and cerebrospinal fluid. Cerebrospinal fluid surrounds the spinal cord. For some reason, the choroid plexuses begin to produce their secret in much smaller quantities. Because of this, the pressure drops.

One of the characteristic signs of hypotensive syndrome is the sudden onset of seizures. A woman may feel great when suddenly there is pain squeezing her head. Moreover, in the sitting position, the pain increases significantly.

The same thing happens if you raise your head sharply. If the head, on the contrary, is lowered, the pain will decrease slightly. An unpleasant moment is the appearance of nausea, and in some cases, the urge to vomit. One of the manifestations of the hypotensive syndrome is drowsiness, causeless mood swings.

Source: Davlenies.ru

Diagnostics

Only a doctor can diagnose a pathology after a comprehensive examination. The treatment of hypotensive syndrome in pregnant women is carried out by a neuropathologist or a neurosurgeon together with a gynecologist. A presumptive diagnosis is made on the basis of the patient's complaints and the collected anamnesis.

The main goal of the examination is to exclude other pathologies that have similar symptoms. First, a general analysis of blood and urine is performed, as well as a biochemical analysis of blood from a vein. If necessary, cerebrospinal fluid is collected by puncture. If there is a history of skull injuries, an x-ray is taken. Finally, an MRI of the brain is performed.

If you have even a few symptoms, you should seek medical help. A woman will not be able to solve the problem on her own. In addition, the existing pregnancy imposes its limitations on the use of many drugs.

Even simple painkillers must be taken with caution, and only with the permission of the attending physician. It will be possible to carry out any treatment only after establishing the causes that caused the appearance of hypotensive syndrome in a pregnant woman.

Treatment

Treatment can be done in two ways. With the use of medications or by performing a surgical operation. Drug treatment is reduced to the elimination of the main symptoms.

alkaloids

A group of alkaloids, which include "Caffeine" and "Securin". You should not take these drugs on your own, especially during pregnancy. The instructions for use have a special warning that this remedy during pregnancy is used only as directed by a doctor and with extreme caution.

Caffeine. Available in solution for injection and tablets. The form of treatment is chosen by the doctor. The active ingredient of this drug is caffeine-sodium benzoate. This remedy has a stimulating effect on the central nervous system. In high doses, the drug can accumulate in tissues. Caffeine, which is part of the drug, differs from natural, although it is isolated from coffee beans and tea leaves.

This tool improves mood, reduces fatigue. Pregnant patients are prescribed caffeine in small doses, since higher doses cause the opposite effect. Namely, they depress the nervous system. Small amounts of caffeine increase blood pressure.

To relieve headaches, the instruction recommends taking up to 100 mg. drug twice a day. But the final dose of the drug and the regimen in case of pregnancy is determined only by the attending physician. When taking tablets, it is forbidden to drink coffee and strong tea.

Co-administration of the drug with coffee will lead to an overdose of caffeine. The drug should be discontinued if any allergic reactions occur. Withdrawal from the drug should be gradual. Abrupt withdrawal of the drug may adversely affect the state of the nervous system.

Securin is available both in solution for injection and in tablets. This remedy stimulates the work of the brain and spinal cord. Its action resembles the effect on the body of a substance such as strychnine. But in this case, the effect on the body is weakened several times and the drug, unlike strychnine, is not toxic.

Tonic

This includes tinctures of ginseng, zamaniha, Chinese magnolia vine. No less effective preparations containing eleutherococcus extract. Ginseng tincture contains a number of biologically active substances that favorably affect the general condition of the body.

In combination, they stimulate the brain, but reduce, albeit slightly, the level of blood pressure. Additionally, they reduce fatigue and increase efficiency. This remedy should only be taken with the permission of a doctor.

The drug is taken only after breakfast. The dose is determined by the doctor. If the dosage is violated, sleep problems appear, blood pressure rises, nosebleeds may begin. According to the instructions, the drug is not recommended for pregnant women, but in the case of hypotensive syndrome, this issue is decided by the doctor on an individual basis.

M-cholinolytics

This includes drugs such as Bellaspon and Atropine.

Bellaspon is available as a dragee. This drug has a sedative and antispasmodic effect. During pregnancy, it is not recommended for use, but in the presence of severe headaches, the issue of admission is decided by the attending physician. Self-medication is strictly prohibited. In addition to these drugs, the patient is prescribed anabolic hormonal drugs, nootropics.

Surgical

The question of surgical treatment arises if drug therapy has not given a positive result. This sometimes happens in the presence of a liquor fistula and with a defect in the dura mater of the brain. The operation is performed by a neurosurgeon. In the first case, the cerebrospinal fluid fistula is surgically closed. In the second case, plastic is performed with the replacement of the defect.

Hypotensive syndrome in the mother during pregnancy does not pose a danger to the life of a woman and a child. For all the time, not a single case of death associated with hypotensive syndrome has been identified. But the manifestations of the syndrome themselves are only the consequences of more serious deviations. Over time, it is these hidden processes in the body that can disrupt the normal functioning of many organs and systems.

Anamnesis. Heredity is not burdened. From childhood diseases she suffered from measles, chicken pox and diphtheria. An adult often suffers from tonsillitis and flu. Menstrual function without features, the last menstruation was on 12/1/1983. Sexual life since 25 years, first marriage.
There was one pregnancy, which 2 years ago ended in an artificial abortion without complications. The second pregnancy is real.
the course of this pregnancy.There were no complications in the first half of pregnancy. Starting from the second half, the woman periodically began to experience weakness, especially in the supine position and with a long stay in an upright position. During the last 2 months she sleeps only on her side. Fetal movement was noted for the first time on December 3, 1983, 2 weeks ago - slight swelling on the legs. 2.3. the pregnant woman turned on her back in her sleep, after which she had a fainting state with a sharp decrease in blood pressure. An emergency doctor was urgently called, who, according to the patient, gave two injections of drugs that increase blood pressure. However, there was no pronounced effect. Only with a change in body position (the woman turned on her right side and maintained this position for 2 hours, these phenomena disappeared.
General and obstetric examination.Pregnant correct physique, satisfactory nutrition. The skin and visible mucous membranes are pink. There are swelling of the legs. Pulse 90 minutes, rhythmic, weak filling. BP 110/60 mm Hg No pathological changes were found in the internal organs. Zhivo» ovoid shape, evenly increased in volume due to the pregnant uterus. The circumference of the abdomen at the level of the navel is 94 cm, the height of the uterus above the womb is 36 cm. The position of the fetus is longitudinal, cephalic presentation, first position, anterior view. The head is balloting over the entrance of the small pelvis. The fronto-occipital head size is 10.5 cm. The fetal heart rate is 136 per minute, rhythmic, to the left below the navel. The estimated weight of the fetus according to Rudakov is 3000 g. There is no labor activity, no water was poured out. Pelvic dimensions: 25, 28, 32, 20 cm. Solovyov's index 14 cm.
During an obstetric examination of a pregnant woman on the couch, she experienced a fainting state: she turned pale sharply, began to complain of a "lack of air", cold sweat appeared, her pulse increased to 120 per minute, and became weak filling. BP dropped to 70/40 mm Hg. The fetal heart rate increased to 150 per minute, but remained moose clear and rhythmic. When boiling urine, protein was found.

What is the diagnosis? What is the origin of this pathology? With what diseases should a differential diagnosis be made? How should a pregnant woman be treated?

Before us is a patient with a gestational age of 36 weeks, with symptoms of nephropathy (swelling of the legs, protein in the urine). However, the collaptoid condition that occurs in a woman with pronounced hypotension in the supine position deserves the most attention, which until recently was called the “compression syndrome of the inferior vena cava”. Currently, it has been given a more correct name - hypotensive syndrome of pregnant women in the supine position.

The pathogenesis of the syndrome is not yet well understood. Proponents of the vascular theory explain its origin as a violation of circulatory processes due to compression of the inferior vena cava by the pregnant uterus, which entails a decrease in blood flow to the right heart. However, vascular therapy does not explain the complex genesis of the changes that occur, since with the same size of the uterus, hypotensive syndrome develops only in some pregnant women, and its severity sometimes does not depend on the duration of pregnancy.

According to the neurogenic theory, this syndrome occurs in a reflex way due to irritation of the nerve plexuses and endings in the abdominal cavity by the pregnant uterus. This theory is confirmed by observations when the phenomena of hypotension and collapse were significantly weakened or disappeared completely after the introduction of atropine into the pregnant woman or infiltration of the solar plexus with a novocaine solution.

Hypotensive syndrome is closely related to the hemodynamic features inherent in pregnancy. In pregnant women, unlike non-pregnant women, when moving from a vertical to a horizontal position, blood pressure almost always decreases significantly, which in the supine position does not have a pronounced tendency to recover.

Predisposing factors for the development of hypotensive syndrome include late toxicosis and hypotension. In late toxicosis with the presence of hypertension, a change in the position of the body of a pregnant woman, as a rule, is accompanied by more pronounced fluctuations in the maximum and minimum blood pressure, while the maximum pressure when the pregnant woman is lying on her back does not tend to return to the initial level.

In women with arterial hypotension, when they move from a vertical position to a horizontal one, the maximum pressure usually decreases more significantly, which is not immediately restored.

It is these features of vascular reactions that apparently underlie the more frequent occurrence of hypotensive syndrome in the supine position with late toxicosis and arterial hypotension.

It should be noted that the pregnant woman observed by us has signs of nephropathy (swelling of the legs, protein in the urine), but blood pressure is not increased and even rather slightly reduced. Perhaps, before pregnancy, the woman suffered from arterial hypotension, which was not diagnosed. Along with this, it is known that nephropathy in the absence of arterial hypertension, especially against the background of previous hypotension, is accompanied by a significant lability of vascular tone. Against this background, hypotensive syndrome develops much more often in the supine position.

The clinical picture of this syndrome is quite characteristic. Usually, hemodynamic disorders occur in the position of a pregnant woman lying on her back and are expressed by motor restlessness, increased sweating, pallor of the skin, increased or slowed pulse and a sharp decrease in blood pressure. In severe forms, vomiting and even short-term loss of consciousness are possible. The use of various cardiac and vascular pharmacological preparations in these pregnant women is ineffective, and only with a change in body position do these symptoms disappear. It is this clinical picture of the hypotensive syndrome observed in the pregnant woman supervised by us.

With what diseases should a differential diagnosis be made?

Premature detachment of a normally located placenta usually occurs against the background of severe arterial hypertension due to the development of severe forms of late toxicosis of pregnant women, hypertension or nephritis. If the detachment occurred over a significant extent of the placenta, then the disease begins with severe pain in the abdomen and tension of the uterus. The behavior of the pregnant woman is restless, she moans from pain, her pulse quickens significantly. With increasing internal (and external) bleeding, a picture of collapse and shock develops relatively quickly. An external obstetric examination makes it possible to establish the tension of the uterus, its soreness, especially pronounced in the area of ​​​​the location of the retroplacental hematoma. Sometimes there is asymmetry of the uterus, corresponding to the location of the placenta. Placental abruption, especially if it occurred in a significant area, quickly leads to intrauterine asphyxia and fetal death. The change in the position of the patient's body does not affect her general serious condition.

Uterine rupture during pregnancy is most often caused by anatomical inferiority of the uterine wall due to cicatricial changes (mainly after caesarean sections) or dystrophic processes that have developed as a result of complicated births or abortions. In the woman we observed, there are no indications in the anamnesis of these unfavorable moments. Threatening uterine rupture is characterized by restless behavior of the pregnant woman, abdominal pain and soreness of the uterus on palpation. Sometimes it is possible to identify local pain at the site of a future rupture of the uterine wall. With the onset of uterine rupture, bloody discharge from the genital tract joins the described signs; intrauterine fetal asphyxia often develops. Changing the posture of the patient does not lead to the disappearance of these symptoms.

Eclampsia without seizures is one of the most severe forms of late toxicosis. It is characterized by typical signs of eclampsia (headaches, visual disturbances, pain in the epigastric region, high blood pressure, edema, oliguria, proteinuria, etc.) and the absence of convulsive seizures. It should be noted that at present, eclampsia, including its form without seizures, can occur against a background of relatively low blood pressure. The severity of the condition in eclampsia does not disappear due to a change in the position of the patient's body, as is the case with the hypotensive syndrome of pregnant women in the supine position.

How should a pregnant woman be treated?

By itself, the hypotensive syndrome does not require treatment. The pregnant woman is advised to avoid the supine position. However, the presence of concomitant nephropathy in her is an indication for hospitalization in the department (ward) of the pathology of pregnant women for the necessary examination and treatment. Transportation of the patient should be carried out by gentle transport (ambulance) in the position on the side. The doctor or midwife of the antenatal clinic must accompany her.

Obstetric seminar, Kiryushchenkov A.P., Saburov Kh.S., 1992

Hypotensive syndrome in the mother is a state of dysregulation of vascular tone, in which there is a decrease in blood pressure to a value of 100/60 mm Hg. and below.

The incidence rate ranges from 1.8 to 29%.

Hypotensive syndrome often occurs in the 1st trimester of pregnancy, and, as a rule, worsens with the course of pregnancy. In the development of pathology, anatomical and physiological changes in the body of a pregnant woman are important, first of all, the occurrence of uteroplacental circulation, as well as changes in the interaction of the autonomic nervous system and a decrease in the function of the adrenal cortex.

It is customary to divide arterial hypotension into primary, which occurred in a woman during the pregestational period, and secondary, first detected during pregnancy. Regardless of the type of hypotension, the condition has a negative impact on the health of the mother and child.

Risk factors for the development of hypotension syndrome are asthenic physique, endocrine pathologies, liver diseases, infections, pathologies of the autonomic nervous system, prolonged bed rest, and nutritional deficiencies.

Some sources refer hypotensive syndrome in pregnant women to gestosis.

The reasons

In the pathogenesis of the development of hypotensive syndrome during gestation, the following factors are important:

  • BCC deficiency as a result of the occurrence of uteroplacental circulation and the conditions caused by it (decrease in venous return to the heart, increase in minute blood volume, etc.)
  • The production of hormones by the placenta that affect the functioning of the pituitary gland, as a result, a decrease in the blood of pressor substances that maintain vascular tone.
  • An increase in the tone of the parasympathetic nervous system, the predominance of parasympathetic activity, and, as a result, a decrease in the tone of smooth muscles, incl. vascular wall.
  • Decreased production of hormones by the ovaries.
  • Maternal production of antibodies to antigens of the fetus and placenta.

Taking certain medications can also cause arterial hypotension.

In late pregnancy, arterial hypotension is often postural in nature and is caused by compression of the inferior vena cava uterus in the position of the woman on her back.

Low blood pressure contributes to the development of hemodynamic disorders in all organs and systems, causing a greater variability of clinical symptoms.

Symptoms

Arterial hypotension may be asymptomatic. Fatigue and weakness, irritability and tearfulness that occur with a decrease in blood pressure, a woman often writes off for the normal course of pregnancy.

There may be dizziness and headache, darkening of the eyes, weakness, "flies" before the eyes when changing the position of the body from horizontal to vertical, fainting, a feeling of lack of air, chest pain, palpitations.

The skin is cold, pale or cyanotic, sweating is characteristic. A systolic murmur is heard at the apex of the heart, the pulse rate is reduced.

In severe cases of the disease, there may be hypotensive crises. They are manifested by collapse, severe weakness, tinnitus, sticky cold sweat, tachycardia, nausea.

Important! A hypotensive crisis in a pregnant woman is a life-threatening condition for a child and requires immediate assistance.

In childbirth, arterial hypotension contributes to the development of anomalies in labor and an increase in blood loss.

Diagnostics

Hypotensive syndrome in the mother is diagnosed on the basis of anamnesis of life and disease, objective examination data and additional research methods.

Important! Complaints in a pregnant woman with an asymptomatic course of the disease may be absent.

When clarifying the anamnesis, attention is paid to the presence of hypotension in a woman before pregnancy, the presence of pathologies of the endocrine and nervous system, the features of the current pregnancy (the presence of anemia, gestosis, hypoglycemia, etc.). The drug history is being investigated.

The pulse is measured, percussion and auscultation of the heart, examination and palpation of the thyroid gland, temperature measurement.

To confirm the diagnosis, blood pressure measurement is prescribed during the day (2-3 times a day).

A general blood test, a general urinalysis, a biochemical blood test, determination of the level of thyroid hormones, ultrasound of the kidneys and adrenal glands, and an ECG are prescribed.

Differential diagnosis is carried out with diseases of the thyroid gland and adrenal glands, infectious diseases, hypotensive syndrome when taking certain drugs, stomach ulcers.

Complications

Arterial hypotension, regardless of the course, affects both the health of the mother and the health of the fetus.

Complications on the maternal side may include:

  • The development of late gestosis.
  • Spontaneous abortion in both early and late gestation.
  • Anemia.
  • Discoordination of labor, prolonged labor (in 75% of cases).
  • Increased blood loss during childbirth.
  • Decreased activity of the adrenal cortex.

Complications on the part of the child include conditions associated with impaired fetoplacental blood flow. Perhaps the development of intrauterine hypoxia, increases the risk of birth trauma, encephalopathy, increases the risk of perinatal death.

Forecast

In the syndrome of arterial hypotension, the prognosis depends on the severity of the course of the disease and the adequacy of the prescribed treatment.

With secondary hypotension, first detected during pregnancy, the prognosis is less favorable, since the course of the disease is more severe, often accompanied by crises.

A large number of hypotensive crises indicates decompensation and is an unfavorable prognostic criterion.

In puerperas with arterial hypotension, the risk of developing postpartum infections is twice as high.

Prevention of the development of hypotensive syndrome in pregnant women is the exclusion of overwork, the normalization of sleep, gymnastics, contrast showers, correction (if necessary) of the diet, massage.

In childbirth, women in labor with arterial hypotension must undergo additional prevention of bleeding.