Turkiye Klinikleri Journal of Internal Medicine

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Gebelik ve Doğum Sonu Dönemde Şiddetli Hipertansiyona İlişkin Güncel Uygulama ve Yaklaşımlar
Applications and Approaches to Severe Hypertension During Pregnancy and Postpartum Period
Ayşe METEa, Nebahat ÖZERDOĞANb
aEbelik Bölümü, Gaziosmanpaşa Üniversitesi Sağlık Bilimleri Fakültesi, Tokat, TÜRKİYE
bEbelik Bölümü, Eskişehir Osmangazi Üniversitesi Sağlık Bilimleri Fakültesi, Eskişehir, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2019;4(3):132-8
doi: 10.5336/intermed.2019-65359
Article Language: TR
Full Text
ÖZET
Şiddetli hipertansiyon, gebelik ve doğum sonu dönemde anne sağlığını ciddi şekilde etkileyebilecek önemli bir sağlık sorunudur. Gebelikte hipertansiyon; gebelik dönemi kronik hipertansiyonu, gebeliğe bağlı (gestasyonel) hipertansiyon, kronik hipertansiyona bağlı preeklampsi/eklampsi ve gebeliğin tetiklediği hipertansiyon (preeklampsi/eklampsi) olarak sınıflandırılır. Doğum sonu dönemi hipertansiyonu ise kronik hipertansiyon geçmişi, gebelik hipertansiyonu, preeklampsi ve eklampsi olarak sınıflandırılır. Doğum sonu dönemdeki hipertansiyonun en yaygın nedeni, genellikle gebelikte seyreden yüksek kan basıncının doğumdan sonra da aynı yükseklikte devam etmesidir. Preeklampsi belirtileri çoğunlukla nonspesifik olduğundan, gebelikte veya doğum sırasında fark edilmeyebilir. Belirtilerin geç fark edilmesi ya da bilinmemesi tedaviyi geciktirir. Sağlık personelinin, gebeleri preeklampsi bulgu ve belirtileri hakkında bilgilendirmesi ve eğer belirtiler mevcut ise sağlık hizmeti veren kurumlarla temasa geçmesinin aciliyetini vurgulaması gerekir. Şiddetli hipertansiyonda (kan basıncı ≥160/100 mmHg) serebrovasküler risklerin artması nedeni ile antihipertansif ajanların uygulanması gerekirken, hafif ve orta şiddetli hipertansiyonda bu ajanların kullanımı hâlâ tartışmalıdır. Dünya Sağlık Örgütü; hipertansiyon, preeklampsi ve eklampsi tedavisine yönelik çeşitli önerilerde bulunmuştur. Sağlık kurumları, çok geniş bir neden ve etki yelpazesine sahip hipertansiyonun yönetimi için buna uygun talimatlar oluşturmalı ve bu talimatlar yayınlara dayalı olarak güncellenmelidir. Bu çalışmada, güncel yayın ve rehberler incelenerek gebelik ve doğum sonu dönemde gelişen şiddetli hipertansiyona ilişkin yeni uygulama ve yaklaşımlar konusunda sağlık hizmeti veren tarafları bilgilendirmeyi amaçlamaktadır.

Anahtar Kelimeler: Hipertansiyon; gestasyonel hipertansiyon; preeklampsi; eklampsi; postpartum dönem
ABSTRACT
Severe hypertension is an important health problem that can seriously affect maternal health during pregnancy and postpartum period. Hypertension during pregnancy is classified as chronic hypertension, gestational hypertension, preeclampsia/eclampsia due to chronic hypertension and hypertension (preeclampsia/eclampsia) triggered by pregnancy. Postpartum period hypertension is classified as history of chronic hypertension, pregnancy hypertension, preeclampsia and eclampsia. The most common cause of postpartum hypertension is the fact that high blood pressure during pregnancy usually continues to stay heigh after birth. Since the symptoms of preeclampsia are mostly nonspecific, they may not be noticed during pregnancy or delivery. Late detection or unknown symptoms may delay treatment. Health personnel should emphasize the urgency of informing pregnant women about the signs and symptoms of preeclampsia and contacting health care providers if symptoms are present. In severe hypertension (blood pressure ≥160/100 mmHg), antihypertensive agents should be administered because of increased cerebrovascular risks, while the use of these agents in mild to moderate hypertension is still controversial. The World Health Organization has made various recommendations for the treatment of hypertension, preeclampsia and eclampsia. Health institutions should establish appropriate instructions for the management of hypertension with a wide range of causes and effects, and these instructions should be updated on the basis of publications. This study aims to inform health service providers about new applications and approaches related to severe hypertension in pregnancy and postpartum period by examining current publications.

Keywords: Hypertension; gestational hypertension; preeclampsia; eclampsia; postpartum period
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