Rest and sedation will be the first step to try to control the blood pressure if it is mild not require hospitalization, maternal-fetal controls will be made within the periods established by the obstetrician.

When the box is moderate or severe, will be used a number of antihypertensive drugs that do not reduce uteroplacental flow, which could be detrimental to the welfare of the fetus. Drugs will be used to accelerate lung maturity, if need be to terminate pregnancy before term.

Should never be used diuretic drugs, nor shall any salt free diets.When checking the fetal lung maturity, will end the pregnancy with an induction to vaginal delivery address if possible, or by performing a cesarean section when circumstances require.

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Prophylaxis

It is essential to think in this disease in pregnant women when they appear one of the risk factors discussed above.

Monitoring of blood pressure in pregnant women in the OB with each visit will help early diagnosis and the establishment of appropriate control measures.

It has been shown how the early administration of antiplatelet acetylsalicylic acid type also reduce the incidence of preeclampsia. Diets rich in calcium, high protein and rich in vitamin C, antioxidants, also appear to reduce the incidence of this disease.

credit to: Dr. Francisco Javier García Santos, Dra. Vibeke Manniche, Dr. Philip Owen

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There are pictures very slight adequately controlled with rest, and allow the arrival of the pregnancy to term without major complications in mother or child.

The middle tier would be those cases that require admission to inpatient treatment and control with the end of gestation, as fetal maturity guarantees are true.The extreme cases in which termination of pregnancy is essential to save the life of the mother and the fetus is mature lung.

Most symptoms disappear within hours or days of the termination of pregnancy may rarely occur pictures of hypertension and pre-eclampsia in the immediate postpartum period, when they occur but are even more dangerous because they no longer thought both of them.

credit to: Dr. Francisco Javier García Santos, Dra. Vibeke Manniche, Dr. Philip Owen

When after the twentieth week of gestation, the pregnant woman has high blood pressure, fluid retention with edema and protein loss in urine, it triggers the table is known as pre-eclampsia.

Not always happen the three groups of clinical signs and symptoms. It is a picture that requires a very strict control obstetric and sometimes can lead, if not properly controlled, to a cataclysmic picture with grave danger to the mother and fetus.

Why there is pre-eclampsia?

Although the ultimate causes are unknown, it appears that because there is mismatching the uterus at the placental system, which causes the production of a number of substances that will increase the resistance of the vessels and therefore reduce arteriovenous flow to the fetus.There are some unsafe conditions that increase the frequency of occurrence of pre-eclampsia:

- The first pregnancy

- Diabetes, both gestational and pregestational diabetes

- Essential hypertension prior

- Chronic kidney disease

- Previous pregnancies with hypertension induced by pregnancy

- Multiple gestations.

What are the symptoms?

- Elevation of blood pressure. When an elevation of blood pressure above 140/90 mmHg in at least two serial measurements with the patient at rest, or when an increase in systolic blood pressure (maximum) above 15 mmHg, or 10 mmHg diastolic (the lowest).

- Very high blood pressure (above 170/110), are pictures of real gravity and maternal fetal often accompanied by other symptoms such as severe headache, abdominal pain, seeing flashing lights, etc..

- High level of protein in urine. In the normal pregnancy protein in urine are high, in boxes pregnancy-induced hypertension, these losses are higher and facilitate the development of edema in the distal lower extremities, upper extremity edema, facial edema etc..

- Epigastric pain is also a sign of alarm, and is produced by the distension of the lining surrounding the liver. Always accompanied by changes in the production of clotting factors, a fact that further complicates the picture that is this serious disease.

credit to: Dr. Francisco Javier García Santos, Dra. Vibeke Manniche, Dr. Philip Owen

The practice of exercise during pregnancy improves cardiovascular fitness, muscular and posture, as well as avoid excessive weight gain, improve blood pressure levels and protect against gestational diabetes. It also helps to relieve digestive problems so characteristic of pregnancy and constipation and mental well-being increases, reducing the degree of anxiety and depression. Similarly, it is useful to reduce insomnia and help to adopt healthy lifestyles.

All these benefits promote improved physical condition to cope with pregnancy and childbirth. In addition, recent data say that shortening the postpartum hospital stay and reduces the number of caesarean sections.

But to take advantage of the exercise should be individualized and the mother, subject to regular medical checks. Experts recommend a number of guidelines:

- Drinking and eating properly, with appropriate input, especially iron, calcium and vitamin supplements. A caloric needs of pregnancy must be added the year. Moreover, as the sensation of thirst is not a good indicator of dehydration, you need to consume before, during and after exercise. Appetite and hunger can also be affected by hormonal changes. Should therefore be close monitoring of nutrition.

- Always carry out programs and stretching after warming up for about 10 minutes after each session.
The exercise should be practiced regularly, 3 to 4 sessions of 30 minutes a week, not intermittently, or high or competitive intensity.

- If you are a little intense, should not exceed 15 minutes and not be in heat or humidity high risk of dehydration and increased temperature.

- Use appropriate clothing and comfortable footwear.

- Exercise non-slip surfaces, best in soils that reduce the impact of the tread.

- Avoid contact sports, jumping, crashing or kickback and large-scale movements, as during pregnancy there is a laxity of the joints that adds an increased risk of sprains and strains.

- Forgoing exercise at risk of falls or blows to the abdomen, especially in the first quarter, as well as others who require to maintain a static position for too long or too abrupt changes, the risk of dizziness and falls.

- Exercises are not recommended requiring forced expirations and with the mouth and nose covered, reducing the oxygen in the mother and fetus.

- Exercises are preferable to the moderate intensity aerobic exercise, not to exceed 70% of theoretical maximum heart rate.

- First signs of fatigue, dizziness or malaise, we must always stop. Above all, avoid burnout.

Suitable sports are walking, swimming and cycling, such as avoiding too irregular terrain. The 30-minute walks a day can increase up to an hour and the right intensity will allow for a chat with the tour.

credit to: Montse Arboix

Also, as usual, given prophylaxis against bacterial endocarditis if the patient suffers from congenital heart disease: from the American Heart Association, as if the mother is subjected to any invasive procedure such as tooth extraction, recommend using ampicillin ( or vancomycin if you suffer from allergy to penicillin) and gentamicin.

During childbirth and postpartum, is closely monitored heart rate and breathing as well as hydration by fluid therapy. The best position for the patient undergoes placed on the left side during the period of expansion. Control pain, elevate the heart rate and blood pressure, is another specialist who will assess the position.

To do so, according to the cardiac disease suffered by the mother, are used more opioid anesthetics, because these drugs often used in pregnant women can cause heart patient vasodilation worsening the underlying disease. Since the SEC, brought to the epidural anesthesia as a safe option.

Delivery of choice is the infection because it causes fewer changes in blood pressure, less blood loss and fewer infectious complications and bleeding. If the stage of labor (from full dilation to birth) is extended, the option is the use of forceps or vacuum, which helps to reduce maternal effort by pushing.

However, some studies suggest that caesarean section to vaginal delivery is preferable to some diseases, such as coarctation of the aorta and Marfan syndrome, as during labor and delivery is intermittent increases in cardiac output and pressure blood, threatening to these patients. In entities that do not let the pregnancy to term, the vaginal route may be at greater risk for a premature baby. In addition, it is easier to plan the time of cesarean completion by the vaginal route.

The most critical period is the immediate postpartum period, due to the distribution of blood flow changes after the expulsion of the placenta, bleeding birth itself and the drugs commonly used in the process. Often, these patients should be seated to reduce the venous return of the lower limbs and, in some situations, you use diuretic drugs.

credit to: Montse Arboix

A healthy woman tolerated in general, the changes in your body throughout pregnancy. However, these changes can lead to decompensation in the heart of a pregnant woman with a history of heart disease. If the risk is very high for the mother, experts recommend stopping. If this risk is acceptable, as in most cases, be scrupulous track throughout the process and the immediate postpartum period.

As you go through pregnancy, women experience physical and physiological changes due to circulatory adjustments to a new type and the requirements of the growing fetus. Although these changes occur in almost all organs and systems and their effects on the heart of pregnant women with cardiac disease may endanger their health and her unborn baby.

Changes in blood volume, vascular resistance, heart rate or blood clotting are some major complications. And although it is frequently the Spanish Society of Cardiology (SEC) estimates that heart disease affects between 0.4 and 2 of every 100 pregnant – should take precautions before and during the whole process.

Regular strict control

Although each of the diseases of the heart requires an individualized approach, some recommendations are general in scope: a strict prenatal care by a multidisciplinary team that has a cardiologist, midwife, obstetrician and anesthesiologist, among others, and pay attention to development of any signs or symptoms of dysfunction (such as increased respiratory rate and breathlessness when lying down, increased heart rate, leg swelling due to fluid retention, tiredness, dizziness, coughing up lung sounds abnormal, etc.).

It is important to remember that many of these symptoms caused by heart disease are similar to those typical of pregnancy. It is therefore important that the patient knows prematurely recognize to treat early and avoid greater evils. It is also recommended reducing physical activity to reduce cardiac output (sometimes, you need to rest in bed, especially during the last quarter), to restrict salt intake and increasing calories and vitamins, not to mention the iron. To circumvent complications, it is also necessary to address the early signs of diseases that could cause cardiac decompensation, such as a cold or urinary tract infection.

Similarly, avoid factors that may encourage the development or worsening of arrhythmias, such as caffeinated beverages, alcohol, snuff or toxic substances, among others.

credit to: Montse Arboix

Being either case, both are more likely to suffer complications during pregnancy. For example:

a) is seven times more likely to have hypertension.
b) have a much better chance of bleeding during childbirth.
c) is more likely to suffer from edema, swelling, etc..
d) has more chances of getting varicose veins.
e) prolonged labor (at a rate of 25%).
f) C-sections with complications (at a rate of 33%).
g) Diabetes after pregnancy at a rate of up to 40%.
h) newborn weight higher than normal.

Weight control of pregnant women with weight problems should be under strict medical supervision, since any deficiency or disorder in the calories of the diet, may adversely affect the baby and herself. The pregnant woman should not lose weight but to increase between 9 and 11 kilograms.

In this regard, it should be noted that a low calorie diet should not contain an amount less than the 1,600 calories a day, because otherwise the determination of an inappropriate use of dietary protein, even if your submission is longer than usual. During lactation, observed the same behavior, an increase of up to 1,800 calories daily.

You should always consider your obesity problem will be resolved in the future, after pregnancy and the birth of your baby it is also advisable to take into account the diet of the appendix, and observe if possible before pregnancy.

Between 30% and 40% of weight gained during pregnancy is preserved after delivery (3 to 4 kg in a normal pregnancy). The extra kilos due to calorie diets are more difficult to lose later, and often the same problem of excess weight is repeated in subsequent pregnancies. It must be borne in mind that pregnancy does not completely transform a woman’s body is the power and desire that this change does not involve disruption or the health of the pregnant or the baby.

We must exclude any type of medication to cut the appetite as well as diuretics and thyroid hormones, drugs and other dangerous and banned completely during pregnancy due to the harmful effects to the fetus.

But being too obese is also a risk to the mother. Weight gain means an increased workload of the liver, kidneys and circulatory system, which would add to the body’s efforts to maintain the pregnancy problems of obesity (hypertension, diabetes, edema, swelling, etc.. .) Ideally, start with the ideal weight and in good shape, so that later weight control does not become an obsession or the physician nor the pregnant woman.

1 – What is recommended to the common flu vaccine during pregnancy?
It is advisable to apply the common flu vaccine in cases where the pregnant woman is in his second or third trimester in winter and flu season.

2 – What extra precautions can be taken to avoid getting influenza A during pregnancy?
The health minister pregnant women included in the risk group therefore requesting moms stay at home during the next 15 days (from 2/7/09) to avoid catching the disease.
Also to be reinforced hygiene measures like the rest of society:
• Wash hands often with soap and plenty of hot water – especially after sneezing or coughing -.
• You can use antibacterial wipes or alcohol gel sanitizer.
• Use mask.
• Cover your nose and mouth with a tissue when coughing or sneezing, then throw it away.
• If you do not have a tissue handy, covered the front of the elbow bent, in order to prevent the virus remains in your hand and can be passed.
• Avoid touching eyes, nose or mouth because germs are easily spread.
• Avoid physical contact with people who are sick or have symptoms of it.

3 – What if a pregnant flu symptoms?
Whenever flu symptoms appear is important to consult your doctor. If the pregnant woman has a fever for more than 12 hours and greater than 38 degrees, you should consult a doctor immediately.

4 – Can affect the baby have influenza?
The risk of this bird is that it induces a high fever. Febrile syndromes can cause harm to the fetus and cause premature labor.

5 – Pregnant and lactating women can take antivirals (oseltamivir phosphate)?
Currently recommended that pregnant women take oseltamivir phosphate at any time during pregnancy, talking to your doctor.

For women who are breastfeeding, it is unclear whether oseltamivir and active metabolite are excreted in breast milk. However, based on an extrapolation of data from animal experiments it seems likely that the above substances pass into breast milk. However, the AAP recommends continuing to breastfeed while taking the antiviral. It is important to remember that antiviral drugs must be prescribed by a physician and never resort to self-medication.

Bacterial infections untreated can cause disruption to the fetus, experts said. Therefore, mothers should not completely avoid antibiotics but consult their doctors which should take.

The new study is the first large-scale analysis of antibiotic use during pregnancy. He found that mothers of babies with birth defects were more likely than healthy babies to have taken two types of antibiotics during pregnancy sulfa drugs such as Bactrim and urinary germicides called nitrofurantoin (Furadantin and as Macrobid).

It is the first time it sees a link between the treatments for urinary tract and congenital defects, said lead author Krista Crider, a geneticist at the Centers for Disease Control and Prevention (CDC), which funded the study. “Further studies will be needed to confirm these conclusions,” he said.

These antibiotics, used for decades, which predate the existence of the Food and Drug Administration (FDA), with its rigorous trials.

The FDA classified all drugs according to their possible effects on the fetus, but in many cases lack of rigorous studies, which is why no antibiotics reached the maximum grade of “A””.

Sulfa antibiotics are older and some animal studies have found that are harmful during pregnancy. As for nitrofurantoin, doctors thought they could use for the treatment of urinary tract infections during pregnancy.

The study, which appears in the journal Archives of Pediatrics & Adolescent Medicine November could lead physicians to choose other drugs to treat infections in pregnant women. The findings were released Monday.

The researchers studied the medical records of more than 13,000 women who gave birth to children with birth defects and 5,000 women from the same regions whose babies were born healthy.