HYPERTENSIVE DISORDERS OF PREGNANCY – MANAGEMENT STRATEGIES IN THE POSTPARTUM PERIOD (LITERATURE REVIEW)

Abstract

Highlights Hypertensive disorders of pregnancy are associated with short- and long-term risks for the mother. We have identified several key points in the management strategy of this pathology in the postpartum period, which should contribute to the emergence of new directions in the prognosis and treatment modalities of this disease. Abstract The article presents an analytical review of modern data on the treatment of hypertensive disorders of pregnancy (HDP) in the postpartum period. HDPs lead to maternal morbidity and mortality in developing and poor countries, and in regions with well-developed healthcare systems as well. HDPs can later progress into hypertension and are associated with the risk of coronary artery disease and stroke. Moreover, HDPs increase the likelihood of low-birth-weight babies and preterm births. The incidence of HDP is growing worldwide despite the implemented prevention methods: according to the Global Health Data Exchange, from 1990 to 2019 HDPs` incidence by 10.9% from 16.3 million to 18.08 million people. However, the introduction of universal approaches to prevention of complications made it possible to reduce mortality from HDP in the same period by 30.05%. The risk of hypertensive complications increases significantly in the postpartum period. Modern research confirms this – the likelihood of worsening HDP and the development of complications increases significantly in the first 24–48 hours after childbirth. About one third of cases of eclampsia occur in the postpartum period, of which almost half occur 48 hours after delivery. Stroke in women with HDP occurs in the postpartum period in half of the cases. Arterial hypertension (AH) in the postpartum period often requires an increase in doses of antihypertensive drugs, whereas after 3–6 months, many patients no longer need such therapy. During the first year after childbirth, the risk of progression of AH and the development of complications due to hypertension is increased, and remains so for many years. The feasibility of antihypertensive therapy in HDP today is beyond doubt, however, there are issues that require further study. They are related to the safety of prescribed drugs during lactation, and as a result, in many guidelines, antihypertensive therapy in the postpartum period is prescribed with reservations. Another problem is the relatively small number of RCTs directly assessing the effectiveness of antihypertensive therapy in the postpartum period.