Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (original) (raw)
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Management of hypertension in pregnancy: prevention, diagnosis, treatment and long‑term prognosis
Kardiologia Polska, 2019
of hypertension in pregnancy 757 to 10% of pregnancies in the United States and Europe. Women with chronic HT (1%-5% of the general population) have a higher risk of PE than women without pre existing HT (17%-25% vs 3%-5%, respectively). Furthermore, 7% to 20% of women with chronic HT have poor BP control in pregnancy (excluding those with PE). Significantly elevated BP in pregnancy is a di rect threat to maternal and fetal health and life. According to the World Health Organization (WHO), HT and its complications are among the leading causes of mortality in pregnancy in developed countries (approx. 16%). 9-11 HT promotes low birth weight (LBW), increas es the risk of PE superimposed on chronic HT and preterm birth, may cause placental abrup tion, leads to complications which require pro longed intensive care of a neonate with special ist neonatal treatment, and may cause intrauter ine fetal death. 12,13 PE is the most dangerous maternal complica tion of HT. PE is associated with a particularly high risk of complications harmful to the mother
Updates in Management of Hypertensive Disorders of Pregnancy
Iris Publishers LLC, 2019
This work is licensed under Creative Commons Attribution 4.0 License WJGWH.MS.ID.000539. Introduction Interestingly, Hypertensive disorders of pregnancy (HDP) were discovered two thousand years ago but our knowledge and data about their nature and pathogenesis are still limited [1]. These disorders can affect many pregnant women all over the world putting them, their families and their countries under significant health burden. For instance, in USA, 240.000 pregnant suffer HDP which equal to 6-12% of all pregnancies [2] and this accounts for 10% of maternal morality being the second common cause of maternal death after postpartum hemorrhage [3]. Moreover, HDP may cause intrauterine fetal death, intrauterine growth restriction and prematurity [4]. Higher prevalence of HDP was found in African Americans, obese, patients with renal disease, chronic hypertensive patients, patients with autoimmune diseases, multiple pregnancy, diabetics and in pregnant women >35 years old or less than twenty [5,6]. Moreover, when we imagine the size of that problem in developing countries, we realize that it is a real disaster affecting families worldwide [7]. Many societies try to classify HDP in spite of presence of an overlap between these classes and subgroups under each category [1]. According to The American College of Obstetricians and Gynecologists (ACOG) and the National High Blood Pressure Education Program Working group on High blood pressure in pregnancy, HDP is classified into chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and preeclampsiaeclampsia superimposed on chronic hypertension [7]. There is difference in hemodynamic and neurohormonal profile of each category [8]. The main goal of all research efforts in treating HDP is how to prevent highly morbid complications and mortality of HDP that may affect both mother and fetus [9]. Mothers with HDP are at risk of renal and liver failure as part of multisystem nature
The Hypertensive Disorders of Pregnancy (29.3)
Best Practice & Research Clinical Obstetrics & Gynaecology, 2015
Hypertensive disorders are the most common medical complication of pregnancy. As such, a large part of antenatal care is dedicated to the detection of pre-eclampsia, the most dangerous of the hypertensive disorders. Highlights of this chapter include progress in the use of out-of-office blood pressure measurement as an adjunct to office blood pressure measurement, pre-eclampsia defined as proteinuria or relevant end-organ dysfunction, antihypertensive therapy for severe and non-severe hypertension, and postpartum follow-up to mitigate the increased cardiovascular risk associated with any of the hypertensive disorders of pregnancy.
The hypertensive disorders of pregnancy
Keywords: hypertension pregnancy pre-eclampsia maternal outcome perinatal outcome long-term prognosis Hypertensive disorders are the most common medical complication of pregnancy. As such, a large part of antenatal care is dedicated to the detection of pre-eclampsia, the most dangerous of the hyper-tensive disorders. The highlights of this chapter include progress in the use of out-of-office blood pressure measurement as an adjunct to office blood pressure measurement, pre-eclampsia defined as proteinuria or relevant end-organ dysfunction, antihypertensive therapy for severe and non-severe hypertension and post-partum follow-up to mitigate the increased cardiovascular risk associated with any of the hypertensive disorders of pregnancy.
Women's Health Reports
Background: Preeclampsia, a condition in pregnancy characterized by new onset high blood pressure and proteinuria, complicates 2%-8% of pregnancies globally. Early detection, careful monitoring, and treatment of high blood pressure are crucial in preventing mortality related to preeclampsia disorders. There is limited data that examines obstetric/gynecologic (OBGYN) provider-type practices concerning management of hypertensive disorders of pregnancy to reduce early onset preeclampsia (EOP). We assessed the knowledge and practice patterns of OBGYN management to reduce EOP. Methods: We conducted a semistructured survey with OBGYN residents, maternal-fetal medicine fellows, and attending physicians (OBGYN and family medicine) at a single academic medical center to assess the management of hypertensive disorders to EOP. Results: Thirty-one participants (71% residents/fellows 29% attendings) completed the survey. Seventy-eight percent of attendings indicated they discuss blood pressure and preeclampsia with all patients compared to 50% of residents/fellows (p = 0.31). Eighty-nine percent of attendings reported they are extremely likely to monitor high-risk patients compared to 36% of residents/fellows (p = 0.07). Conclusion: Attending physicians were more likely to appropriately manage hypertension in women at risk for pregnancy compared to residents/fellows. Further research is needed on monitoring high-risk patients.
Guidelines for the Management of Hypertensive Disorders of Pregnancy, 2008
Obstetric Anesthesia Digest, 2010
This is the Executive Summary of updated guidelines developed by the Society of Obstetric Medicine of Australia and New Zealand for the management of hypertensive diseases of pregnancy. They address a number of challenging areas including the definition of severe hypertension, the use of automated blood pressure monitors, the definition of non-proteinuric pre-eclampsia and measuring proteinuria. Controversial management issues are addressed such as the treatment of severe hypertension and other significant manifestations of pre-eclampsia, the role of expectant management in pre-eclampsia remote from term, thromboprophylaxis, appropriate fluid therapy, the role of prophylactic magnesium sulfate and anaesthetic issues for women with pre-eclampsia. The guidelines stress the need for experienced team management for women with pre-eclampsia and mandatory hospital protocols for treatment of hypertension and eclampsia. New areas addressed in the guidelines include recommended protocols for maternal and fetal investigation of women with hypertension, preconception management for women at risk of pre-eclampsia, auditing outcomes in women with hypertensive diseases of pregnancy and long-term screening for women with previous pre-eclampsia.
HYPERTENSIVE DISORDERS OF PREGNANCY: AN ONGOING HOLOCOUST
National Journal of Community Medicine, 2014
Background: Hypertensive disorders of pregnancy (H.D.P.) can lead to serious complications for both mother and fetus in her womb. Objective: To determine prevalence and some epidemiological factors of hypertensive disordersof pregnancy. Material and Methods: Present study conducted on pregnant women attending antenatal clinicin medical college.It was a cross- sectional study. Information was obtained by face-to-faceinterviews of study subjects. Results:Out of 1566 randomly selected study subjects, 95(6%) were hypertensive. Out of 95hypertensive pregnant women 63.3% were diagnosed as pre-eclampsia, 21.1% as gestationalhypertension, 11.5% as eclampsia and 4.1% as chronic hypertension. H.D.P. is common inwomen with age group >33yrs (20%), who arelabourer(13.2%). It is more prevalent in third trimester(11.1%) of pregnancy and in grandmultiparas (21.6%). Conclusion: Hypertensive disorders of pregnancy are one of the common medical complicationsworsening the outcome of pregnancy.
Archives of Gynecology and Obstetrics, 2005
Objective: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. Materials and methods: A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests. Results: Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28±3.5 and 1000±416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births Conclusion: Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.