Management of hypertension in 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
CLINICAL PRACTICE 78 Management of Hypertension in Pregnancy
ABSTRAK Mortalitas maternal akibat hipertensi mencapai 16% bila dibandingkan dengan penyebab lain seperti sepsis, perdarahan maupun abortus. Ibu hamil dengan hipertensi berpotensi mengalami sejumlah komplikasi antara lain koagulasi intravaskular diseminata (KID), perdarahan otak, gangguan fungsi hati, dan gagal ginjal akut. Sedangkan pada janin dapat berakibat pertumbuhan janin terhambat, prematuritas dan mortalitas perinatal. Hipertensi pada kehamilan perlu ditatalaksana dengan baik agar dapat menurunkan angka morbiditas serta mortalitas ibu dan janin, yaitu dengan menghindarkan ibu dari resiko peningkatan tekanan darah, mencegah perkembangan penyakit dan mencegah timbulnya kejang dan pertimbangan terminasi kehamilan jika ibu atau janin dalam keadaan bahaya. ABSTRACT Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for exp...
Bangladesh Journal of Obstetrics & Gynaecology, 2016
The ratios of maternal and perinatal mortality are indicators of the health status of a nation.Maternal near-miss ratio is more commonly used than maternal mortality ratio because it is more frequent than maternal deaths, making for more detailed analyses of the problems in obstetric care 1. High maternal near miss/ maternal mortality ratio and low mortality index show good quality of obstetric care 2 .
Maternal complications of hypertension in pregnancy – A five year study
Indian Journal of Obstetrics and Gynecology Research, 2020
Introduction: Hypertension is the most common medical problem encountered in pregnancy. Approximately 18% of maternal deaths worldwide are due to hypertension complicating pregnancy. For every woman who dies, it is estimated that 20 others suffer severe morbidity or disability. The proportion of women surviving severe maternal complications has been proposed as a useful gauge for the evaluation of the quality of maternal health care and its determinants, with the potential to complement the information obtained from the reviews of maternal deaths. Objectives: To study the prevalence and document the incidence of various maternal complications in women with hypertension in pregnancy. Materials and Methods: A retrospective study was conducted at JSS hospital, Mysuru. The medical records of women with hypertension in pregnancy from 2011 to 2015 were retrieved. The maternal complications were documented. Results: The prevalence of hypertension in pregnancy was 8.5%. Mild pre eclampsia was the most commonly encountered problem. Majority of the women developed hypertension only after 34 weeks. However, various complications such as abruptio placentae, HELLP, acute renal shutdown, disseminated intravascular coagulation, posterior reversible encephalopathy syndrome, retinal changes, and ascites were observed. The mortality rate was 1.6%. Conclusion: Hypertension continues to be a leading cause of maternal morbidity and mortality. However, with timely management, the complications and mortality can be reduced.
BackgroundHypertensive disorders of pregnancy are one of the important causes for adverse maternal and fetal outcome. A proper understanding of this medical disorder in pregnancy is essential to reduce the complications associated with it.ObjectiveTo analyze the maternal and perinatal outcome in hypertensive disordercomplicating pregnancy.Materials & Methods:It is a prospective, observational study of 180 pregnant women with hypertensive disorders of pregnancy admitted to GVH from November 2016 to October 2017. Data was collected regarding antenatal care-booked and unbooked cases, age, parity, gestational age, mode of delivery and maternal complications.Perinatal outcome including birth weight, NICU admissions and perinatal deaths was recorded. Data was analysed and tabulated using SPSS version 24.Results:The total number of deliveries during this period was 7,422 and 180 women had hypertension complicating pregnancy giving an incidence of 2.4%.Normal vaginal delivery was seen in 90 cases (50%) and instrumental delivery in 18 cases (10%). The caesarian section rate was 40%. The number of cases with pulmonary edema was 2 (1.1%), HELLP was 5 cases (2.7%) and abruption was 6 cases (3.3%). DIC was seen in 2 cases (1.1%), renal failure in 1 case (0.5%) and PPH in 11 cases (6.1%) and in 1 case (0.5%) thromboembolism was seen. There were 2 maternal deaths, one with DIC and one with thromboembolism. The number of stillbirths was 20 (11.11%) and growth retardation was 27 cases (15%). The number of cases with birth weight less than 2.5 kg was 39 (21.66%). NICU admission was required for 42 babies (23.33%). Early neonatal deaths occurred in 4 cases (2.2%). The perinatal death rate was 13.3 %.Conclusion:Hypertension in pregnancy is associated with adverse maternal and perinatal outcome. Good antenatal care and early referral can reduce complications.
Control of hypertension in pregnancy
Current Hypertension Reports, 2009
The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. Complications are not limited to preeclampsia but also complicate both preexisting hypertension and isolated gestational hypertension. Blood pressure (BP) management is important but is only one aspect of management of the hypertensive disorders of pregnancy, which may be caused or exacerbated by underlying uteroplacental mismatch between maternal supply and fetal demand. BP treatment thresholds and goals vary in international guidelines, largely refl ecting differences in opinion rather than differences in published data. Because of short-term maternal risks, there is consensus that BP should be treated when sustained at greater than or equal to 160 to 170 mm Hg systolic and/or 110 mm Hg diastolic. There is no consensus regarding management of nonsevere hypertension, and randomized controlled trials involving just over 3000 women have not clarifi ed the relative maternal and perinatal risks and benefi ts. Although antihypertensive therapy may decrease transient severe maternal hypertension, therapy may also impair fetal growth and perinatal health and outcomes. The CHIPS Trial (Control of Hypertension In Pregnancy Study) is recruiting to answer this question.
Factors Affecting with the Prevalence of Hypertension in Pregnancy: Scoping Review
PLACENTUM: Jurnal Ilmiah Kesehatan dan Aplikasinya, 2022
Background: Hypertension is a clinical term to describe the pressure of high blood which cause fetal morbidity due to reduced blood flow to the placenta, such as stunted fetal growth, fetal death in utero to premature birth to cause maternal morbidity such as pulmonary edema, bleeding in the brain, eclamptic seizures, blood clots in the veins, acute kidney failure and even death in the mother. Hypertension in Pregnancy is a major complication that causes 60% to 80% of maternal deaths and maternal morbidity in the worldwide. The purpose of this scoping review is to determine the factors that influence the incidence of hypertension in pregnancy.Method: Scoping Review uses the following databases: Pubmed, Wiley Online Library, and ProQuest. Search results that meet the criteria will then be parsed into articles. Study Use of the Joana Briggs Institute/JBI and synthetic methods using transforming PEOS.Results: From the 108 articles related to the title and abstract, 9 articles met the i...
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
MATERNAL AND PERINATAL OUTCOME IN PREGNANCIES COMPLICATED WITH HYPERTENSIVE DISORDER OF PREGNANCY.
International Journal of Advanced Research (IJAR), 2019
Background:Hypertensive disorders in pregnancy remain a major global health issue because of the associated perinatal morbidity and mortality. The outcomes of women with hypertensive disorders in pregnancy in our hospital in rural area of India have not yet been documented. Objective: To determine maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy at a tertiary care hospital in rural area of India. Material and methods: A prospective study was undertaken on 200 consecutive women of hypertensive disorder in pregnancies that were managed in the Department of Obstetrics &Gynaecology in our hospital from October 2017 to September 2018. The demographic data, clinical and laboratory findings delivery route, indications of caesarean section, foetal and maternal complications were determined. Results:Out of 200 women, 62.2% were found to have pre-eclampsia, 8% had eclampsia, and 27 % had gestational hypertension and 2.5% had chronic hypertension. Proteinuria was demonstrated in 67.5%, thrombocytopenia in 15.5%, liver dysfunction in 11%, abruptio placenta in 4.5%, HELLP syndrome in 3%, and retinal detachment in 0.5% of women. 46.5% women had caesarean section delivery. There was no maternal mortality. 45% neonates were small for gestational age (SGA), 22.5% needed NICU admission. There were 4.5% still births and 3.5% neonatal deaths. Conclusions:Hypertensive disorder of pregnancy is associated with increased risk of maternal and perinatal adverse outcome. The complications could be reduced by regular antenatal check-up, early identification of hypertension and timely referral and specialist care during labour and after birth.