High risk pregnancy series:and expert’s viewDiagnosis and Management of Gestational Hypertension and Preeclampsia
Section snippets
Gestational hypertension
Defined as a systolic BP of at least 140 mm Hg and/or a diastolic BP of at least 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation in women known to be normotensive before pregnancy and before 20 weeks’ gestation. The BP recordings used to establish the diagnosis should be no more than 7 days apart.1 Gestational hypertension is considered severe if there is sustained elevations in systolic BP to at least 160 mm Hg and/or in diastolic BP to at least 110
Etiology and pathophysiology
The etiology of preeclampsia is unknown. During the past centuries several etiologies have been suggested, but most of them have not withstood the test of time. Some of the remaining potential etiologies include abnormal trophoblast invasion of uterine blood vessels, immunological intolerance between fetoplacental and maternal tissues, maladaptation to the cardiovascular changes or inflammatory changes of pregnancy, dietary deficiencies, and genetic abnormalities.
The pathophysiologic
Prediction and prevention
Prevention of any disease process requires knowledge of its etiology and pathogenesis, as well as the availability of methods to predict or identify those at high risk for this disorder. Numerous clinical, biophysical, and biochemical tests have been proposed for the prediction or early detection of preeclampsia. Unfortunately, most of these tests suffer from poor sensitivity and poor positive predictive values, and the majority of them are not suitable for routine use in clinical practice.11
At
Gestational hypertension
In general, the majority of cases of mild gestational hypertension develop at or beyond 37 weeks’ gestation, and thus pregnancy outcome is similar or superior to that seen in women with normotensive pregnancies (Table 2). Both gestational age at delivery and birth weight in these pregnancies are higher than those in normotensive pregnancies.3, 4, 5, 6 However, women with gestational hypertension are more likely to have higher rates of induction of labor for maternal reasons and higher rates of
Antepartum management of mild hypertension–preeclampsia
The optimal treatment of women with mild gestational hypertension or preeclampsia before 37 weeks’ gestation is controversial. There is disagreement regarding the benefits of hospitalization, complete bed rest, and use of antihypertensive medications.
Expectant management of severe preeclampsia?
The clinical course of severe preeclampsia may be characterized by progressive deterioration in both maternal and fetal conditions. Because these pregnancies have been associated with increased rates of maternal morbidity and mortality and with significant risks for the fetus (growth restriction, hypoxemia, and death), there is universal agreement that all such patients should deliver if the disease develops after 34 weeks’ gestation. Prompt delivery is also clearly indicated when there is
Recommended management
The primary objective of management in women with gestational hypertension–preeclampsia must always be safety of the mother and then delivery of a mature newborn who will not require intensive and prolonged neonatal care. This objective can be achieved by formulating a management plan that takes into consideration one or more of the following: the severity of the disease process, fetal gestational age, maternal and fetal status at time of initial evaluation, presence of labor, cervical Bishop
Summary
The etiology and pathogenesis of gestational hypertension and preeclampsia remain unknown. Despite all the recent research efforts, there are no reliable tests to predict the development of preeclampsia and there are no effective therapeutic methods to prevent preeclampsia. As a result, gestational hypertension and preeclampsia remain a major obstetric problem, accounting for a large percentage of maternal and perinatal morbidities. At present, there are few, if any, multicenter randomized
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