Diagnosis and Management of Gestational Hypertension and Preeclampsia

Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0526, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 08/2003; 102(1):181-92. DOI: 10.1016/S0029-7844(03)00475-7
Source: PubMed

ABSTRACT Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications. Women with diagnosed gestational hypertension-preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks' gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks' gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertension-preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia.

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    ABSTRACT: Preeclampsia affects 2-3% of the pregnancies worldwide and is one of the main causes of maternal death and premature birth. Its first stage is related to the invasion of the maternal decidua and the remodeling of the uterine spiral arteries by the extravillous trophoblast. An enhancement of the systemic and local renin-angiotensin system has been identified in PE patients, and the RAS counter-regulatory kallikrein–kinin system is expressed in extravillous trophoblasts. The aim of the present study was to evaluate the effect of a misbalance provoked by exogenous Angiotensin II (AII) and blockade of the B2R receptor by the non-peptide antagonist Bradyzide (BDZ) on the migratory phenotype and and on invasive capacity of HRT8/SVneo cells, a well accepted trophoblast in vitro model. HTR-8/SVneo cells express Kalicrein, Kininogen, AT1, AT2, B1R and B2R. AII, AII+BDZ and losartan induced marked changes in the length and shape of filopodias. AII and AII+BDZ reduced significantly the number of filopodias, the migration and invasion capacity. Losartan reverted the effect of AII on the number of filopodias and the invasion index. In conclusion an induced disequilibrium between the AT1 and B2R alters morphological and motile characteristics that could explain in part the cellular aspects of the impaired trophoblastic invasion present on preeclampsia and could be a potential treatment target for preeclampsia.
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    ABSTRACT: Objective To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Methods A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders. Results A total of 368 women were analyzed. Of 10 maternal deaths, three (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders. Conclusion Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia.
    International Journal of Gynecology & Obstetrics 12/2014; 5(1). DOI:10.1016/j.ijgo.2014.06.010 · 1.56 Impact Factor
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    ABSTRACT: Discussion continues as to whether de novo hypertension in pregnancy with significant proteinuria (pre-eclampsia; PE) and non-proteinuric new hypertension (gestational hypertension; GH) are parts of the same disease spectrum or represent different conditions. Non-pregnant hypertension, pregnancy and PE are all associated with oxidative stress. We have established a 6 weeks postpartum clinic for women who experienced a hypertensive pregnancy. We hypothesized that PE and GH could be distinguished by markers of oxidative stress; thiobarbituric acid reactive substances (TBARS) and antioxidants (ferric ion reducing ability of plasma; FRAP). Since the severity of PE and GH is greater pre-term, we also compared pre-term and term disease. Fifty-eight women had term PE, 23 pre-term PE, 60 had term GH and 6 pre-term GH, 11 pre-existing (essential) hypertension (EH) without PE. Limited data were available from normotensive pregnancies (n = 7) and non-pregnant controls (n = 14). There were no differences in postpartum TBARS or FRAP between hypertensive states; TBARS (P = 0.001) and FRAP (P = 0.009) were lower in plasma of non-pregnant controls compared to recently-pregnant women. Interestingly FRAP was higher in preterm than term GH (P = 0.013). In PE and GH, TBARS correlated with low density lipoprotein (LDL)-cholesterol (P = 0.036); this association strengthened with inclusion of EH (P = 0.011). The 10 year Framingham index for cardiovascular risk was positively associated with TBARS (P = 0.003). Oxidative stress profiles do not differ between hypertensive states but appear to distinguish between recently-pregnant and non-pregnant states. This suggests that pregnancy may alter vascular integrity with changes remaining 6 weeks postpartum. LDL-cholesterol is a known determinant of oxidative stress in cardiovascular disease and we have shown this association to be present in hypertensive pregnancy further emphasizing that such a pregnancy may be revealing a pre-existing cardiovascular risk.
    Frontiers in Physiology 08/2014; 5:310. DOI:10.3389/fphys.2014.00310


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