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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    • "Currently the preeclampsia management is the pregnancy termination [3] supported by the control of blood pressure and coagulation administrating aspirin and methyldopa [20] however, this strategy does not improve significantly the clinical outcome and their use is associated with several side effects [21]. Even when the management of RAS alterations appears to be a logical choice, given the strong evidence about an excessive AT1 receptor activation during preeclampsia and the studies carried on animal models [22] [23] [24], there is a complete lack of clinical studies testing low doses of Losartan in preeclampsia patients. "
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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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    • "Although the frequency of eclampsia in this hypertensive population was high, it is similar to the rate of 15% reported by Buga et al. [11], but higher than that of 11% reported by Yücesoy et al. [21]. Generally, the frequency of eclampsia in a population of women with pre-eclampsia is about 1% [22]. The higher figure obtained in the present study might be attributed to large numbers of complicated cases of hypertensive disorders in pregnancy, including women with eclampsia who were referred to KBTH for specialist care. "
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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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    • "Gestational hypertension (blood pressure ≥140/90 mmHg on at least two separate readings spaced ≥6 hours apart after 20 weeks’ gestation occurring in women who were normotensive before pregnancy) and preeclampsia (gestational hypertension accompanied by proteinuria) collectively refer to a spectrum of hypertensive conditions that develop during pregnancy, with or without accompanying organ dysfunction.198 Approximately half of gestational hypertension cases that develop prior to 30 weeks’ gestation will progress to preeclampsia.198 "
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    ABSTRACT: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.
    Drug, Healthcare and Patient Safety 09/2014; 6:109-29. DOI:10.2147/DHPS.S43308
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