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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy.
    The western journal of emergency medicine 03/2015; 16(2):291-301. DOI:10.5811/westjem.2015.1.23688
  • [Show abstract] [Hide abstract]
    ABSTRACT: HELLP syndrome is a collection of symptoms described as hemolysis, elevated liver enzymes and low platelets. HELLP syndrome complicates 0.01-0.6% of pregnancies and can be considered a severe variant of preeclampsia. The occurrence of HELLP syndrome diagnosed before the 20th week of gestation has been most commonly reported in association with antiphospholipid antibody syndrome (APS) or triploid chromosomal anomalies. A 41-year-old primigravida was admitted at 17 weeks and 6 days gestation with hypertension, proteinuria, hemolytic anemia and acute renal injury. She was diagnosed with HELLP syndrome, and subsequently suffered from an intrauterine fetal demise. After delivery, the clinical manifestations of HELLP syndrome resolved within 7 days with the exception of her acute renal failure. Interdisciplinary teams of physicians were able to exclude other imitators of preeclampsia, such as hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), APS, lupus and acute fatty liver of pregnancy. This case is difficult to diagnose, given the similar presentation of several microangiopathic hemolytic anemias. The clinical manifestations and laboratory findings of HELLP and its mimicking conditions seem as if they are mirror images of each other. However, the discrete differences in our patient presentation, clinical findings, laboratory results and overall postpartum course leave HELLP syndrome as the most consistent diagnosis. It is imperative to investigate for all possible etiologies as HELLP syndrome at 17 weeks gestation is extremely rare and mimicking conditions may require alternative management strategies.
    12/2014; 3(4):147-150. DOI:10.14740/jcgo297w
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hypertensive disorders of pregnancy are the most common causes of adverse maternal & perinatal outcomes. Such investigations in resource limited settings would help to have great design strategies in preventing maternal and perinatal morbidity and mortality. To determine management outcome and factor associated with pregnancy related hypertensive disorder in Mettu Karl Referral Hospital, Mettu, Ethiopia. A retrospective study deign was conducted at Mettu Karl Referral Hospital from 1st January 2010 to December 1st 2013 by reviewing medical records and logbooks. Descriptive, binary and multiple logistic regression analysis were used. A 95% CI and P- value of < 0.05 were considered statistically significant. The magnitude of pregnancy related hypertensive disorder was 2.4%. Majority 82.6% of the mothers were in the age range between 18 to 34 year with a mean age and standard deviation (SD) of 24.4 (SD ± 5.12). Sever preeclampsia was the most prevalent diagnosis made to 35.5% of the mother, followed by 19% cases of eclampsia and 12.4% of HELLP. Fetal management outcomes indicates 120.37 perinatal mortality per 1000 deliveries and a stillbirth rate of 10.2%, low birth weight of 30.5%, and low APGAR score of 18.5%, abortion 10.7% and preterm delivery 31.4%. In this study severe preeclampsia is the most common of all pregnancy related hypertension disorders followed by Eclampsia. Fetal complications like low Apgar score and preterm deliveries were statistically significant and associated with fetal management outcomes.
    Journal of Ovarian Research 01/2015; 8(1):10. DOI:10.1186/s13048-015-0135-5 · 2.03 Impact Factor


Available from