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New Treatments for Hypertension in Pregnancy

Hypertension occurs in 6-10% of pregnancies, and it causes 15% of maternal deaths. Perinatal morbidity and mortality occur secondary to direct fetal effects and iatrogenic preterm delivery. The cause of pregnancy induced hypertension is unknown, and the disease process is reversed only by delivery. Two distinct entities are commonly encountered in pregnant women: Chronic hypertension and pregnancy-induced hypertension (PIH).

These two conditions may coexist; the risk of developing PIH is significantly increased in women with underlying chronic hypertension.

Classification of Hypertensive Diseases in Pregnancy

Chronic Hypertension is defined as blood pressure >140/90 at <20 weeks of gestation.

Pregnancy Induced Hypertension is defined as a sustained blood pressure increase to 140/90 at >20 weeks gestation.

Superimposed Pregnancy-Induced Hypertension is defined as coexistence of chronic hypertension and pregnancy-induced hypertension.

Clinical Manifestations of Severe Disease in Patients with PIH

Blood pressure >160-180 mm Hg systolic or >110 mm Hg diastolic

Proteinuria >5 g/24 h or > 1+ on dipstick (normal <300 mg/24 h)

Elevated serum creatinine

Generalized seizures (eclampsia)

Pulmonary edema

Oliguria <500 mL/24 hours

Microangiopathic hemolysis

Thrombocytopenia

Hepatocellular dysfunction (elevated alanine toxemia preeclampsia, aminotransferase, aspartase aminotransferase)

Intrauterine growth restriction or oligohydramnios

Symptoms suggesting significant end-organ involvement: headache, visual disturbances, or epigastric or right-upper quadrant pain

Pregnancy Induced Hypertension