Hypertension and Pregnancy : an important issue
Keywords:
Pregnancy induced Hypertension, Pathophysiology, management
Abstract
Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. It has effects both on expectant mother and foetus. The impact due to hypertensive disorders in pregnancy on maternal and neonatal mortality and morbidity is very high in India and other developing countries. The incidence of pregnancy induced hypertension in India is about 7-10% of all antenatal admission. Severe forms of hypertensive disorders of pregnancy like eclampsia is a major cause of maternal mortality. Hypertensive disorders in pregnancy complicate 1 in 10 pregnancies, often associated with maternal and neonatal mortality and morbidity. Pregnancy induced hypertension is one of the common medical disorders of pregnancy. It complicates 6 to 8% of pregnancies and is the third common cause for maternal mortality and morbidity next to haemorrhage and infections. 18% of maternal deaths are due to pregnancy related hypertension complications. It affects both mother and foetus. Hypertension during pregnancy predisposes to complications like eclampsia, abruptio placentae, disseminated intravascular coagulation, pulmonary oedema, blindness, cerebrovascular haemorrhages, HELLP syndrome, foetus growth restriction and foetal demise. Controlling hypertension in pregnancy prevents complications both in mother and foetus. There are various theories for the aetiology of pregnancy induced hypertension. The common pathophysiological changes seen are imbalance between vasoconstrictor thromboxane and vasodilator prostacyclin resulting in generalised vasospasm. This leads to endothelial damage resulting in release of vasoactive substances. This causes decreased intravascular volume and increased extravascular volume. The effects of this are placental insufficiency resulting in complications. Controlling hypertension in pregnancy using antihypertensive drugs brings down these complications. In this review, we will briefly discuss about Pregnancy induced Hypertension, its pathophysiology, diagnosis and its management.
References
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2. Abdel-Hady el-S, Fawzy, M., El-Nageri, M, Nezar, M., Ragab and Helal, A.S. (2010); Is expectant management of early – onset severe preeclampsia worth while in low resource settings?; Arch Gynecol Obstet; 282(1); 23-27.
3. Bell, M.J. (2010); A historical overview of preeclampsia-eclampsia; J Obstet Gynecol Neonatal Nurs; 39(5);510-518.
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7. Barton, J.R., O’brien, J.M., Bergauer, N.K., Jacques, D.L. and Sibai, B.M. (2001); Mild gestational hypertension remote from term; progression and outcome; Am J Obstet Gynecol; 184(5);979-983.
8. Briones-Garduno, J.C., deLeon-Ponce, M.D., Gonzalez-Vargas, A. and Briones-Vega , C.G. (2003); Perinatal result with conservative treatment in preeclampsia-eclampsia; Cir Cir; 71(2); 112-115.
9. Brichant, G., Dewandre, P.Y., Foidart, J.M. and Brichant, J.F., (2010); Management of severe preeclampsia; Acta Clin Belg; 65(3); 163-169.
10. Bao, S.H. and Liu, J. (1990); Outcome of the mother and baby delivered by caesarean section in pregnancy induced hypertension Analysis of 487 cases; Zhonghua Fu Chan Ke Za Zhi;25(1); 9-11.
11. Churchill, D., Beevers, G.D, Meher, S. and Rhodes, C. (2007); Diuretics for preventing pre-eclampsia; Cochrane Database Syst Rev, (1); CD004451.
12. Chung, N.A., Beevers, D.G. and Lip, G.Y. (2001); Management of hypertension in pregnancy; Am J Cardiovasc Drugs; 1(4); 253-262.
13. Chandiramani, M., Joash, K. and Shennan, A.H. (2010); Options and decisionmaking: hypertensive disorders of pregnancy; Future Cardiol, 6(4);535-546.
14. Chen, G., Wilson, R., Cumming, G., Walker, J. and Smith, W.E. (1993); Prostacyclin, thromboxane and antioxidant levels in pregnancy induced hypertension; Europ J Obstet Gynaec Reprod Biol, 50;243-250.
15. Davey, D.A. and MacGillivary, I. (1998); The classification and definition of hypertensive disorders of pregnancy; Am J Obstet Gynecol; 158;892-898.
16. Duley, L. (2009); The global impact of pre-eclampsia and eclampsia; Semin Perinatol;33(3);130-137.
17. Granger, J.P., Alexander, B.T., Bennett, W.A. and Khalil, R.A. (2001a). Pathophysiology of pregnancy-induced hypertension. Am J Hypertens, 14(6):178S185S.
18. Ghanem, F.A. and Movahed, A. (2008); Use of antihypertensive drugs during pregnancy and lactation; Cardiovasc Ther; 26(1); 38-49.
19. Haddad, B., Masso, C., Deis, S., Touboul, C. and Kayem, G. (2010); Criteria of pregnancy termination in women with preeclampsia. Ann Fr Anesth Reanim; 29(4); e59-68.
20. Haddad, B., Deis, S., Goffinet, F., Paniel, B.J., Cabrol, D. and Siba, B.M. (2004);Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks gestation; Am J Obstet Gynecol; 190(6); 1595-1597.
21. Homer, C.S., Brown, M.A., Mangos, G. and Davis, G.K. (2008); Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension; J Hypertens; 26(2); 295-302.
22. Haram, K., Biorge, L. and Guttu, K. (2000); Pathophysiology and clinical manifestations in pre eclampsia. Tidsskr Nor Laegeforen; 120(12); 1426-1431.
23. Higgins, J.R and de Swiet, M. (2001); Blood pressure measurement and classification in pregnancy; Lancet; 357(9250); 131-5.
24. Helewa, M.E., Burrows, R.F., Smith, J., Williams, K., Brain, P. and Rabkin, S.N. (1997); Report of the Canadian Hypertension Society Consensus Conference: 1: Definitions, evaluation and classification of hypertensive disorders of pregnancy; Can Med Assoc J; 157; 715-725.
25. Huang Y. (2001); Incidence of pregnancy induced hypertension and the effects on mother and fetus in Shanghai during 1989-98; Zhonghua Fu Chan KeZa Zhi; 36 (3);137-139.
26. Jain, L. (1997); Effects of pregnancy-induced and chronic hypertension on pregnancy outcome; J Perinatol; 17(6); 425-427.
27. Koopmans, C.M., Bijenga, D., Aarnoudse, van Beek, E., Bekedam, D.J., van den Berg P.P., et al., (2007); Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial; BMC Pregnancy Childbirth; 27; 7-14.
28. Leeman, L. and Fontaine, P. (2008); Hypertensive disorders of pregnancy. Am Fam Physician; 78(1); 93-100.
29. Lowe, S.A. and Rubin, P.C. (1992); The pharmacological management of hypertension in pregnancy; J Hypertens; 10(3);201-207.
30. Magee, L.A., Helewa, M., Moutquine, J.M. and von Dadelszen, P., (2008); Diagnosis, evaluation and management of the hypertensive disorders of pregnancy; JOGC; 30(3); S1-S31.
31. Medina Lomeli, J.M. and Medina Castro, N. (2005); Differences and similarities of preeclampsia and gestational hypertension; Ginecol Obstet Mex; 73(1); 48-53.
32. Moodley, J. (2011); Maternal deaths associated with hypertension in South Africa: lessons to learn from the saving mothers report, 2005-2007; Cardiovasc J Afr; 22(1); 31-35.
33. NHBPEP, Working Group on High Blood Pressure in Pregnancy, (2000); Report of National High Blood Pressure Education Program, working group on high blood pressure in pregnancy; Am J Obstet Gynecol; 183; S1-S22.
34. Pourrat, O. and Pierre, F. (2010); Medical assessment after a pre-eclampsia: why? for whom? when? how? for what purpose? Rev Med Interne; 31(11); 766-771.
35. Palmsten, K., Buka, S.L. and Michels, K.B. (2010); Maternal pregnancy-related hypertension and risk for hypertension in offspring later in life; Obstet Gynecol; 116(4); 858-864.
36. Podymow, T. and August, P. (2008); Update on the Use of Antihypertensive Drugs in pregnancy; Hypertension; 51; 960-969.
37. Podymow, T. and August, P. (2010); Postpartum course of gestational hypertension and preeclampsia; Hypertens Pregnancy; 29(3); 294-300.
38. Steegers, E.A., von Dadelszen, P., Duvekot, J.J. and Pijnenborg, R. (2010); Preeclampsia; Lancet; 376(9741); 631-644.
39. Shruti, S., Dubhashi, R., Wani, J., Priti Chikhal and Hegde, C.V. (2008); PIHconfounding situations, management dilemmas and severe consequences: Does antenatal care have a role?; Bombay Hospital Journal; 50; 34-37.
40. Soares, V.M., de Souz, K.V., Freygang, T.C., Correa, V. and Saito, M.R. (2009); Maternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil; Rev Bras Ginecol Obstet;31(11); 566-573.
41. Sarsam, D.S., Shamden, M. and Al Wazan, R. (2008); Expectant versus aggressive management in severe preeclampsia remote from term; Singapore Med J; 49(9);698- 703.
42. Suzuki, S. (2010); The benefit of labor induction for preeclampsia beyond 37 weeks gestation; J Matern Fetal Neonatal Med; 23(9);1072.
43. WHO, World Health Organization Group, (1987); The Hypertensive disorders in pregnancy; Technical Report Series, WHO; 758.
44. Wang, A., Rana, S. and Anath Karumanchi, S. (2009); Preeclampsia: The role of angiogenic factors in its pathogenesis; Physiology; 24(3); 147-158.
45. Weeks, A.D., Alia, G., Ononge, S., Otolorin, E.O. and Mirembe, F.M. (2005); A criteria-based audit of the management of severe pre-eclampsia in Kampala, Uganda; Int J Gynaecol Obstet; 91(3); 292-297.
46. Witlin, A.G., Saade, G.R., Mattar, F. and Sibai, B.M. (2000); Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks’ gestation; Am J Obstet Gynecol; 182(3); 607-611.
47. Xiong, X., Buekens, P., Pridjan, G. and Fraser, W.D. (2007); Pregnancy-induced hypertension and perinatal mortality; J Reprod Med; 52(5);402-406.
48. Yucesoy, G., Ozkan, S., Bodur, H., Tan, T., Caliskan,E., Vural, B. and Corakci, A. (2005); Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care centre; Arch Gynecol Obstet; 273(1); 43-49.
49. Ye, R.W., Li, H.T, Ma, R., Ren, A.G. and Liu, J.M. (2010); Prospective cohort study of pregnancy induced hypertension and risk of preterm delivery and low birth weight; Zhonghua Yu Fang Yi Xue Za Zhi; 44(1); 70-74.
2. Abdel-Hady el-S, Fawzy, M., El-Nageri, M, Nezar, M., Ragab and Helal, A.S. (2010); Is expectant management of early – onset severe preeclampsia worth while in low resource settings?; Arch Gynecol Obstet; 282(1); 23-27.
3. Bell, M.J. (2010); A historical overview of preeclampsia-eclampsia; J Obstet Gynecol Neonatal Nurs; 39(5);510-518.
4. Brown, M.A., Hague, W.M., Higgins, J., Lowe, S., McCowan, L., Oats, J., et al., (2000); The detection, investigation and management of hypertension in pregnancy; Aust N Z J Obstet Gynaecol; 40(2);133-138.
5. Brown, M.A., Lindheimer, M.D., de Swiet, M., Van Assche, A. and Moutquine, J.M. (2001); The classification and diagnosis of hypertensive disorders of pregnancy; Hypertens Preg; 20; 9-14.
6. Brown, M.A. and de Swiet, M. (1999); Classification of hypertension in pregnancy; Baillieres Best Pract Res Clin Obstet Gynaecol; 13(1);27-39.
7. Barton, J.R., O’brien, J.M., Bergauer, N.K., Jacques, D.L. and Sibai, B.M. (2001); Mild gestational hypertension remote from term; progression and outcome; Am J Obstet Gynecol; 184(5);979-983.
8. Briones-Garduno, J.C., deLeon-Ponce, M.D., Gonzalez-Vargas, A. and Briones-Vega , C.G. (2003); Perinatal result with conservative treatment in preeclampsia-eclampsia; Cir Cir; 71(2); 112-115.
9. Brichant, G., Dewandre, P.Y., Foidart, J.M. and Brichant, J.F., (2010); Management of severe preeclampsia; Acta Clin Belg; 65(3); 163-169.
10. Bao, S.H. and Liu, J. (1990); Outcome of the mother and baby delivered by caesarean section in pregnancy induced hypertension Analysis of 487 cases; Zhonghua Fu Chan Ke Za Zhi;25(1); 9-11.
11. Churchill, D., Beevers, G.D, Meher, S. and Rhodes, C. (2007); Diuretics for preventing pre-eclampsia; Cochrane Database Syst Rev, (1); CD004451.
12. Chung, N.A., Beevers, D.G. and Lip, G.Y. (2001); Management of hypertension in pregnancy; Am J Cardiovasc Drugs; 1(4); 253-262.
13. Chandiramani, M., Joash, K. and Shennan, A.H. (2010); Options and decisionmaking: hypertensive disorders of pregnancy; Future Cardiol, 6(4);535-546.
14. Chen, G., Wilson, R., Cumming, G., Walker, J. and Smith, W.E. (1993); Prostacyclin, thromboxane and antioxidant levels in pregnancy induced hypertension; Europ J Obstet Gynaec Reprod Biol, 50;243-250.
15. Davey, D.A. and MacGillivary, I. (1998); The classification and definition of hypertensive disorders of pregnancy; Am J Obstet Gynecol; 158;892-898.
16. Duley, L. (2009); The global impact of pre-eclampsia and eclampsia; Semin Perinatol;33(3);130-137.
17. Granger, J.P., Alexander, B.T., Bennett, W.A. and Khalil, R.A. (2001a). Pathophysiology of pregnancy-induced hypertension. Am J Hypertens, 14(6):178S185S.
18. Ghanem, F.A. and Movahed, A. (2008); Use of antihypertensive drugs during pregnancy and lactation; Cardiovasc Ther; 26(1); 38-49.
19. Haddad, B., Masso, C., Deis, S., Touboul, C. and Kayem, G. (2010); Criteria of pregnancy termination in women with preeclampsia. Ann Fr Anesth Reanim; 29(4); e59-68.
20. Haddad, B., Deis, S., Goffinet, F., Paniel, B.J., Cabrol, D. and Siba, B.M. (2004);Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks gestation; Am J Obstet Gynecol; 190(6); 1595-1597.
21. Homer, C.S., Brown, M.A., Mangos, G. and Davis, G.K. (2008); Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension; J Hypertens; 26(2); 295-302.
22. Haram, K., Biorge, L. and Guttu, K. (2000); Pathophysiology and clinical manifestations in pre eclampsia. Tidsskr Nor Laegeforen; 120(12); 1426-1431.
23. Higgins, J.R and de Swiet, M. (2001); Blood pressure measurement and classification in pregnancy; Lancet; 357(9250); 131-5.
24. Helewa, M.E., Burrows, R.F., Smith, J., Williams, K., Brain, P. and Rabkin, S.N. (1997); Report of the Canadian Hypertension Society Consensus Conference: 1: Definitions, evaluation and classification of hypertensive disorders of pregnancy; Can Med Assoc J; 157; 715-725.
25. Huang Y. (2001); Incidence of pregnancy induced hypertension and the effects on mother and fetus in Shanghai during 1989-98; Zhonghua Fu Chan KeZa Zhi; 36 (3);137-139.
26. Jain, L. (1997); Effects of pregnancy-induced and chronic hypertension on pregnancy outcome; J Perinatol; 17(6); 425-427.
27. Koopmans, C.M., Bijenga, D., Aarnoudse, van Beek, E., Bekedam, D.J., van den Berg P.P., et al., (2007); Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial; BMC Pregnancy Childbirth; 27; 7-14.
28. Leeman, L. and Fontaine, P. (2008); Hypertensive disorders of pregnancy. Am Fam Physician; 78(1); 93-100.
29. Lowe, S.A. and Rubin, P.C. (1992); The pharmacological management of hypertension in pregnancy; J Hypertens; 10(3);201-207.
30. Magee, L.A., Helewa, M., Moutquine, J.M. and von Dadelszen, P., (2008); Diagnosis, evaluation and management of the hypertensive disorders of pregnancy; JOGC; 30(3); S1-S31.
31. Medina Lomeli, J.M. and Medina Castro, N. (2005); Differences and similarities of preeclampsia and gestational hypertension; Ginecol Obstet Mex; 73(1); 48-53.
32. Moodley, J. (2011); Maternal deaths associated with hypertension in South Africa: lessons to learn from the saving mothers report, 2005-2007; Cardiovasc J Afr; 22(1); 31-35.
33. NHBPEP, Working Group on High Blood Pressure in Pregnancy, (2000); Report of National High Blood Pressure Education Program, working group on high blood pressure in pregnancy; Am J Obstet Gynecol; 183; S1-S22.
34. Pourrat, O. and Pierre, F. (2010); Medical assessment after a pre-eclampsia: why? for whom? when? how? for what purpose? Rev Med Interne; 31(11); 766-771.
35. Palmsten, K., Buka, S.L. and Michels, K.B. (2010); Maternal pregnancy-related hypertension and risk for hypertension in offspring later in life; Obstet Gynecol; 116(4); 858-864.
36. Podymow, T. and August, P. (2008); Update on the Use of Antihypertensive Drugs in pregnancy; Hypertension; 51; 960-969.
37. Podymow, T. and August, P. (2010); Postpartum course of gestational hypertension and preeclampsia; Hypertens Pregnancy; 29(3); 294-300.
38. Steegers, E.A., von Dadelszen, P., Duvekot, J.J. and Pijnenborg, R. (2010); Preeclampsia; Lancet; 376(9741); 631-644.
39. Shruti, S., Dubhashi, R., Wani, J., Priti Chikhal and Hegde, C.V. (2008); PIHconfounding situations, management dilemmas and severe consequences: Does antenatal care have a role?; Bombay Hospital Journal; 50; 34-37.
40. Soares, V.M., de Souz, K.V., Freygang, T.C., Correa, V. and Saito, M.R. (2009); Maternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil; Rev Bras Ginecol Obstet;31(11); 566-573.
41. Sarsam, D.S., Shamden, M. and Al Wazan, R. (2008); Expectant versus aggressive management in severe preeclampsia remote from term; Singapore Med J; 49(9);698- 703.
42. Suzuki, S. (2010); The benefit of labor induction for preeclampsia beyond 37 weeks gestation; J Matern Fetal Neonatal Med; 23(9);1072.
43. WHO, World Health Organization Group, (1987); The Hypertensive disorders in pregnancy; Technical Report Series, WHO; 758.
44. Wang, A., Rana, S. and Anath Karumanchi, S. (2009); Preeclampsia: The role of angiogenic factors in its pathogenesis; Physiology; 24(3); 147-158.
45. Weeks, A.D., Alia, G., Ononge, S., Otolorin, E.O. and Mirembe, F.M. (2005); A criteria-based audit of the management of severe pre-eclampsia in Kampala, Uganda; Int J Gynaecol Obstet; 91(3); 292-297.
46. Witlin, A.G., Saade, G.R., Mattar, F. and Sibai, B.M. (2000); Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks’ gestation; Am J Obstet Gynecol; 182(3); 607-611.
47. Xiong, X., Buekens, P., Pridjan, G. and Fraser, W.D. (2007); Pregnancy-induced hypertension and perinatal mortality; J Reprod Med; 52(5);402-406.
48. Yucesoy, G., Ozkan, S., Bodur, H., Tan, T., Caliskan,E., Vural, B. and Corakci, A. (2005); Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care centre; Arch Gynecol Obstet; 273(1); 43-49.
49. Ye, R.W., Li, H.T, Ma, R., Ren, A.G. and Liu, J.M. (2010); Prospective cohort study of pregnancy induced hypertension and risk of preterm delivery and low birth weight; Zhonghua Yu Fang Yi Xue Za Zhi; 44(1); 70-74.
Published
2019-08-01
How to Cite
[1]
Maqbool, M. and Khan, M. 2019. Hypertension and Pregnancy : an important issue. PharmaTutor. 7, 8 (Aug. 2019), 71-78.
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Articles
