Hypertensive disorders in pregnancy

Abstract

Hypertensive disorders in pregnancy (HDP) affect 10% of pregnant patients and are the second most common cause of maternal mortality and adverse fetal outcomes in developed countries. HDP is a group of diseases that includes preeclampsia, eclampsia, pregnancy induced hypertension and HELLP syndrome.

Inadequate placentation, immune intolerance and genetics are accounted as possible etiological factors. Clinically, HDP manifests as hypertension, multi-organ dysfunction and placental insufficiency due to vasoconstriction, endothelial dysfunction and micro-thrombosis. Moderate to severe disease requires inpatient management with antihypertensive drugs, magnesium and early delivery. Early epidural analgesia is beneficial in reducing blood pressure and providing effective block for obstetric interventions.

Early diagnosis, adequate blood pressure control, seizure prophylaxis and identification of the most suitable time for delivery improve feto-maternal outcomes.

Citation:Jafar MF. Hypertensive disorders in pregnancy. Anaesth Pain & Intensive Care 2015;19(1):80-86

Abbreviations used:

PIH                 Pregnancy induced hypertension

HDP                Hypertensive disorders of pregnancy

SDB                 Systolic blood pressure

DBP                Diastolic blood pressure

CVP                 Central venous pressure

CTG                Cardiotocograph

ECG                Electrocardiogram

VEGF             Vascular endothelial growth factor

PIGF               Placental growth factor

sFlt-1               Placental soluble fms-like tyrosine kinase 1

ACE                Angiotensin converting enzyme

ARBs               Angiotensin receptor blockers