title: [Hypertensive disorders in pregnancy: vigilance on the part of general practitioners].
abstract: Hypertensive disorders of pregnancy are one of the main causes of maternal morbidity and mortality in the Netherlands. In this paper, we present 3 cases of nulliparous pregnant women, two 25-year-olds and a 31-year-old, who developed symptoms between 27 en 29 weeks of gestation for which they consulted their general practitioner. In spite of available guidelines, there was a significant delay in all cases in the diagnosis and treatment of severe pre-eclampsia. In 2 cases, the delay occurred because blood pressure measurements were not performed; in 1 of these cases proteinuria was mistaken for cystitis and treated as such. In the third case failure to recognize key symptoms led to untimely referral to a gynaecologist. All 3 women delivered preterm and 1 neonate died of necrotizing enterocolitis shortly after delivery. To prevent unnecessary delay we therefore stress the importance of the timely recognition of signs and symptoms of hypertensive disorders of pregnancy in a primary care setting, as well as appropriate early antenatal education and counseling for all pregnant women.
authors.affiliation: Vrije Universiteit medisch centrum, afd. Verloskunde en gynaecologie, Amsterdam, the Netherlands. s.luitjes@vumc.nl
authors.forename: Susanne H E
authors.initials: SH
authors.lastname: Luitjes
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Bas B
authors.initials: BB
authors.lastname: van Rijn
authors.forename: Antoinette C
authors.initials: AC
authors.lastname: Bolte
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D009426:Netherlands; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care; D013997:Time Factors