Hypertension in pregnancy.
Hypertensive disorders of pregnancy represent the second commonest cause of direct maternal death and complicate an estimated 5-10 % of pregnancies. Classification systems aim to separate hypertension similar to that seen outside pregnancy (chronic and gestational hypertension) from the potentially fatal pregnancy-specific conditions. Preeclampsia, HELLP syndrome, and eclampsia represent increasing severities of this disease spectrum. The American College of Obstetricians and Gynecologists' 2013 guidelines no longer require proteinuria as a diagnostic criterion, because of its variable appearance in the disease spectrum. The cause involves inadequate cytotrophoblastic invasion of the myometrium, resulting in placental hypoperfusion and diffuse maternal endothelial dysfunction. Changes in angiogenic and antiangiogentic peptide profiles precede the onset of clinical preeclampsia. Women with preeclampsia should be closely monitored and receive magnesium sulfate intravenously if severe features, HELLP syndrome, or eclampsia occur. Definitive therapy is delivery of the fetus. Hypertension in pregnancy increases future maternal risk of hypertension and cardiovascular disorders.
Heart Failure Fellow, Heart and Vascular Institute, Cleveland Clinic, Ohio, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, vesta@ccf.org.
Amanda R
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Vest
Leslie S
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Cho
D020533:Angiogenesis Inhibitors / Q000032:analysis / Q000378:metabolism; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use; D001795:Blood Pressure Determination; D019468:Disease Management; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008428:Maternal Mortality; D008429:Maternal Welfare; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index
D020533:Angiogenesis Inhibitors; D000959:Antihypertensive Agents