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Contents:
  1. References
  2. Hypertension in pregnancy: an emerging risk factor for cardiovascular disease
  3. High blood pressure and pregnancy: Know the facts - Mayo Clinic
  4. Gestational hypertension

After initial ultrasonography to evaluate fetal anatomy, ultrasonography is done monthly starting at about 28 weeks to monitor fetal growth; antenatal testing often begins at 32 weeks. Ultrasonography to monitor fetal growth and antenatal testing may start sooner if women have additional complications eg, renal disorders or if complications eg, growth restriction occur in the fetus. Delivery should occur by 37 to 39 weeks but may be induced earlier if preeclampsia or fetal growth restriction is detected or if fetal test results are nonreassuring.

Initial methyldopa dose is mg po twice a day, increased as needed to a total of 2 g a day unless excessive somnolence, depression, or symptomatic orthostatic hypotension occurs. The most commonly used beta-blocker is labetalol a beta-blocker with some alpha-1 blocking effects , which can be used alone or with methyldopa when the maximum daily dose of methyldopa has been reached. Usual dose of labetalol is mg twice or 3 times a day, increased as needed to a total maximum daily dose of mg. Adverse effects of beta-blockers include increased risk of fetal growth restriction, decreased maternal energy levels, and maternal depression.

References

Thiazide diuretics are only used to treat chronic hypertension during pregnancy if the potential benefit outweighs the potential risk to the fetus. Dose may be adjusted to minimize adverse effects such as hypokalemia. ACE inhibitors are contraindicated because risk of fetal urinary tract abnormalities is increased. ARBs are contraindicated because they increase risk of fetal renal dysfunction, lung hypoplasia, skeletal malformations, and death.

Aldosterone antagonists spironolactone and eplerenone should be avoided because they may cause feminization of a male fetus. Both chronic and gestational hypertension increase risk of preeclampsia, eclampsia, other causes of maternal mortality or morbidity eg, hypertensive encephalopathy, stroke, renal failure, left ventricular failure, HELLP syndrome , and uteroplacental insufficiency. Check for other causes of hypertension if severe hypertension occurs for the first time in a pregnant woman who does not have a multifetal pregnancy or gestational trophoblastic disease.

If drug therapy is necessary, start with methyldopa , a beta-blocker, or a calcium channel blocker. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. Common Health Topics. Videos Figures Images Quizzes.

General reference. Key Points. Venous gasometry: normal. Chest X-ray: no pathological findings. Electrocardiogram: sinus rhythm, no blockages or signs of ischaemia. Funduscopy: normal. Anatomopathological exam of the placenta: normal.

Hypertension in pregnancy: an emerging risk factor for cardiovascular disease

The examination was completed with a CT with contrast medium and magnetic resonance imaging, which revealed a 1cm-adenoma in the left suprarenal gland Figure 1. At present, BP is controlled with 50mg of spironolactone per day, and the patient is waiting for a left suprarenalectomy to avoid complications in future pregnancies. It is not usually associated with oedemas or proteinuria and BP normalises after the birth, although high BP levels can persist up to 10 days following delivery. In our study, having dismissed previous essential ATH and pre-eclampsia, we investigated the possibility of secondary ATH, and finally diagnosed primary hyperaldosteronism from the supplementary tests mentioned above.

Approach to the patient with hypertension and hypokalemia. UpToDate Lobular pattern of choriocapillaris in pre-eclampsia with aldosteronism. Ophthalmol ;74 11 Primary aldosteronism in pregnancy.


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J Nippon Med Sch ;67 4 Revista Nefrolog?? Manual de hipertensi?? Int J Gynaecol Obstet ; Diagnosis and management of primary aldosteronism in pregnancy: case report and review of the literature. Am J Perinatol ;19 1 Villa Alc?? Medimecum The adrenal incidentaloma: treatment, unilateral adrenal masses. Laparoscopic adrenalectomy on a patient with primary aldosteronism during pregnancy.

High blood pressure and pregnancy: Know the facts - Mayo Clinic

Endocr J ;53 4 Epub Jul 5. Zafer Nursal T,?? Caliskan K,?? Ertorer E,?? Parlakgumus A,??

Moray G. Laparoscopic treatment of primary hyperaldosteronism in a pregnant patient. Can J Surg ;52 5 :EE Subscribe to our newsletter. Print Send to a friend Export reference Mendeley Statistics. The role of women throughout the history of Both types of hypertension increase risk of preeclampsia and eclampsia and of other causes of maternal mortality or morbidity, including. Risk of fetal mortality or morbidity increases because of decreased uteroplacental blood flow, which can cause vasospasm, growth restriction, hypoxia, and abruptio placentae.

Gestational hypertension

Obstet Gynecol 5 —, BP is measured routinely at prenatal visits. If severe hypertension occurs for the first time in pregnant women who do not have a multifetal pregnancy or gestational trophoblastic disease , tests to rule out other causes of hypertension eg, renal artery stenosis , coarctation of the aorta , Cushing syndrome , SLE , pheochromocytoma should be considered. Methyldopa , beta-blockers, or calcium channel blockers tried first. For moderate or severe hypertension, antihypertensive therapy, close monitoring, and, if condition worsens, possibly termination of pregnancy or delivery, depending on gestational age.

Recommendations for chronic and gestational hypertension are similar and depend on severity. However, chronic hypertension may be more severe. In gestational hypertension, the increases in BP often occur only late in gestation and may not require treatment. Treatment of mild to moderate hypertension without renal insufficiency during pregnancy is controversial; the issues are whether treatment improves outcome and whether the risks of drug treatment outweigh risks of untreated disease.

Because the uteroplacental circulation is maximally dilated and cannot autoregulate, decreasing maternal BP with drugs may abruptly decrease uteroplacental blood flow. Diuretics reduce effective maternal circulating blood volume; consistent reduction increases risk of fetal growth restriction. However, hypertension with renal insufficiency is treated even if hypertension is mild or moderate. For mild to moderate hypertension systolic BP to mm Hg or diastolic BP 90 to mm Hg with labile BP, reduced physical activity may decrease BP and improve fetal growth, making perinatal risks similar to those for women without hypertension.

However, if this conservative measure does not decrease BP, many experts recommend drug therapy. Women who were taking methyldopa , a beta-blocker, a calcium channel blocker, or a combination before pregnancy may continue to take these drugs. Risk of complications—maternal progression of end-organ dysfunction, preeclampsia and fetal prematurity, growth restriction, stillbirth —is increased significantly.