A 30-Year-Old Woman With Chronic Hypertension Trying to Conceive

Powrie, Raymond

doi:10.1001/jama.298.13.1548

Cited by 16 publications

(3 citation statements)

References 89 publications

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“…5 The rate, however, is only 15% in those who have mild hypertension before conception or early in pregnancy, whereas it approaches 50% in those with severe prepregnancy hypertension. 6,7 For women with pregestational diabetes mellitus, risk for preeclampsia and adverse outcomes depends on the duration of diabetes as well as on the presence of vascular complications and glucose control during pregnancy. 8 -10 The rate of preeclampsia increases in a manner that parallels the severity of diabetes by White's classification (Fig.…”

Section: Prediction Of Recurrent Preeclampsia Preconceptionmentioning

confidence: 99%

Prediction and Prevention of Recurrent Preeclampsia

Barton

Sibai

2008

Obstetrics &Amp; Gynecology

275

182

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Women with a history of previous preeclampsia are at increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. The objective in the management of these patients is to reduce risk factors by optimizing maternal health before conception and to detect obstetric complications as early as possible. This objective can be achieved by formulating a rational approach that includes preconception evaluation and counseling, early antenatal care, frequent monitoring of maternal and fetal well-being, and timely delivery. First-trimester ultrasound examination is essential for accurate dating and establishing fetal number. Laboratory studies are obtained to assess the function of different organ systems that are likely to be affected by preeclampsia and to establish a baseline for future assessment. Recent studies have confirmed that there is no single biomarker that can be clinically useful for the prediction of recurrent preeclampsia. Combinations of biomarkers and biophysical parameters appear promising, but more data are needed to confirm their use in clinical practice. Supplementation with fish oil, calcium, or vitamin C and E and the use of antihypertensives have been shown to be ineffective in the prevention of recurrent preeclampsia and are not recommended. Supplementation with low-dose aspirin may be offered on an individualized basis. Because women with previous preeclampsia are at increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. This monitoring may include more frequent prenatal visits, home blood pressure monitoring, or nursing contacts. For patients with a prior pregnancy complicated by preeclampsia with fetal growth restriction, we recommend serial ultrasound evaluation of fetal growth and amniotic fluid volume. The development of severe gestational hypertension, fetal growth restriction, or recurrent preeclampsia requires maternal hospitalization.

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Section: Prediction Of Recurrent Preeclampsia Preconceptionmentioning

confidence: 99%

Prediction and Prevention of Recurrent Preeclampsia

Barton

Sibai

2008

Obstetrics &Amp; Gynecology

275

182

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“…La complicación más frecuente fue la preeclampsia sobreagregada siendo la frecuencia encontrada mayor a la de otros estudios los que reportan entre 4,7 y 52% (5,12). Una de las explicaciones sería la mayor edad de nuestras pacientes; otra por variables socio-demográficas como el nivel socio-económico.…”

Section: Discussionunclassified

Características clínicas de las gestantes con hipertensión arterial crónica atendidas en un hospital general de Lima

Bravo

Sanchez²,

Sosa³

et al. 2013

Rev Med Hered

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Describir las características epidemiológicas, clínicas y de laboratorio de las gestantes con hipertensión arterial crónica (HTAC), así como, conocer los resultados del producto de la gestación. Material y métodos: Estudio descriptivo, observacional, longitudinal, retrospectivo, tipo serie de casos. Se incluyeron pacientes gestantes con HTAC cuyo parto fue atendido en el Hospital Nacional Cayetano Heredia entre 2006 y 2012. Se utilizó estadística descriptiva, se determinaron frecuencias y porcentajes para las variables categóricas y medias y desviación estándar para las numéricas continuas. Resultados: Se incluyeron 41 gestantes con HTAC. El 56,1% tenía 35 o más años, 68,3% presentó preeclampsia sobreagregada. La tasa de filtración glomerular estimada fue < 90ml/min en 9,8%, el 58,8% presentó proteinuria en 24 horas > 300mg. El 73,2% tuvo parto abdominal, 41,5% de los recién nacidos fueron prematuros y el 39,1% tuvo peso menor a 2 500 g. Conclusiones: Las gestantes con HTAC presentan características clínicas y epidemiológicas similares a las descritas en otros estudios; con la diferencia que presentaron frecuencia alta de preeclampsia sobreagregada y complicaciones materno -perinatales.PALABRAS CLAVE: Complicaciones del embarazo, hipertensión, resultado del embarazo. (Fuente: DeCS BIREME) SUMMARYObjectives: To describe epidemiological, clinical and laboratory characteristics of pregnants with chronic hypertension (CH), as well as to investigate the outcome of their pregnancies. Methods: Case series that included pregnants with CH atttended at Hospital Nacional Cayetano Heredia from 2006 to 2012. Descriptive statistics were used for categorial and continuos variables. Results: A total of 41 pregnants with CH were included; 56% had at least 35 years of age; 68.3% presented associated pre-eclampsia; 9.8% had estimated glomerular filtration rates < 90 mil/min, and 58.8% had proteinuria > 300mg measured in a 24 hour period. Abdominal delivery occured in 73.2%; 41.5% of newborns were pre-term, and 39.1% had body weight less than 2 500g. Conclusions: Pregnants with CH in this setting present with similar features as previously described in other studies, but higher rates of pre-eclampsia and mother-child complications were observed.

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“…The next step is to understand the severity of her medical conditions and to perform a detailed evaluation, ideally in co-management with the internal medicine team, to exclude possible secondary causes of hypertension (which are rare, but need to be considered) and to investigate evidence of potential "target organ" damage. For example, there is a significant difference in the risk of preeclampsia superimposed on mild chronic hypertension and on severe pre-pregnancy hypertension, [19][20][21] and there is also increased risk in preeclampsia associated with diabetes. A detailed medical history (including family history) could point towards investigating other diseases, such as autoimmune diseases or thrombophilia, which can correlate with adverse maternal outcomes and severe preeclampsia and have specific treatment and prophylaxis.…”

Section: Clinical Scenarios Case 1 Pre-conception Consultationmentioning

confidence: 99%

Preeclampsia: Reflections on How to Counsel About Preventing Recurrence

Costa

2015

Journal of Obstetrics and Gynaecology Canada

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Preeclampsia is one of the most challenging diseases of pregnancy, with unclear etiology, no specific marker for prediction, and no precise treatment besides delivery of the placenta. Many risk factors have been identified, and diagnostic and management tools have improved in recent years. However, this disease remains one of the leading causes of maternal morbidity and mortality worldwide, especially in under-resourced settings. A history of previous preeclampsia is a known risk factor for a new event in a future pregnancy, with recurrence rates varying from less than 10% to 65%, depending on the population or methodology considered. A recent review that performed an individual participant data meta-analysis on the recurrence of hypertensive disorders of pregnancy in over 99 000 women showed an overall recurrence rate of 20.7%; when specifically considering preeclampsia, it was 13.8%, with milder disease upon recurrence. Prevention of recurrent preeclampsia has been attempted by changes in lifestyle, dietary supplementation, antihypertensive drugs, antithrombotic agents, and others, with much uncertainty about benefit. It is always challenging to treat and counsel a woman with a previous history of preeclampsia; this review will be based on hypothetical clinical cases, using common scenarios in obstetrical practice to consider the available evidence on how to counsel each woman during pre-conception and prenatal consultations.

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A 30-Year-Old Woman With Chronic Hypertension Trying to Conceive

Cited by 16 publications

References 89 publications

Prediction and Prevention of Recurrent Preeclampsia

Prediction and Prevention of Recurrent Preeclampsia

Características clínicas de las gestantes con hipertensión arterial crónica atendidas en un hospital general de Lima

Preeclampsia: Reflections on How to Counsel About Preventing Recurrence

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