Committee Opinion No. 623

Preeclampsia is characterized by blood pressure greater than 140/90 mmHg in the second half of pregnancy. This disease is a major contributor to preterm and low birth weight babies. The early delivery of the baby, which becomes necessary for maintaining maternal well-being, makes pre-eclampsia the leading cause for preterm labor and infant mortality and morbidity. Currently, there is no cure for this pregnancy disorder. The current clinical management of PE is hydralazine with labetalol and magnesium sulfate to slow disease progression and prevent maternal seizure, and hopefully prolong the pregnancy. This review will highlight factors implicated in the pathophysiology of preeclampsia and current treatments for the management of this disease.

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“…When administered timely and appropriately, these interventions have been shown to decrease maternal and fetal morbidity and mortality [71]. …”

Section: Resultsmentioning

confidence: 99%

Pathophysiology and Current Clinical Management of Preeclampsia

et al. 2017

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“…Maybe these patients would have a better prognosis if a standardized clinical protocol was adopted for the management of hypertensive disorders in pregnancy. We recommend that all maternity units have clear guidelines for the management of severe preeclampsia and treatment protocols should include emergency antihypertensive agents (nifedipine, hydralazine or labetalol), which were preferred as first-line therapy for emergency therapy of acute-onset severe hypertension by the American College of Obstetricians and Gynecologists in 2015 (14). Clark et al (15) also stated that disease-specific protocols were beneficial in the reduction of maternal mortality because of hypertensive disorders of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality due to hypertensive disorders in pregnancy, childbirth, and the puerperium between 2012 and 2015 in Turkey: A nation-based study

Keskinkılıç¹,

Engin-Üstün²,

Sanisoğlu³

et al. 2017

J Turkish German Gynecol AssocJ Turkish German Gynecol Assoc

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Objective:To analyze maternal deaths in Turkey due to hypertensive disorders.Material and Methods:In this retrospective study 812 maternal deaths were analyzed. Maternal demographic features, presence of antenatal care, medical and obstetric history, mode of delivery, and use emergency antihypertensive therapy were recorded. The delay model for each case was investigated.Results:Hypertensive disorders accounted for 15.5% (n=126) out of all maternal mortality. They were the third most frequent cause among all causes and the 2nd among direct causes of maternal deaths. Sixty-one (48.4%) cases were in severe preeclampsia or pre-existing hypertensive disorder with increased/superimposed proteinuria, 30.1% were in eclampsia, 9.5% cases were diagnosed as hemolysis, elevated liver enzymes, low platelet count syndrome, and 11.1% in pre-existing hypertension complicating pregnancy, childbirth, and puerperium without increased or superimposed proteinuria. The median age was 32 years, 37.3% women were ≥35 years. All deaths except for 2 cases occurred during the postpartum period. Twenty-three percent of deaths occurred in the first 48 hours postpartum, and 51.6% between 8-42 days. Intracranial hemorrhage was the major final cause of death with a rate of 41.3%. With the exception of fifteen patients with intracranial hemorrhage, emergency antihypertensive agents were not implemented in optimal dose and/or duration. A first and/or third delay was identified in 36.5% of cases.Conclusion:Approximately one third of maternal death due to hypertensive disorders could be prevented. The importance of acute antihypertensive treatment should be emphasized because of most frequent cause of death was intracranial hemorrhage.

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“…[7][8][9] In pregnancy, acute-onset severe hypertension that is accurately measured using standard techniques and persistent for ≥15 minutes is regarded as a hypertensive emergency. [7][8][9] If not adequately treated, severe hypertension can cause cerebral injury. A systolic BP of >160 mmHg is included in the definition of severe hypertension in pregnancy.…”

Section: Immediate Treatment Of Severe Hypertension In Pregnancymentioning

confidence: 99%

“…Severe diastolic hypertension of ≥110 mmHg is also regarded as a hypertensive emergency. [7][8][9][10] Pregnant women with acute-onset, severe systolic and/or diastolic BPs in the ante-, intra-, or immediate The goal should be to lower high BP levels to a range of 140 -150/90 -100 mmHg in order to prevent repeated prolonged exposure of the patient to severe systolic hypertension with subsequent loss of cerebral vasculature autoregulation. [10] Some case scenarios and the '5 Rs' in severe hypertension in pregnancy…”

Section: Immediate Treatment Of Severe Hypertension In Pregnancymentioning

confidence: 99%

See 1 more Smart Citation

Severe hypertension in pregnancy: Using dynamic checklists to save lives

Moodley

Ngene

2016

S Afr Med J

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Severe hypertension is a major cause of morbidity and mortality. The South African Saving Mothers report (2011 -2013) indicates that cerebral injury due to severe hypertension is resulting in avoid able maternal deaths. This demands that management of severe hypertension in pregnancy needs to be improved. A rapid-acting antihypertensive is recommended for the initial management of severe hypertension during pregnancy. A single dose of a rapid-acting agent may be ineffective, in which case incremental doses of the same medication or another antihypertensive may be required for adequate blood pressure control. To ensure that appropriate antihypertensives at the correct doses are administered, the use of a guideline in a dynamic checklist format is advocated and discussed in this article. It is envisaged that the use of dynamic checklists will be valuable to all healthcare professionals providing care during pregnancy and the puerperium.

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Committee Opinion No. 623

Cited by 76 publications

References 20 publications

Pathophysiology and Current Clinical Management of Preeclampsia

Pathophysiology and Current Clinical Management of Preeclampsia

Maternal mortality due to hypertensive disorders in pregnancy, childbirth, and the puerperium between 2012 and 2015 in Turkey: A nation-based study

Severe hypertension in pregnancy: Using dynamic checklists to save lives

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