Preventing deaths due to the hypertensive disorders of pregnancy

Abstract

In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs.

Perinatal outcome of hypertensive pregnant women is related to the severity of preeclampsia

“…Among hypertensive disorders of pregnancy, PE is the one posing the greatest risk for mortality, especially in its severe form or when occurring before 34 weeks' gestation 9 . Maternal recovery from PE is initiated only after delivery 10 . In cases of chronic or gestational hypertension, there were no significant differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications among women assigned to tight control of hypertension (target diastolic BP, 85 mmHg) vs. those assigned to a less-tight control (target diastolic BP, 100 mmHg).…”

Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique

“…1,2 The most dangerous of the hypertensive disorders of pregnancy is preeclampsia, the origins of which lie in a mixture of maternal and placental factors. 3,4 Currently, delivery is the only mechanism by which to initiate the resolution of preeclampsia, 3 whether that delivery is spontaneous or iatrogenic.…”

“…Iatrogenic delivery is predicated on a timely diagnosis of preeclampsia, with additional safeguards being offered through avoidance of, and response to, severe maternal hypertension and eclampsia for women and risks of prematurity for fetuses before term. 1 The diagnosis of the hypertensive disorders of pregnancy, especially preeclampsia, largely remains reliant on women having access to accurate blood pressure (BP) measurement, estimation of urinary protein, and testing for end organ complications. Women in their community and admitted to hospital with a hypertensive disorders of pregnancy can be assessed for actuarial risk using either the demographics-, symptom-, and sign-based miniPIERS (Pre-Eclampsia Integrated Estimate of Risk) tool, especially when supplemented by pulse oximetry 5,6 or the demographics-, symptom-, sign-, and laboratory testbased fullPIERS tool.…”

Associations between postpartum depression and hypertensive disorders of pregnancy

“…1 Together, these conditions represent the leading global cause of maternal and neonatal morbidity and mortality, leading to 30 000 maternal deaths and 500 000 perinatal deaths each year. 2 Although HDP affects 20% of high-income countries, it is three to four times more frequent in low-income countries. 3 Given both its prevalence and the potential for adverse outcomes, HDP is a serious publichealth problem.…”