Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring

Abstract

Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) weekly.

Anaemia at mid-pregnancy is associated with prehypertension in late pregnancy among urban women

“…In countries struggling to manage gestational hypertension, such as South Africa, the association the authors found between anaemia and higher blood pressure may be especially important. Hypertensive disorders of pregnancy account for 18% of maternal deaths (Ngene & Daef 2021 ). In this study’s sample of pregnant women, 18%, 15% and 15% of women were prehypertensive at early, mid- and late pregnancy, respectively, despite routine iron, folic acid and calcium supplementation.…”

Atypical preeclampsia-eclampsia syndrome at 18 weeks of gestation: A case report

“…Placental histology may help elucidate features of placental-mediated diseases such as fetal growth restriction and preeclampsia. Placental vascular malformations (including maldevelopment and malperfusion) are among the microscopic features that may support the diagnosis of preeclampsia [ 25 ]. In the index case, the placenta was not sent for histology due to logistic challenges.…”

Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

“…Гіпертензивні розлади вагітності, як-от гестаційна гіпертензія (ГГ) та прееклампсія, залишаються значною причиною материнської та плодової захворюваності і смертності в усьому світі [1][2][3][4][5][6]. Хоча точна патофізіологія цих розладів усе ще не до кінця зрозуміла, очевидно, що існують гемодинамічні шляхи, які відіграють вирішальну роль у їхньому розвитку [7][8][9].…”