Treatment of hypertension during pregnancy

Abstract

68eclampsia. Amongst these women, pulmonary oedema (28%), intracranial haemorrhage (23%), cerebral oedema resulting in coning (9%) and brain death following a hypoxic event (7%) were the most frequently recorded final causes of death. Although most of these deaths occurred in tertiary and regional hospitals, hypertensive deaths still comprised 15% of all maternal deaths at Community Health Centres, emphasising the importance of correct initial management at all levels of care.(6) With regards to the timing of the emergency event related to hypertension, 28% (n=191) occurred in the postpartum period. An important aspect of the Saving Mothers report is the attention paid by assessors to avoidable factors, missed opportunities and sub-standard care. In the most recent report, health worker orientated emergency management problems were noted in 42% of hypertensive deaths at Community Health Centres and District hospitals, 33% at Regional hospitals and 17% at Tertiary hospitals.(6) Not only is the mortality associated with hypertensive disorders in pregnancy high, but these conditions are a frequent source of significant morbidity. (8,9) Cases with Severe Acute Maternal Morbidity (SAMM) share many characteristics with maternal deaths. (10) Therefore understanding and managing SAMM also helps to decrease or prevent maternal mortality.

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

“…In the antepartum period, however, one is apprehensive of the possible effects of combined antihypertensive medications on the foetus but it is prudent to control BP in pregnancy and postpartum period to avert adverse outcomes such as stroke. Despite the scarcity of robust data to direct the drug treatment of hypertension during pregnancy and the puerperium [80], women in the index study were only treated with the commonly recommended antihypertensive agents with long history of safety in pregnancy.…”