A consistent approach to hypertension in pregnancy

Abstract

This issue opens with an article written by the authors of the latest guidelines for the management of hypertensive disease in pregnancy, published at the end of last year by the Society for Obstetric Medicine of Australia and New Zealand (SOMANZ). There have been several of these ‘consensus statements’ about hypertension in pregnancy and all have strived for the same aim – to achieve consistency in the approach to the management of one of the most common medical disorders in pregnancy. Even with comprehensive antenatal care available for most women there is still significant morbidity and mortality associated with pre-eclampsia and eclampsia. Interestingly, despite the most recent New Zealand figures showing a high maternal mortality ratio (MMR), deaths from hypertension do not feature prominently in the list of causes, suggesting that women who developed this complication were well managed via the various different models of care. This is in contrast with the last Australian figures for the triennium 2003–2005 showing five deaths related to hypertension. The full text of the SOMANZ guidelines is available on the website (http://www.somanz.org). The first two papers in the obstetric section are looking at the outcomes for fetuses with a normal karyotype with either very large nuchal translucency (NT) measurements or extremely low PAPP-A levels. The take-home messages are that some fetuses with very large NT measurements will be normal, and that a low PAPP-A can be an early warning of placental insufficiency. It is still important to answer the question about how low does the PAPP-A need to be to cause concern and how closely should these pregnancies be monitored? Following these is an article from the South Australian group working on non-obstetric causes of cerebral palsy, reporting on genetic susceptibility and viruses. They provide evidence for a role for viral infections in pregnancy as a possible cause of cerebral palsy, as well as arguing that genetic susceptibility plays an important part. On the gynaecological side the paper about knowledge of emergency contraception in students from Far North Queensland is very interesting and demonstrates that changes in availability of treatments doesn't always improve access and usage – education is a key ingredient. The article on the value of laparoscopic skills courses follows on very well from the discussion in the last issue about the future of gynaecological surgery. Despite an Editorial policy to restrict the number, I am sent more and more interesting case reports, and some of these are certainly worthy of publication. There are six included in this issue, including one from East Timor illustrating that there can be significant harm caused to women by illegal abortion, even on our own doorstep. This problem remains a major cause of maternal mortality in developing countries. Finally, since I last wrote there have been two very significant publishing events for our profession. The Report of the Maternity Services Review in Australia has been released, as well as the report from the New Zealand Perinatal and Maternal Mortality Committee. I was very pleased to see that the first recommendation in the Australian review was ‘That the Australian Government, in consultation with states and territories and key stakeholders, agree and implement arrangements for consistent, comprehensive national data collection, monitoring and review, for maternal and perinatal mortality and morbidity’. It would be good to see some action on this front in the near future and ensure that we have timely publication of data (and commentary) on all aspects of maternal and perinatal mortality and morbidity, as well as a clear link to ways to improve outcomes. Perhaps in the future we may see a similar comprehensive approach to looking at women's health outcomes in relation to gynaecological conditions.