Hypertension in pregnancy: recommendations for diagnosis and treatment.

Abstract

Hypertensive disorders in pregnancy remain a major cause of maternal, fetal and neonatal morbidity and mortality not only in less developed but, also, in the industrialized countries. Pregnant women with hypertension are at higher risk for severe complications such as abruptio placentae, cerebrovascular accident, organ failure, and disseminated intravascular coagulation. The fetus is at risk for intrauterine growth retardation, prematurity, and intrauterine death. Physiologically, blood pressure falls in the second trimester, reaching a mean of 15 mmHg lower than levels before pregnancy. In the third trimester, it returns to pre-pregnancy levels. This fluctuation occurs in both normotensive and chronically hypertensive women. Definition of hypertension in pregnancy The definition of hypertension in pregnancy is not uniform. It used to include an elevation in blood pressure during the second trimester from a baseline reading in the first trimester, or to prepregnancy levels, but a definition based on absolute blood pressure values (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) is now preferred. Measurement of blood pressure It is essential to confirm high blood pressure readings on two occasions. It is recommended that both Phase IV and V Korotkoff sounds be recorded. Phase IV should be used for initiating clinical investigation and management.