Abstract
Hypertensive disorders such as gestational hypertension, preeclampsia, eclampsia and HELLP syndrome are one of the most common pregnancy-associated entities that imply substantial maternal-fetal mortality and morbidity. When hypertensive disorders are associated with a multiple pregnancy, the outset is established sooner, with a rapid evolution and a more severe development. Although, the pathophysiology of hypertensive disorders is not fully understood, there are several risk factors that could be identified. A multiple pregnancy implies additional risks due to specific features: larger or multiple placentas, failure of the uteroplacental unit to uphold the natural development of multiple fetuses or elevated risk of abnormal placental site. Hypertensive disorders include complications that are common for both single and multiple pregnancies, complications such as kidney failure, liver dysfunction, neurological or hematological malfunction, among others. Maternal features, including mean arterial blood pressure, uterine artery pulsatility index and blood levels of PAPP-A and/or PlGF could be determined at an early age and used as screening methods.
Highlights
Pregnancy represents an eventful experience in a woman’s life, with important cardiovascular and hemodynamic alterations in order to sustain fetal and placental growth
Preeclampsia is defined as the recent establishment of hypertension after 20 weeks of pregnancy, oftentimes associated with proteinuria, but not exclusively, as other risk factors might be present in the absence of proteinuria [2] as they are noted in table 1
Proteinuria at the time of pregnancy is characterized by a minimum of 300 mg/dl of protein in a daily urine acquisition or a minimum proportion of protein-to-creatinine of 0.3, dipstick urinalysis accounted as an alternative method when rapid results are needed, 2+ being taken into consideration as a positive result [5]
Summary
Pregnancy represents an eventful experience in a woman’s life, with important cardiovascular and hemodynamic alterations in order to sustain fetal and placental growth. Gestational hypertension develops in a formerly normally blood pressure woman, after 20 weeks of gestation and implies a systolic blood pressure of minimum 140 mmHg with or without diastolic blood pressure of a minimim 90 mmHg [3], while preeclampsia develops when systolic blood pressure exceeds systolic blood pressure of 160 mmHg and diastolic blood pressure of 110 mmHg [4]. With a systolic blood pressure of minimum 140 mmHg with or without diastolic blood pressure of a minimim 90 mmHg. As Sibai noted, proteinuria or organ deterioration might occur in up to half of the pregnant women diagnosed with gestational hypertension, especially when the diagnosis is established before the third trimester of pregnancy [6]. Accounted as a severe form of preeclampsia, implying elevated maternal mortality and morbidity, HELLP syndrome is defined by hemolysis: lactate dehydrogenase of a minimum 600 IU/l, high liver enzymes more than double of the upper limit and low platelet, beneath 100x109/l and as Barton noted, it involves a a well-defined management plan, sometimes, after 34 weeks of gestation, implying the need for delivery [7]
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