The management of hypertensive disease in pregnancy

Abstract

Hypertension occurs in around 15% of all pregnancies. The majority of the patients do well, but it remains a significant cause of maternal and neonatal mortality and morbidity. The essence of good management is an accurate diagnosis of the problem, the assessment of the risk to the mother and the baby, and individualised treatment of the severe patient. This article will describe the system of care developed at the Glasgow Royal Maternity Hospital over the last twelve years by a specialist team. The mainstay of management is the Daycare Assessment Unit which delivers inpatient monitoring on an outpatient basis. This allows an accurate assessment of the hypertension and the risk to the patient to be made without need of admission to hospital. By screening out the low risk patient, more intensive efforts can be directed at those who most need it. Antihypertensive drugs are used to lower blood pressure if this is thought to be appropriate. Delivery remains the only cure, but the optimal timing and place of the delivery can make a significant difference to the mortality and morbidity of the mother and baby. Postpartum management in the severely affected patient requires the maintenance of vigilance until recovery is complete. Fluid overload is a common occurrence post delivery and measures should be taken to prevent this. Pregnancies complicated by hypertension should result in a successful outcome for mother and baby in the majority of pregnancies.