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Hypertension in pregnancy 

Hypertension in pregnancy
Chapter:
Hypertension in pregnancy
Author(s):

Fergus McCarthy

DOI:
10.1093/med/9780198746690.003.0266
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date: 05 March 2021

High blood pressure (BP >140/90 mm Hg) complicates approximately 10% of pregnancies and may be due to white coat hypertension, chronic hypertension, gestational hypertension, or pre-eclampsia (de novo or superimposed on chronic hypertension).

Pre-eclampsia occurs in 2–8% of pregnancies and remains a common cause of fetal and maternal death in developing countries. Maternal symptoms include headache/visual disturbances, breathlessness, epigastric pain, and seizures (eclampsia); signs include pulmonary oedema, liver tenderness, hyper-reflexia/clonus, and papilloedema.

Treatment of pre-eclampsia is by timely delivery of the fetus (and placenta) to minimize maternal complications and maximize fetal gestational age, while avoiding morbidity and mortality. Pharmacological treatment to control hypertension is generally given when BP consistently exceeds 150 mm Hg (systolic) or 90 mm Hg (diastolic). Commonly used agents include labetalol, nifedipine, amlodipine, and α‎-methyldopa. ACEi, ARBs, and diuretics should not be used in pregnancy. Intravenous magnesium sulphate is given to women at risk of eclampsia.

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