gynecology and obstetrics
Hypertension in Pregnancy
Introduction
Recommendations regarding classification, diagnosis, and management of hypertensive disorders (including preeclampsia) are available from the American College of Obstetricians and Gynecologists (ACOG [ General reference ]). (See also Hypertension .) In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the evaluation of high blood pressure (BP). They lowered the definitions for hypertension as follows: Normal: < 120/80 mm Hg Elevated: 120 to 129/< 80 mm Hg) Stage 1 hypertension: 130 to 139/80 to 89 mm Hg Stage 2 hypertension: ≥ 140/90 mm Hg ACOG defines chronic hypertension as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg on 2 occasions before 20 weeks gestation. Data on the effect of hypertension as defined by the ACC/AHA during pregnancy are limited. Thus, pregnancy management is likely to evolve. Hypertension during pregnancy can be classified as one of the following: Chronic:BP is high before pregnancy or before 20 weeks gestation. Chronic hypertension complicates about 1 to 5% of all pregnancies. Hypertension develops after 20 weeks gestation (typically after 37 weeks) and remits by 6 weeks postpartum; it occurs in about 5 to 10% of pregnancies, more commonly in Multifetal Pregnancy . Both types of hypertension increase risk of Preeclampsia and Eclampsia and of other causes of maternal mortality or morbidity, including Hypertensive encephalopathy Stroke Renal failure Left ventricular failure HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) Risk of fetal mortality or morbidity increases because of decreased uteroplacental blood flow, which can cause vasospasm, growth restriction, hypoxia, and placental abruption. Outcomes are worse if hypertension is severe (systolic BP ≥ 160 mm Hg, diastolic BP ≥ 110 mm Hg, or both) or accompanied by renal insufficiency (eg, creatinine clearance<60 mL/min, serum creatinine>2 mg/dL [>180μmol/L]). 