Gestational hypertension

Notes-. Percentages listed come from the studies shown as references. Only the maternal complications with increased prevalence have been included. Complications are more frequently observed in OH than in SCH. G. hypertension, gestational hypertension OH, overt hypothyroidism SCH, subclinical hypothyroidism ND, nondetermined. 

Chronic hypertension (blood pressure greater than or equal to 140/90 mm Hg prior to pregnancy or prior to 20 weeks gestation that lasts more than 12 weeks postpartum)... 

Chronic hypertension with superimposed preeclampsia (onset of proteinuria after 20 weeks gestation in a woman with chronic hypertension)... 

For women at high risk for preeclampsia, low-dose aspirin after 12 weeks gestation reduces the risk for preeclampsia by 19%. Aspirin may reduce the risk of preterm birth by 7% and fetal or neonatal death by 16%. Calcium, 1 g/day, is recommended for all pregnant women, as it may help prevent hypertension in pregnant women and reduce the risk of preeclampsia by 31% to 67%. 

No major teratogenic effects have been identified with the SSRIs or TCAs. However, evaluations to date suggest a possible association of fluoxetine with low birth weight and respiratory distress. Another study reported a sixfold greater likelihood of the occurrence of persistent pulmonary hypertension of newborn infants exposed to an SSRI after the twentieth week of gestation. 

Gonzalez-Quintero VH, Smarkusky LP, Jimenez JJ, Mauro LM, Jy W, Hortsman LL, O Sullivan MJ, Ahn YS. Elevated plasma endothelial microparticles Preeclampsia versus gestational hypertension. Am J Obstet Gynecol 2004 191 1418-1424. 

Hypertension can develop rapidly during the third trimester of pregnancy. Untreated, it can pose a danger to both mother and child. So-called gestational hypertension commonly disappears after pregnancy but not always. And if your blood pressure was elevated prior to pregnancy it s particularly important to monitor it on a regular basis. 

The use of nifedipine during pregnancy and labor has been widely debated, although its effects on child development have not been well evaluated. In one study nifedipine did not affect the development and health of 190 children, aged 18 months, born to women with mild to moderate hypertension who had been randomized to nifedipine, given for 12-34 gestational weeks before delivery, or expectant management (45). 

Gaseous nitric oxide is a short-lived molecule that has been used in the treatment of patients with primary pulmonary hypertension and is used in subgroups of severely ill and hypoxic children with persistent pulmonary hypertension of the newborn, in preterm infants of less than 34 weeks gestation, and in adults with acute lung injury and adult respiratory distress syndrome. There are some reports of its use for intestinal ischemia, reperfusion injury, thrombotic disorders, and sickle cell crises. 

In newborn infants the benefit of accurate assessment of gestational age by examination of the anterior vascular capsule of the lens and the value of funduscopic examination in ill premature babies must be weighed against the possible risks of the associated increase in blood pressure produced by the pupillary dilators. Since there is no increase in mydriatic effect with repeated instillation or increasing concentration, and their small body mass places premature neonates at increased risk of phenylephrine overdose, it is prudent to use the lowest possible concentration, as well as the most effective combination of mydriatics for indirect ophthalmoscopy in premature infants when such examination is absolutely necessary. The hypertensive effect is likely to be maximal at some time within the first 20 minutes, and whenever possible (or when risk factors are present) the blood pressure should be monitored. 

Bart s (y ). Mothers carrying a fetus with Hb Bart s usually present clinically between 20 and 26 weeks gestation with pregnancy-induced hypertension and polyhydramnios. Ultrasound of the fetus shows hydrops. Severe anemia (Hb usually <80g/L) is noted on a fetal blood sample obtained by cordocentesis. It is important to rule out other causes for the hydropic fetus by performing TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex) testing. 

Since diabetes mellitus is an insidious disorder, testing of asymptomatic patients may be desirable under certain conditions, including age 45 years or older obesity first-degree relatives of diabetics members of high-risk ethnic population (e.g.. Native American, Hispanic, African-American) women who have delivered an infant weighing more than 9 lb (4.08 kg) or have had gestational diabetes mellitus hypertension abnormal lipid studies recurring... 

Many women with pregnancy-inflnenced gastrointestinal issues can be treated safely with lifestyle modification or medications, many of them nonprescription. Gestational diabetes, hypertension, and thyrotoxicosis may or may not require drug therapy venous thromboembolism usually will require therapy with a low-molecular-weight heparin and compression stockings. 

Appropriate treatment of asthma is critical to the health of mother and infant. Undertreated asthma in the mother is associated with preterm labor, gestational hypertension, preeclampsia, and uterine hemorrhage. In the infant, intrauterine growth retardation, low birth weight, and congenital malformations may result from poor asthma control. 

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