Sunday, 30 September 2012

Introduction of Hypertension in pregnancy

Two etiologically distinct entities account for most hypertensive disorders in pregnancy. One is a disorder induced by pregnancy, which, in this chapter, we refer to as ‘pregnancy-induced hypertension’, if not accompanied by proteinuria, as ‘pre-eclampsia’ if there is associated proteinuria, and as ‘eclampsia’ if it leads to convulsions and/or coma. The other is chronic hypertension that precedes or coincides with preg- nancy, and is sometimes associated with a known underlying condition,  such as renal disease. In addition, a combination of the two conditions may occur; this is referred to as ‘superimposed pre-eclampsia’  

Introduction of Hypertension in pregnancy


The outcome for pregnancies complicated by hypertensive disorders is often good, but sometimes these conditions may have devastating consequences for mother and baby. For example, the woman may develop renal or hepatic failure, disseminated intravascular coagulation, or a cerebrovascular hemorrhage. The baby may have intrauterine growth restriction, suffer the consequences of being born too early, or die in utero. 

The risk of adverse effects has been recognized for a long time, and a bewildering array of medical and surgical regimens have been proposed or used for the prevention and treatment of pre-eclampsia and eclampsia. One author reports that women with eclampsia have been ‘blistered, bled, purged, packed, lavaged, irrigated, punctured, starved, sedated, anesthetized, paralyzed, tranquillized, rendered hypotensive, drowned, given diuretics, had mastectomies, been dehydrated, forcibly delivered, and neglected’. Thankfully, most of these ‘remedies’ are now obsolete. In this chapter we assess the available evidence about current approaches to either preventing or treating pregnancy-induced hypertension, pre-eclampsia, and eclampsia.  

Introduction of Hypertension in pregnancy


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