Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Chronic hypertension:Systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg prior to pregnancy of before 20 weeks of gestationHypertension that persists beyond the 12th postpartum weekGestational hypertension:New-onset hypertension after midpregnancy without proteinuria that resolves within 12 weeks postpartumPreeclampsia:New-onset hypertension after 20 weeks gestation associated with >300 mg per day proteinuriaNew-onset seizures in the setting of preeclampsia are defined as eclampsiaPreeclampsia superimposed on chronic hypertension ++Table Graphic Jump Location|Download (.pdf)|PrintHemodynamic Characteristics of Hypertensive Disorders during Pregnancy1HealthyEarly preeclampsiaLate preeclampsiaGestational or chronic hypertensionCardiac output6.28.95.09.0Systemic vascular resistance1,2101,0821,687922Wedge pressure7.59137Stroke volume8010458110LVSWI48613364Colloid oncotic pressure181714181No ranges are given; numbers are presented for comparison as representative values. ++Table Graphic Jump Location|Download (.pdf)|PrintChronic HypertensionAffects 3% of pregnant populationMore common inAfrican Americans (up to 44%)Older gravidas (>12% after the age of 35) Frequently associated with obesity, diabetes mellitusMaternal complicationsSuperimposed preeclampsia10–25% incidence of progression to preeclampsia2.7-fold increase in risk for severe preeclampsiaPlacental abruptionCommonly used oral medications1α-MethyldopaLabetalolMetoprolol SR is an alternativeNifedipine SRLess commonly used oral medications1HydrochlorothiazideHydralazine (oral)Fetal complicationsIUGR/low birth rateFetal demiseContraindicated in pregnancy1ACEIs, ARBs, direct renin inhibitorsPropranolol (atenolol)1Pharmacological options for the treatment of gestational hypertension are the same as those for chronic hypertension. ++Table Graphic Jump Location|Download (.pdf)|PrintPreeclampsiaEstimated frequency in healthy nulliparous women is 2–7%Majority of cases (75%): mild, near term or intrapartum onset, negligible increase in risk for adverse outcomeFrequency and severity is higher with history ofMultiple gestationChronic hypertensionPrior pregnancy with preeclampsiaPregestational diabetes mellitusThrombophiliaMaternal complicationsPlacental abruption (1–4%)Disseminated coagulopathy/HELLP syndrome (10–20%)Pulmonary edema/aspiration (2–5%)Acute renal failure (1–5%)Eclampsia (1%)Liver failure or hemorrhage (1%)Stroke (rare)Death (rare)Long-term cardiovascular morbidityDiagnosis and management is supported by adequate prenatal careMain objective remains the safety of the motherExpectant management for pre-34 weeks remains controversialMultisystem disorder with poorly understood pathomechanismAbnormal vascular response to placentationPlacental humoral factors (sFlt-1, sEng) cause endothelial dysfunction in motherUnique to human pregnancyCharacterized byMicrovascular dysfunctionIncreased SVRActivation of inflammatory pathwaysEnhanced coagulationIncreased platelet activation and aggregationEndothelial barrier dysfunctionPreeclampsia is most likely the common manifestation of a number of diseases affecting pregnant womenFetal effectsIUGR/low birth weightReduced amniotic fluidRestricted placental oxygen exchange, fetal hypoxia and neurological injuryPreterm deliveryAntihypertensivesLittle evidence for benefit in mild/moderate casesSevere hypertension (>160 mm Hg systolic, >100 mm Hg diastolic) should be treated to prevent maternal end-organ damageHydralazine was associated with more maternal side effects ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth