Advertisement

National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy

        This paper is only available as a PDF. To read, Please Download here.

        Abstract

        This consensus report focuses the presentation, pathophysiology, and management of the hypertensive disorders of pregnancy expanding on recommendations first presented in 1988 by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Practicing physicians should determine whether a patient's hypertension during pregnancy falls into the classification of (1) chronic hypertension, (2) preeclampsia, (3) preeclampsia superimposed on chronic hypertension, or (4) transient hypertension. The distinction, for management considerations, is made between hypertension that is present before pregnancy (chronic and preexisting) and that occurring as part of the pregnancy-specific condition preeclampsia. When maternal blood pressure reaches diastolic levels of 100 mm Hg or greater, treatment should be instituted to avoid hypertensive vascular damage. The report includes a discussion of antihypertensive therapy specific to the chronic or acute hypertension occurring concomitantly with pregnancy. The roles of calcium supplementation and low-dose aspirin to prevent preeclampsia and chronic and transient hypertension are under investigation.

        Key words

        To read this article in full you will need to make a payment

        Purchase one-time access:

        Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
        One-time access price info
        • For academic or personal research use, select 'Academic and Personal'
        • For corporate R&D use, select 'Corporate R&D Professionals'

        Subscribe:

        Subscribe to American Journal of Obstetrics & Gynecology
        Already a print subscriber? Claim online access
        Already an online subscriber? Sign in
        Institutional Access: Sign in to ScienceDirect

        References

          • Chesley LC
          Hypertensive disorders in pregnancy. Appleton-Century-Crofts, New York1978
          • Cunningham FG
          • Leveno KJ
          Management of pregnancyinduced hypertension.
          in: Rubin PC Handbook of hypertension, Hypertension in pregnancy. vol 10. Elsevier, Amsterdam1988: 290-319
          • Pollak VE
          Pre-eclampsia and kidney disease.
          in: Coggins CH Cummings NB Prevention of kidney and urinary tract diseases. DREW Publication No. (NIH) 78855, 1978: 95-129
          • Robinson N
          Salt in pregnancy.
          Lancet. 1958; 1: 178-181
          • MacGillivray I
          Some observations on the incidence of preeclampsia.
          J Obstet Gynaecol Br Empire. 1958; 65: 536-539
          • Thompson AM
          • Chun D
          • Baird D
          Perinatal mortality in Hong Kong and in Aberdeen, Scotland.
          J Obstet Gynaecol Br Commonwealth. 1963; 70: 871-877
          • The 1988 Joint National Committee
          The 1988 report of the joint Committee on Detection, Evaluation, and Treatment of High Blood Pressure.
          Arch Intern Med. 1988; 148: 1023-1038
        1. Hughes EC Obstetric-gynecologic terminology. Davis, Philadelphia1972: 422-423
        2. American College of Obstetricians and Gynecologists. Management of preeclampsia. ACOG Technical Bulletin Feburary 1986, No. 91.

          • World Health Organization Study Group
          The hypertensive disorders of pregnancy.
          WHO Technical Report Series No. 758. World Health Organization, Geneva1987
          • Davey DA
          • MacGillivray I
          The classification and definition of the hypertensive disorders of pregnancy.
          Clin Exp Hypertens Pregnancy. 1986; B5: 97-133
          • Chesley LC
          • Annitto JE
          Pregnancy in the patient with hypertensive disease.
          Am J Obstet Gynecol. 1947; 53: 372-381
          • Dieckmann WJ
          The toxemias of pregnancy. 2nd ed. CV Mosby, St. Louis1952: 422
          • Sibai BM
          • McCubbin JH
          • Anderson GD
          • Lipshitz J
          • Dilts Jr, PV
          Eclampsia. I. Observations from sixty-seven recent cases.
          Obstet Gynecol. 1981; 58: 609-613
          • Herrick WW
          • Tillman AJB
          The mild toxemias of late pregnancy: their relation to cardiovascular and renal disease.
          Am J Obstet Gynecol. 1936; 31: 832-844
          • Berman S
          Observations in the toxemia clinic, Boston Lying-in Hospital, 1923-1930.
          N Engl J Med. 1930; 203: 361-363
          • Adams EM
          • MacGillivray I
          Long-term effect of preeclampsia on blood pressure.
          Lancet. 1961; 2: 1373-1375
          • Redman CW
          • Beilin LJ
          • Bonnar I
          • et al.
          Plasma urate measurements in predicting fetal death in hypertensive pregnancy.
          Lancet. 1976; 1: 1370-1373
          • Fisher KA
          • Luger A
          • Spargo BH
          • Lindheimer MD
          Hypertension in pregnancy: clinical-pathological correlations and remote prognosis.
          Medicine. 1981; 60: 267-276
          • Aarnoudse JG
          • Houthoff HJ
          • Weits J
          • Vellenga E
          • Huisjes HJ
          A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy: a clinical and histopathological study.
          Br j Obstet Gynaecol. 1986; 93: 145-155
          • Hinselmann H
          Allgemeine Krankheitslehre.
          in: Hinselmann H Die Eclampsie. Cohen, Bonn1924: 187
          • Chesley LC
          • Cooper DW
          Genetics of hypertension in pregnancy: possible single gene control of pre-eclampsia and eclampsia in the descendants of eclampsic women.
          Br J Obstet Gynaecol. 1986; 93: 898-908
          • White P
          Pregnancy complicating diabetes.
          Surg Gynecol Obstet. 1935; 61: 324-332
          • Page EW
          The relation between hydatid moles, relative ischemia of the gravid uterus, and the placental origin of eclampsia.
          Am J OBsTF.r GYNECOE. 1939; 37: 291-293
          • Jann R
          Spatgestosen bei Hydrops fetus et placentae infolge Rhesus-Inkompatibilitat.
          Arch Gynaekol. 1954; 184: 731-748
          • Scott JS
          Pregnancy toxaemia associated with hydrops foetalis, hydatidiform mole, and hydramnios.
          J Obstet Gynaecol Br Empire. 1958; 65: 689-701
          • Nelson TR
          A clinical study of pre-eclampsia, pts I and 11.
          J Obstet Gynaecol Br Empire. 1955; 62: 48-66
          • Redman CW
          Eclampsia still kills.
          Br Med J. 1988; 296: 1209-1210
          • Talledo OF
          • Chesley LC
          • Zuspan FP
          Renin-angiotensin system in normal and toxemic pregnancies. III. Differential sensitivity to angiotensin II and norepinephrine in toxemia of pregnancy.
          Am J Obstet Gynecol. 1968; 100: 218-221
          • Gant NF
          • Daley GL
          • Chand S
          • Whalley PJ
          • MacDonald PC
          A study of angiotensin II pressor response throughout primigravid pregnancy.
          ,J Clin Invest. 1973; 52: 2682-2689
          • Hankins GD
          • Wendel Jr, GD
          • Cunningham FG
          • Leveno KJ
          Longitudinal evaluation of hemodynamic changes in eclampsia.
          Am J Obstet Gynecol. 1984; 150: 506-512
          • Groenendiik R
          • Trimbros JB
          • Wallenburg HC
          Hemodynamic measurements in preeclampsia: preliminary observations.
          Am ,J OBSTt°r GYNECOL. 1984; 150: 232-236
          • Wallenburg HCS
          Hemodynamics in hypertensive pregnancy.
          in: Ruben PC Handbook of hypertension, Hypertension in pregnancy. vol 10. Elsevier, Amsterdam1988: 66-101
          • Pritchard JA
          • Cunningham FG
          • Pritchard SA
          The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases.
          Am .1 OBSTET GYNECOL. 1984; 148: 951-963
          • Pritchard JA
          • Cunningham FG
          • Mason RA
          Coagulation changes in eclampsia: their frequency and pathogenesis.
          Am J OBSTE r GYNECO1. 1976; 124: 855-859
          • Roberts JM
          • Taylor RN
          • Musci TJ
          • Rodgers GM
          • Hubel CA
          • McLaughlin MK
          Preeclampsia: an endothelial cell disorder.
          Am J Obstet Gynecol. 1989; 161: 1200-1204
          • Saleh AA
          • Bottoms SF
          • Welch RA
          • Ali AM
          • Mariona FG
          • Mammen EF
          Preeclampsia, delivery and the hemostatic system.
          Am J Obstet Gynecol. 1987; 157: 331-336
          • Burrows RF
          • Hunter DJ
          • Andrew M
          • Kelton JG
          A prospective study investigating the mechanism of thrombocytopenia in preeclampsia.
          Obstet Gynecol. 1987; 70: 334-338
          • Pritchard JA
          • Cunningham FG
          • Pritchard SA
          • Mason RA
          How often does maternal preeclampsia-eclampsia incite throinbocytopenia in the fetus.
          Obstet Gynecol. 1987; 69: 292-295
          • Gaber LW
          • Spargo BH
          • Lindheimer MD
          Renal pathology in preeclampsia.
          Clin Obstet Gynaecol (Bailliere). 1987; 1: 971-995
          • Chesley LC
          Diagnosis of preeclampsia.
          Obstet Gynecol. 1985; 65: 423-425
          • Spargo B
          • McCartney CP
          • Winemiller R
          Glomerular capillary endotheliosis in toxemia of pregnancy.
          Arch Pathol. 1959; 68: 593-599
          • Sibai BM
          • Taslimi MM
          • el Nazer A
          • Amon E
          • Mabie BC
          • Ryan GM
          Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelets in severe preeclampsia-eclampsia.
          Amj OBsorEr GYNECOL. 1986; 155: 501-509
          • Sheehan HL
          Pathologic lesions in the hypertensive toxemias of pregnancy.
          in: Hammond J Browne FJ Wolstenholm GEW Toxemias of pregnancy: human and veterinary. Blakiston, Philadelphia1950: 16-22
          • McCall ML
          Cerebral circulation and metabolism in toxemia of pregnancy: observations on the effects of Veratrum viride and Apresoline (1-hydrazinophthalazine).
          Am J OBsTF r GYNECOL. 1953; 66: 1015-1030
          • Sibai BM
          • Spinnato JA
          • Watson DL
          • Lewis JA
          • Anderson GD
          Eclampsia. IV. Neurological findings and future outcome.
          Am J Obstet Gynecol. 1985; 152: 184-192
          • Brown CE
          • Purdy P
          • Cunningham FG
          Head computed tomographic scans in women with eclampsia.
          Am J Obstet Gynecol. 1988; 159: 915-920
        3. Cerebral lesions.
          in: Sheehan HL Lynch JB Pathology of toxaemia of pregnancy. Williams & Wilkins, Baltimore1973: 524-553
          • Browne JCM
          • Veall N
          The maternal placental blood flow in normotensive and hypertensive women.
          J Obstet Gynaecol Br Empire. 1953; 60: 141-147
          • Fleischer A
          • Schulman H
          • Farmakides G
          • et al.
          Uterine artery Doppler velocimetry in pregnant women with hypertension.
          Am J Obstet Gynecol. 1986; 154: 806-813
          • Trudinger BJ
          • Giles WB
          • Cook CM
          Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations.
          Am J Obstet Gynecol. 1985; 152: 155-163
          • Sibai BM
          • Taslimi M
          • Abdella TN
          • Brooks TF
          • Spinnato JA
          • Anderson GD
          Maternal and perinatal outcome of conservative management of severe preeclamp sia in midtrimester.
          Am J Obstet Gynecol. 1985; 152: 32-37
          • Weiner CP
          • Kwaan HC
          • Xu C
          • Paul M
          • Burmeister L
          • Hauck W
          Antithrombin III activity in women with hypertension during pregnancy.
          Obstet Gynecol. 1985; 65: 301-306
          • Entman SS
          • Kambam JR
          • Bradley CA
          • Cousar JB
          Increased levels of carboxyhemoglobin and serum iron as an indicator of increased red cell turnover in preeclampsia.
          Am J Obstet Gynecol. 1987; 156: 1169-1173
          • Taufield PA
          • Ales KL
          • Resnick LM
          • Druzin ML
          • Gertner JM
          • Laragh JH
          Hypocalciuria in preeclampsia.
          N Engl J Med. 1987; 316: 715-718
          • Lindheimer MD
          • Katz AI
          Preeclampsia: pathophysiology, diagnosis, and management.
          Annu Rev Med. 1989; 40: 233-250
          • Foidart JM
          • Hunt J
          • Lapiere CM
          • et al.
          Antibodies to laminin in preeclampsia.
          Kidney Int. 1986; 29: 1050-1057
          • Rodgers GM
          • Taylor RN
          • Roberts JM
          Preeclampsia is associated with a serum factor cytotoxic to human endothelial cells.
          Am J Obstet Gynecol. 1988; 159: 908-914
          • Musci TJ
          • Roberts JM
          • Rodgers GM
          • Taylor RN
          Mitogenic activity is increased in the sera of preeclampsic women before delivery.
          Am J Obstet Gynecol. 1988; 159: 1446-1451
          • Ellison GT
          • Mansberger JA
          • Mansberger Jr, AR
          Malignant recurrent pheochromocytoma during pregnancy: case report and review of the literature.
          Surgery. 1988; 103: 484-489
          • Schenker JG
          • Chowers I
          Pheochromocytoma and pregnancy: review of eighty-nine cases.
          Obstet Gynecol Surv. 1971; 26: 739-747
          • Packham DK
          • Fairley KF
          • Ihle BU
          • Whitworth JA
          • Kincaid-Smith P
          Comparison of pregnancy outcome between normotensive and hypertensive women with primary glomerulonephritis.
          Clin Exp Hypertens [A]. 1987-1988; B6: 387-399
          • Hou SH
          • Grossman SD
          • Madias NE
          Pregnancy in women with renal disease and moderate renal insufficiency.
          Am J Med. 1985; 78: 185-194
          • Lindheimer MD
          • Katz AL
          Gestation in women with kidney disease: prognosis and management.
          Clin Obstet Gynaecol (Bailliere). 1987; 1: 921-937
          • Papiernik E
          • Kaminski M
          Multifactorial study of the risk of prematurity at thirty-two weeks of gestation. I. A study of the frequency of thirty predictive characteristics.
          Perinat Med. 1974; 2: 30-36
          • Gallery ED
          • Hunyor SN
          • Györy AZ
          Plasma volume contraction: a significant factor in both pregnancyassociated hypertension (pre-eclampsia) and chronic hypertension in pregnancy.
          Q J Med. 1979; 48: 593-602
          • Palomaki JF
          • Lindheimer MD
          Sodium depletion simulating deterioration in a toxemic pregnancy.
          N Engl J Med. 1970; 282: 88-89
          • Kawasaki N
          • Matsui K
          • Ito M
          • et al.
          Effect of calcium supplementation on the vascular sensitivity to angiotensin II in pregnant women.
          Am J Obstet Gynecol. 1985; 153: 576-582
          • Villar J
          • Repke J
          • Belizan JM
          • Pareja G
          Calcium supplementation reduces blood pressure during pregnancy: results of a randomized controlled clinical trial.
          Obstet Gynecol. 1987; 70: 317-322
          • Rayburn WF
          • Zuspan FP
          • Piehl EJ
          Self-monitoring of blood pressuring during pregnancy.
          Am J Obstet Gynecol. 1984; 148: 159-162
          • Page EW
          • Christianson R
          The impact of mean arterial blood pressure in the middle trimester upon the outcome of pregnancy.
          Am J Obstet Gynecol. 1976; 125: 740-745
          • Friedman EA
          • Neff RK
          Pregnancy hypertension: a systematic evaluation of clinical diagnostic criteria. PSG, Littleton, MA1977
          • Dunlop JCH
          Chronic hypertension and perinatal mortality.
          Proc R Soc Med. 1966; 59: 838-841
          • Leather HM
          • Humphreys DM
          • Baker P
          • Chadd MA
          A controlled trial of hypotensive agents in hypertension in pregnancy.
          Lancet. 1968; 2: 488-490
          • Rubin PC
          • Butters L
          • Clark DM
          • et al.
          Placebo-controlled trial of atenolol in treatment of pregnancy-associated hypertension.
          Lancet. 1983; 1: 431-434
          • Wichman K
          • Ryden G
          • Karlberg BE
          A placebocontrolled trial of metoprolol in the treatment of hypertension in pregnancy.
          Scand J Clin Lab Invest Suppl. 1984; 169: 90-95
          • Landesman R
          • McLarn WD
          • Ollstein RN
          • Mendelsohn B
          Reserpine in toxemia of pregnancy.
          Obstet Gynecol. 1957; 9: 377-383
          • Fletcher AE
          • Bulpitt CJ
          A review of clinical trials in pregnancy.
          in: Rubin PC Hypertension in pregnancy. Elsevier, New York1988: 186-201
          • Redman CW
          • Beilin LJ
          • Bonnar J
          • Ounsted MK
          Fetal outcome in trial of antihypertensive treatment in pregnancy.
          Lancet. 1976; 2: 753-756
          • Ferris TF
          • Weir EK
          Effect of captopril on uterine blood flow and prostaglandin E synthesis in the pregnant rabbit.
          J Clin Invest. 1983; 71: 809-815
          • Schubiger G
          • Flury G
          • Nussberger J
          Enalapril for pregnancy-induced hypertension: acute renal failure in a neonate.
          Ann Intern Med. 1988; 108 (Published erratum appears in Ann Intern Med 1988;108:777.): 215-216
          • Rosa FW
          • Bosco LA
          • Graham CF
          • Milstien JB
          • Dreis M
          • Creamer J
          Neonatal anuria with maternal angiotensinconverting enzyme inhibition.
          Obstet Gynecol. 1989; 74: 371-374
          • Scott AA
          • Purohit DM
          Neonatal renal failure: a complication of maternal antihypertensive therapy.
          Am J Obstet Gynecol. 1989; 160: 1223-1224
          • Knott PD
          • Thorpe SS
          • Lamont CAR
          Congenital renal dysgenesis possibly due to captopril.
          Lancet. 1989; 1: 451
          • Barron WM
          • Murphy MD
          • Lindheimer MD
          Management of hypertension during pregnancy.
          in: Laragh JH Brenner BM Hypertension, diagnosis and management. Raven Press, New York1990: 1809-1827
          • Redman CW
          A controlled trial of the treatment of hypertension in pregnancy: labetalol compared with methyldopa.
          in: Riley A Symonds EM Investigation of labetalol in the management of hypertension in pregnancy, International Congress series 591 Excerpta Medica, Amsterdam1982: 101-110
          • Sibai BM
          • Gonzalez AR
          • Mabie WC
          • Moretti M
          A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term.
          Obstet Gynecol. 1987; 70: 323-327
          • Sibai BM
          • Mabie WC
          • Villar M
          • Shamsa F
          • Anderson GD
          A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy.
          Am J OBSTE'r GYNECOL. 1990; 162: 960-966
          • Butters L
          • Kennedy S
          • Rubin P
          Atenolol and fetal weight in chronic hypertension [Abstract].
          Clin Exp Hypertens [A]. 1989; B8: 468
          • Constantine G
          • Beevers DG
          • Reynolds AL
          • Luesley DM
          Nifedipine as a second-line antihypertensive drug in pregnancy.
          Br J Obstet Gynaecol. 1987; 94: 1136-1142
          • Ulmsten U
          Treatment of normotensive and hypertensive patients with preterm labor using oral nifedipine, a calcium antagonist.
          Arch Gynecol. 1984; 236: 69-72
          • Fidler J
          • Smith V
          • Fayers P
          • DeSwiet M
          Randomized controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy.
          Br Med J. 1983; 286: 1927-1930
          • Kincaid-Smith P
          • Bullen M
          • Mills J
          Prolonged use of methyldopa in severe hypertension in pregnancy.
          Br Med J. 1966; 1: 274-276
          • Redman CW
          Treatment of hypertension in pregnancy.
          Kidney Int. 1980; 18: 267-278
          • Ounsted M
          • Cockburn J
          • Moar VA
          • Redman CW
          Maternal hypertension with superimposed pre-eclampsia: effects of child development at 71/2 years.
          Br J Obstet Gynaecol. 1983; 90: 644-649
          • Hays PM
          • Cruikshank DP
          • Dunn LJ
          Plasma volume determination in normal and preeclamptic pregnancies.
          Am J OBSTE"r GYNECOL. 1985; 151: 958-966
          • Arias F
          • Zamora J
          Antihypertensive treatment and pregnancy outcome in patients with mild chronic hypertension.
          Obstet Gynecol. 1979; 53: 489
          • Sibai BM
          • Grossman RA
          • Grossman HG
          Effects of diuretics on plasma volume in pregnancies with long-term hypertension.
          Am J Obstet Gynecol. 1984; 150: 831-835
          • Kraus GW
          • Marchese JR
          • Yen SSC
          Prophylactic use of hydrochlorothiazide in pregnancy.
          JAMA. 1966; 198: 1150-1154
          • Collins R
          • Yusuf S
          • Peto R
          Overview of randomised trials of diuretics in pregnancy.
          Br Med J. 1985; 290: 17-23
          • Widerlov E
          • Karlman I
          • Storsater J
          Hydralazineinduced neonatal thrombocytopenia (letter).
          N Engl J Med. 1980; 301: 12-35
          • Beaufils M
          • Uzan S
          • Donsimoni R
          • Colau JC
          Prevention of pre-eclampsia by early antiplatelet therapy.
          Lancet. 1985; 1: 840-842
          • Wallenburg HC
          • Dekker GA
          • Makovitz JW
          • Rotmans P
          Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae.
          Lancet. 1986; 1: 1-3
          • Schiff E
          • Peleg E
          • Goldenberg M
          • et al.
          The use of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A1 to prostacyclin in relatively high-risk pregnancies.
          N Engl J Med. 1989; 321: 351-356
          • Benigni A
          • Gregorini G
          • Frusca T
          • et al.
          Effect of lowdose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy induced hypertension.
          N Engl _1 Med. 1989; 321: 357-362
          • Stuart MJ
          • Gross SJ
          • Elrad H
          • Graeber JE
          Effects of acetylsalicylic-acid ingestion on maternal and neonatal hemostasis.
          N Engl J Med. 1982; 307: 909-912
          • Davison JM
          • Lindheimer MD
          Hypertension and pregnancy.
          in: Schrier RW Gottschalk CW 4th ed. Diseases of the kidney. vol 2. Little Brown & Co, Boston1988: 1653-1686
          • Ferris TF
          How should hypertension during pregnancy be managed? An internist's approach.
          Med Clin North Am. 1984; 68: 491-503
          • Naden RP
          • Redman CW
          Antihypertensive drugs in pregnancy.
          Clin Perinatol. 1985; 12: 521-538
          • Walters BN
          • Redman CW
          Treatment of severe pregnancy-associated hypertension with the calcium antagonist nifedipine.
          Br J Obstet Gynaecol. 1984; 91: 330-336
          • Naulty J
          • Cefalo RC
          • Lewis PE
          Fetal toxicity of nitroprusside in the pregnant ewe.
          Am J Obstet Gynecol. 1981; 139: 708-711
          • Ferris TF
          Prostanoids in normal and hypertensive pregnancy.
          in: Rubin PC Hypertension in pregnancy. Elsevier, New York1988: 102-117
          • Dinsdale HB
          Does magnesium sulfate treat eclamptic seizures? Yes.
          Arch Neurol. 1988; 45: 1360-1361
          • Kaplan PW
          • Lesser RP
          • Fisher RS
          • Repke JT Hanley DF
          No, magnesium sulfate should not be used in treating eclamptic seizures.
          Arch Neurol. 1988; 45: 1361-1364
          • Thurnau GR
          • Kemp DB
          • Jarvis A
          Cerebrospinal fluid levels of magnesium in patients with preeclampsia after treatment with intravenous magnesium sulfate: a preliminary report.
          Am J Obstet Gynecol. 1987; 157: 1435-1438
          • Sibai BM
          • Spinnato JA
          • Watson DL
          • Lewis JA
          • Anderson GD
          Effect of magnesium sulfate on electroencephalographic findings in preeclampsia-eclampsia.
          Obstet Gynecol. 1984; 64: 261-266
          • Watson KV
          • Moldow CF
          • Ogburn PL
          • Jacob HS
          Magnesium sulfate: rationale for it use in preeclampsia.
          Proc Natl Acad Sci USA. 1986; 83: 1075-1078
          • Sibai BM
          • Anderson GD
          Pregnancy outcome of intensive therapy in severe hypertension in first trimester.
          Obstet Gynecol. 1986; 67: 517-522
          • Pruett KM
          • Kirshon B
          • Cotton DB
          • Adam K
          • Doody KJ
          The effects of magnesium sulfate therapy on Apgar scores.
          Am J Obstet Gynecol. 1988; 159: 1047-1048
          • Gallery ED
          • Delprado W
          • Györy AZ
          Antihypertensive effect of plasma volume expansion in pregnancyassociated hypertension.
          Aust NZ J Med. 1981; 11: 20-24
          • Qlian P
          • Mahan JM
          • Noddeland H
          • Fadnes HO
          Transcapillary fluid balance in pre-eclampsia.
          Br J Obstet Gynaecol. 1986; 93: 235-259
          • Zinaman M
          • Rubin J
          • Lindheimer MD
          Serial plasma oncotic pressure levels and echoencephalography during and after delivery in severe pre-eclampsia.
          Lancet. 1985; 1: 1245-1247
          • Clark SL
          • Cotton DB
          Clinical indications for pulmonary artery catheterization in the patient with severe preeclampsia.
          Am J Obstet Gynecol. 1988; 158: 453-458
        4. . American College of Obstetricians and Gynecologists. Invasive hemodynamic monitoring in obstetrics and gynecology. ACOG Technical Bulletin October 1988, No. 121.

          • White WB
          M.tnagement of hypertension during lactation.
          Hypertension. 1984; 6: 297-300
          • White WB
          • Andreoli JW
          • Cohn RD
          Alpha-methyldopa disposition in mothers with hypertension and in their breast-fed infants.
          Clin Pharmacol Ther. 1985; 37: 387-390
          • Miller ME
          • Cohn RD
          • Burghart PH
          Hydrochlorothiazide disposition in a mother and her breast-fed infant.
          J Pediatr. 1982; 101: 789-791
          • Krause W
          • Stoppelli I
          • Milia S
          • Rainer E
          Transfer of mepindolol to newborns by breast-feeding mothers after single and repeated daily doses.
          Fur J Clin Pharmacol. 1982; 22: 53-55
          • Bryans Jr, CI
          The remote prognosis in toxemia of pregnancy.
          Clin Obstet Gynecol. 1966; 9: 973-990
          • Chesley LC
          • Annitto JE
          • Cosgrove RA
          The remote prognosis of eclamptic women: sixth periodic report.
          Am J Obstet Gynecol. 1976; 124: 446-459
          • Hamilton M
          • Pickering GW
          • Roberts JAF
          • Sowry GSC
          The aetiology of essential hypertension: the arterial blood pressure in the general population.
          Clin Sci. 1954; 13: 11-35
          • Frohlich ED
          • Grim C
          • Labarthe DR
          • Maxwell MH
          • Perloff D
          • Weidman W
          Recommendations for human blood pressure determination by sphygmomanometers: re port of a special task force appointed by the Steering Committee, American Heart Association.
          Hypertension. 1988; 11: 209-222