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 accessOne-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 & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypertensive disorders in pregnancy. Appleton-Century-Crofts, New York1978
- Management of pregnancyinduced hypertension.in: Rubin PC Handbook of hypertension, Hypertension in pregnancy. vol 10. Elsevier, Amsterdam1988: 290-319
- 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
- Salt in pregnancy.Lancet. 1958; 1: 178-181
- Some observations on the incidence of preeclampsia.J Obstet Gynaecol Br Empire. 1958; 65: 536-539
- Perinatal mortality in Hong Kong and in Aberdeen, Scotland.J Obstet Gynaecol Br Commonwealth. 1963; 70: 871-877
- The 1988 report of the joint Committee on Detection, Evaluation, and Treatment of High Blood Pressure.Arch Intern Med. 1988; 148: 1023-1038
- Hughes EC Obstetric-gynecologic terminology. Davis, Philadelphia1972: 422-423
American College of Obstetricians and Gynecologists. Management of preeclampsia. ACOG Technical Bulletin Feburary 1986, No. 91.
- The hypertensive disorders of pregnancy.WHO Technical Report Series No. 758. World Health Organization, Geneva1987
- The classification and definition of the hypertensive disorders of pregnancy.Clin Exp Hypertens Pregnancy. 1986; B5: 97-133
- Pregnancy in the patient with hypertensive disease.Am J Obstet Gynecol. 1947; 53: 372-381
- The toxemias of pregnancy. 2nd ed. CV Mosby, St. Louis1952: 422
- Eclampsia. I. Observations from sixty-seven recent cases.Obstet Gynecol. 1981; 58: 609-613
- The mild toxemias of late pregnancy: their relation to cardiovascular and renal disease.Am J Obstet Gynecol. 1936; 31: 832-844
- Observations in the toxemia clinic, Boston Lying-in Hospital, 1923-1930.N Engl J Med. 1930; 203: 361-363
- Long-term effect of preeclampsia on blood pressure.Lancet. 1961; 2: 1373-1375
- Plasma urate measurements in predicting fetal death in hypertensive pregnancy.Lancet. 1976; 1: 1370-1373
- Hypertension in pregnancy: clinical-pathological correlations and remote prognosis.Medicine. 1981; 60: 267-276
- 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
- Allgemeine Krankheitslehre.in: Hinselmann H Die Eclampsie. Cohen, Bonn1924: 187
- 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
- Pregnancy complicating diabetes.Surg Gynecol Obstet. 1935; 61: 324-332
- 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
- Spatgestosen bei Hydrops fetus et placentae infolge Rhesus-Inkompatibilitat.Arch Gynaekol. 1954; 184: 731-748
- Pregnancy toxaemia associated with hydrops foetalis, hydatidiform mole, and hydramnios.J Obstet Gynaecol Br Empire. 1958; 65: 689-701
- A clinical study of pre-eclampsia, pts I and 11.J Obstet Gynaecol Br Empire. 1955; 62: 48-66
- Eclampsia still kills.Br Med J. 1988; 296: 1209-1210
- 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
- A study of angiotensin II pressor response throughout primigravid pregnancy.,J Clin Invest. 1973; 52: 2682-2689
- Longitudinal evaluation of hemodynamic changes in eclampsia.Am J Obstet Gynecol. 1984; 150: 506-512
- Hemodynamic measurements in preeclampsia: preliminary observations.Am ,J OBSTt°r GYNECOL. 1984; 150: 232-236
- Hemodynamics in hypertensive pregnancy.in: Ruben PC Handbook of hypertension, Hypertension in pregnancy. vol 10. Elsevier, Amsterdam1988: 66-101
- The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases.Am .1 OBSTET GYNECOL. 1984; 148: 951-963
- Coagulation changes in eclampsia: their frequency and pathogenesis.Am J OBSTE r GYNECO1. 1976; 124: 855-859
- Preeclampsia: an endothelial cell disorder.Am J Obstet Gynecol. 1989; 161: 1200-1204
- Preeclampsia, delivery and the hemostatic system.Am J Obstet Gynecol. 1987; 157: 331-336
- A prospective study investigating the mechanism of thrombocytopenia in preeclampsia.Obstet Gynecol. 1987; 70: 334-338
- How often does maternal preeclampsia-eclampsia incite throinbocytopenia in the fetus.Obstet Gynecol. 1987; 69: 292-295
- Renal pathology in preeclampsia.Clin Obstet Gynaecol (Bailliere). 1987; 1: 971-995
- Diagnosis of preeclampsia.Obstet Gynecol. 1985; 65: 423-425
- Glomerular capillary endotheliosis in toxemia of pregnancy.Arch Pathol. 1959; 68: 593-599
- 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
- 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
- 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
- Eclampsia. IV. Neurological findings and future outcome.Am J Obstet Gynecol. 1985; 152: 184-192
- Head computed tomographic scans in women with eclampsia.Am J Obstet Gynecol. 1988; 159: 915-920
- Cerebral lesions.in: Sheehan HL Lynch JB Pathology of toxaemia of pregnancy. Williams & Wilkins, Baltimore1973: 524-553
- The maternal placental blood flow in normotensive and hypertensive women.J Obstet Gynaecol Br Empire. 1953; 60: 141-147
- Uterine artery Doppler velocimetry in pregnant women with hypertension.Am J Obstet Gynecol. 1986; 154: 806-813
- Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations.Am J Obstet Gynecol. 1985; 152: 155-163
- Maternal and perinatal outcome of conservative management of severe preeclamp sia in midtrimester.Am J Obstet Gynecol. 1985; 152: 32-37
- Antithrombin III activity in women with hypertension during pregnancy.Obstet Gynecol. 1985; 65: 301-306
- 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
- Hypocalciuria in preeclampsia.N Engl J Med. 1987; 316: 715-718
- Preeclampsia: pathophysiology, diagnosis, and management.Annu Rev Med. 1989; 40: 233-250
- Antibodies to laminin in preeclampsia.Kidney Int. 1986; 29: 1050-1057
- Preeclampsia is associated with a serum factor cytotoxic to human endothelial cells.Am J Obstet Gynecol. 1988; 159: 908-914
- Mitogenic activity is increased in the sera of preeclampsic women before delivery.Am J Obstet Gynecol. 1988; 159: 1446-1451
- Malignant recurrent pheochromocytoma during pregnancy: case report and review of the literature.Surgery. 1988; 103: 484-489
- Pheochromocytoma and pregnancy: review of eighty-nine cases.Obstet Gynecol Surv. 1971; 26: 739-747
- Comparison of pregnancy outcome between normotensive and hypertensive women with primary glomerulonephritis.Clin Exp Hypertens [A]. 1987-1988; B6: 387-399
- Pregnancy in women with renal disease and moderate renal insufficiency.Am J Med. 1985; 78: 185-194
- Gestation in women with kidney disease: prognosis and management.Clin Obstet Gynaecol (Bailliere). 1987; 1: 921-937
- 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
- Plasma volume contraction: a significant factor in both pregnancyassociated hypertension (pre-eclampsia) and chronic hypertension in pregnancy.Q J Med. 1979; 48: 593-602
- Sodium depletion simulating deterioration in a toxemic pregnancy.N Engl J Med. 1970; 282: 88-89
- Effect of calcium supplementation on the vascular sensitivity to angiotensin II in pregnant women.Am J Obstet Gynecol. 1985; 153: 576-582
- Calcium supplementation reduces blood pressure during pregnancy: results of a randomized controlled clinical trial.Obstet Gynecol. 1987; 70: 317-322
- Self-monitoring of blood pressuring during pregnancy.Am J Obstet Gynecol. 1984; 148: 159-162
- The impact of mean arterial blood pressure in the middle trimester upon the outcome of pregnancy.Am J Obstet Gynecol. 1976; 125: 740-745
- Pregnancy hypertension: a systematic evaluation of clinical diagnostic criteria. PSG, Littleton, MA1977
- Chronic hypertension and perinatal mortality.Proc R Soc Med. 1966; 59: 838-841
- A controlled trial of hypotensive agents in hypertension in pregnancy.Lancet. 1968; 2: 488-490
- Placebo-controlled trial of atenolol in treatment of pregnancy-associated hypertension.Lancet. 1983; 1: 431-434
- A placebocontrolled trial of metoprolol in the treatment of hypertension in pregnancy.Scand J Clin Lab Invest Suppl. 1984; 169: 90-95
- Reserpine in toxemia of pregnancy.Obstet Gynecol. 1957; 9: 377-383
- A review of clinical trials in pregnancy.in: Rubin PC Hypertension in pregnancy. Elsevier, New York1988: 186-201
- Fetal outcome in trial of antihypertensive treatment in pregnancy.Lancet. 1976; 2: 753-756
- Effect of captopril on uterine blood flow and prostaglandin E synthesis in the pregnant rabbit.J Clin Invest. 1983; 71: 809-815
- 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
- Neonatal anuria with maternal angiotensinconverting enzyme inhibition.Obstet Gynecol. 1989; 74: 371-374
- Neonatal renal failure: a complication of maternal antihypertensive therapy.Am J Obstet Gynecol. 1989; 160: 1223-1224
- Congenital renal dysgenesis possibly due to captopril.Lancet. 1989; 1: 451
- Management of hypertension during pregnancy.in: Laragh JH Brenner BM Hypertension, diagnosis and management. Raven Press, New York1990: 1809-1827
- 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
- A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term.Obstet Gynecol. 1987; 70: 323-327
- A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy.Am J OBSTE'r GYNECOL. 1990; 162: 960-966
- Atenolol and fetal weight in chronic hypertension [Abstract].Clin Exp Hypertens [A]. 1989; B8: 468
- Nifedipine as a second-line antihypertensive drug in pregnancy.Br J Obstet Gynaecol. 1987; 94: 1136-1142
- Treatment of normotensive and hypertensive patients with preterm labor using oral nifedipine, a calcium antagonist.Arch Gynecol. 1984; 236: 69-72
- Randomized controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy.Br Med J. 1983; 286: 1927-1930
- Prolonged use of methyldopa in severe hypertension in pregnancy.Br Med J. 1966; 1: 274-276
- Treatment of hypertension in pregnancy.Kidney Int. 1980; 18: 267-278
- Maternal hypertension with superimposed pre-eclampsia: effects of child development at 71/2 years.Br J Obstet Gynaecol. 1983; 90: 644-649
- Plasma volume determination in normal and preeclamptic pregnancies.Am J OBSTE"r GYNECOL. 1985; 151: 958-966
- Antihypertensive treatment and pregnancy outcome in patients with mild chronic hypertension.Obstet Gynecol. 1979; 53: 489
- Effects of diuretics on plasma volume in pregnancies with long-term hypertension.Am J Obstet Gynecol. 1984; 150: 831-835
- Prophylactic use of hydrochlorothiazide in pregnancy.JAMA. 1966; 198: 1150-1154
- Overview of randomised trials of diuretics in pregnancy.Br Med J. 1985; 290: 17-23
- Hydralazineinduced neonatal thrombocytopenia (letter).N Engl J Med. 1980; 301: 12-35
- Prevention of pre-eclampsia by early antiplatelet therapy.Lancet. 1985; 1: 840-842
- Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae.Lancet. 1986; 1: 1-3
- 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
- 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
- Effects of acetylsalicylic-acid ingestion on maternal and neonatal hemostasis.N Engl J Med. 1982; 307: 909-912
- Hypertension and pregnancy.in: Schrier RW Gottschalk CW 4th ed. Diseases of the kidney. vol 2. Little Brown & Co, Boston1988: 1653-1686
- How should hypertension during pregnancy be managed? An internist's approach.Med Clin North Am. 1984; 68: 491-503
- Antihypertensive drugs in pregnancy.Clin Perinatol. 1985; 12: 521-538
- Treatment of severe pregnancy-associated hypertension with the calcium antagonist nifedipine.Br J Obstet Gynaecol. 1984; 91: 330-336
- Fetal toxicity of nitroprusside in the pregnant ewe.Am J Obstet Gynecol. 1981; 139: 708-711
- Prostanoids in normal and hypertensive pregnancy.in: Rubin PC Hypertension in pregnancy. Elsevier, New York1988: 102-117
- Does magnesium sulfate treat eclamptic seizures? Yes.Arch Neurol. 1988; 45: 1360-1361
- No, magnesium sulfate should not be used in treating eclamptic seizures.Arch Neurol. 1988; 45: 1361-1364
- 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
- Effect of magnesium sulfate on electroencephalographic findings in preeclampsia-eclampsia.Obstet Gynecol. 1984; 64: 261-266
- Magnesium sulfate: rationale for it use in preeclampsia.Proc Natl Acad Sci USA. 1986; 83: 1075-1078
- Pregnancy outcome of intensive therapy in severe hypertension in first trimester.Obstet Gynecol. 1986; 67: 517-522
- The effects of magnesium sulfate therapy on Apgar scores.Am J Obstet Gynecol. 1988; 159: 1047-1048
- Antihypertensive effect of plasma volume expansion in pregnancyassociated hypertension.Aust NZ J Med. 1981; 11: 20-24
- Transcapillary fluid balance in pre-eclampsia.Br J Obstet Gynaecol. 1986; 93: 235-259
- Serial plasma oncotic pressure levels and echoencephalography during and after delivery in severe pre-eclampsia.Lancet. 1985; 1: 1245-1247
- Clinical indications for pulmonary artery catheterization in the patient with severe preeclampsia.Am J Obstet Gynecol. 1988; 158: 453-458
. American College of Obstetricians and Gynecologists. Invasive hemodynamic monitoring in obstetrics and gynecology. ACOG Technical Bulletin October 1988, No. 121.
- M.tnagement of hypertension during lactation.Hypertension. 1984; 6: 297-300
- Alpha-methyldopa disposition in mothers with hypertension and in their breast-fed infants.Clin Pharmacol Ther. 1985; 37: 387-390
- Hydrochlorothiazide disposition in a mother and her breast-fed infant.J Pediatr. 1982; 101: 789-791
- Transfer of mepindolol to newborns by breast-feeding mothers after single and repeated daily doses.Fur J Clin Pharmacol. 1982; 22: 53-55
- The remote prognosis in toxemia of pregnancy.Clin Obstet Gynecol. 1966; 9: 973-990
- The remote prognosis of eclamptic women: sixth periodic report.Am J Obstet Gynecol. 1976; 124: 446-459
- The aetiology of essential hypertension: the arterial blood pressure in the general population.Clin Sci. 1954; 13: 11-35
- 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
Article Info
Identification
Copyright
© 1990 Mosby. Published by Elsevier Inc. All rights reserved.
