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Pregnancy induced hypertension (PIH) in patient of essential hypertension is a high risk factor for both mother and child. From July 1959 to June 1991 there were 52,898 deliveries after the 28th week of gestation in our hospital, among whom essential hypertension occurred in 2.5% and 337 cases were superimposed by PIH with an incidence of 25.9%. There was a perinatal fetal mortality rate of 117.6/1000 in those 337 cases. A scoring system for perinatal fetal prognosis was worked out. The clinical criteria consist of: preexisting diastolic blood pressure, the highest diastolic pressure during pregnancy, proteinuria and the time of onset of PIH. A perinatal survival rate of 75.0% was obtained in those patients with preexisting diastolic pressure lower than 14.8 kPa (110 mmHg). A perinatal survival rate of more than 98.0% may be expected of those patients developing P I H after the 36th week of gestation. When the score is more than 8, the patient could usually get a living baby. If the score is less than 7, it is important to treat P I H effectively, terminate pregnancy at an appropriate time and keep the baby in the intensive care unit.
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PMID:[Perinatal fetal prognosis of essential hypertension complicating pregnancy]. 139

Gestational hypertension is the development of hypertension and proteinuria after the 20th week of gestation. The most common causes of increased peripheral resistance are the vasoconstriction and hemoconcentration with plasma volume contraction. Additional rheological parameters are an elevated red blood cell aggregation and impaired erythrocyte deformability. Preeclamptic patients showed a significantly low cardiac output and central venous pressure than normal pregnant women. It has already been shown by the studies by Hytten and Paintin (1963) and also by the subsequent studies by Garn et al. (1981), Murphy et al. (1986) that a strong correlation exists between newborn weight and plasma volume. Other authors (Gallery et al. (1979/1981)) show the possibility that plasma volume contraction plays an even larger role than vasoconstriction in the fetal growth retardation that often accompanies maternal hypertension. This possibility is supported by the finding that hypertension and perinatal complications can be reduced in some pregnant women by the admission of oncotic solutions (i.e. hydroxyethyl-starch) that expand plasma volume. Volume expansion with hydroxyethyl-starch appears to be of therapeutic benefit for hypertensive patients and patients with fetal growth retardation with low cardiac output.
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PMID:[Rheology and gravidic hypertension]. 172 87

Pregnancy-induced hypertension is a disorder of unknown etiology unique to pregnant women. Classic clinical manifestations include hypertension, proteinuria, and edema. Early recognition and proper management of this disease may serve to avoid serious maternal complications. Ultimate maternal treatment depends on delivery of the fetus and placenta. Advanced stages of this disease result in multi-organ system dysfunction that may be life-threatening to the mother and her fetus. Such maternal complications of PIH include severe hypertension, oliguria or anuria, HELLP syndrome, eclamptic seizures, liver rupture, pulmonary edema, cerebral edema, and abruptio placentae. A multidisciplinary approach of the critical care team often will effect a reduction in maternal morbidity and mortality.
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PMID:Management of severe preeclampsia and eclampsia. 174 3

Pregnancy-induced hypertension (PIH) is characterized by a relative decrease in plasma volume and renin and aldosterone concentrations as well as increased capillary permeability compared with normal pregnancy. As many of these features could be explained by the actions of atrial natriuretic peptide (ANP), we examined the relationship between plasma volume and plasma ANP in women with PIH and in normal third trimester pregnant women, and whether ANP responses to alterations in posture were intact in women with PIH. Basal plasma ANP measured after 20 min lateral recumbency in women with PIH was 24.0 (13.9, 33.1) pmol/L (median [25th, 75th percentile]), which was significantly greater than in normal pregnant women (9.9 [6.3, 16.0]), (P less than .05). Plasma ANP did not differ between those with and without proteinuria in the PIH group. Plasma volume was decreased in women with PIH (20.1 [19.0, 23.2] mL/cm) v 23.5 [21.4, 25.3], P less than .05). Plasma renin concentration but not plasma aldosterone concentration was also decreased significantly in women with PIH compared with normal pregnant women (P less than .001) and both were correlated negatively with plasma ANP. Following prolonged lateral recumbency, plasma ANP rose to 26.9 [19.1, 44.1] pmol/L in women with PIH (P less than .05), which was still significantly greater than in normal pregnant women (15.5 [6.7, 21.9] pmol/L) (P less than .05). In a subgroup of these subjects, 30 min head-up tilt decreased plasma ANP by 5.2 [0.9, 22.3] pmol/L in women with PIH and by 6.1 [2.2, 10.3] pmol/L in normal pregnant women, a nonsignificant difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Atrial natriuretic peptide and plasma volume in pregnancy-induced hypertension. 183 91

The diagnosis of preeclampsia is often erroneous in primigravidas and usually so in multiparas. Gestational hypertension, defined as acute hypertension without proteinuria or abnormal edema, is often misdiagnosed as mild preeclampsia. Several follow-up studies are cited as evidence for the conclusions that (1) eclampsia and "true" preeclampsia seldom if ever cause chronic hypertension in women who otherwise never would have developed it; (2) gestational hypertension often is a sign of latent essential hypertension unmasked by pregnancy, and as such it often portends later chronic hypertension; and (3) normotensive pregnancies indicate a low prevalence of later chronic hypertension, and if it does develop, it usually does so at an age later than the average time of onset.
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PMID:The remote prognostic significance of the level of blood pressure in pregnancy. 700 Apr 71

The clinical diagnosis of preeclampsia is often erroneous, for it may be confused with latent hypertension, acute or chronic renal disease, or frank essential hypertension that had abated during much of pregnancy. Eclampsia and "true" preeclampsia run in families with a frequency suggesting that a single recessive gene may be responsible. Eclampsia and "true" preeclampsia do not cause chronic hypertension, whatever their durations. Gestational hypertension is merely hypertension without proteinuria or abnormal edema. It often has been the basis for the diagnosis of mild preeclampsia, although renal biopsy samples almost never show the characteristic lesion in the absence of proteinuria. Gestational hypertension is often a sign of latent hypertension unmasked by pregnancy. Women with gestational hypertension ultimately have a high prevalence of chronic hypertension, whereas all those whose pregnancies are normotensive ultimately have a low prevalence.
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PMID:Hypertension in pregnancy: definitions, familial factor, and remote prognosis. 700 1

This is the first report of the largest study of blood pressure measurement in pregnancy in a New Zealand population using standardized definitions and methodology. Over 3,800 women who delivered in an 8-month period in the Wellington region were included in the study. Blood pressure measurement and the presence of oedema and proteinuria were recorded from booking until delivery and in the puerperium. Only 2.7% of women were unable to be contacted after delivery for details on outcomes. The results established normal ranges for blood pressure throughout pregnancy. The data show that blood pressure greater than 140/90 until 35 weeks' gestation is outside 2 standard deviations at all gestations and justifies using these measurements as the definition of hypertension in pregnancy. The fall in blood pressure in the 2nd trimester was less than 1 mm Hg per week in both the systolic and diastolic pressures. This fall was smaller than previously recorded in other studies. Gestational hypertension was the commonest blood pressure abnormality occurring in 15.2% of the population. This represented 69% of the pregnant women with a hypertensive disorder. The overall incidence of both gestational hypertension and preeclampsia was 18.5% which is higher than reported in other parts of the world. In this study obesity was significantly associated with hypertensive disorders in pregnancy. An arm circumference of > 33 cm, one of the measurements of obesity, was found in 6.8% of the study population. Even after the effect of arm circumference was taken into account, hypertensive disorders were also more common in Pacific Island women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Measurements of blood pressure, oedema and proteinuria in a pregnant population of New Zealand. 777 96

To investigate the use of uterine artery flow velocity waveforms in predicting gestational hypertension (GH), preeclampsia (PE) and intrauterine growth retardation (IUGR), Colour Doppler ultrasound of the uterine arteries was performed at 19-24 weeks gestation in 51 women with known renal disease. On four consecutive waveforms, peak systolic (A), end-diastolic (B) and early diastolic (C) velocities were measured. Resistance index (RI) was calculated as (A-B)/A, and the severity of the waveform notch expressed as the AC ratio (A/C). Gestational hypertension was defined as a blood pressure (BP) > or = 140/90 mmHg with an increase of at least 15 mmHg in diastolic BP. PE included women with gestational hypertension and proteinuria > 300 mg/24 h or a doubling of early gestation protein excretion. IUGR was defined as a birthweight less than the 10th percentile for gestation. RI and/or AC ratio in 14 women (27%) exceeded the 90th percentile for gestational age of our low risk control population. Of the women with an abnormal test, 11 (79%) developed complications, 8 (57%) developed GH or PE, 3 (21%) IUGR alone, 2 (14%) GH and IUGR, and in one women intrauterine fetal death of an IUGR infant occurred, and 3 (21%) had an uncomplicated pregnancy. Of the women with a normal test, 34 (92%) had an uncomplicated pregnancy, and only 3 (8%) developed GH or IUGR. In summary, uterine artery waveform indices at 19-24 weeks gestation may be useful for the prediction of pregnancy complications in woman with underlying renal disease.
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PMID:Uterine artery waveform as a predictor of pregnancy outcome in women with underlying renal disease. 788 99

Pregnancy-induced hypertension (PIH) is a heterogeneous disorder which complicates 5-7% of all pregnancies and remains a leading cause of maternal, fetal and neonatal morbidity and mortality. Severe preeclampsia is the most distinctive and life-threatening form; a multi-system disorder more common in first pregnancies, it is characterized by high blood pressure and proteinuria. In a series of Caucasian women with pregnancy-induced hypertension, we have observed a significant association of preeclampsia with a molecular variant of angiotensinogen, T235, found previously to be associated with essential hypertension. This finding is corroborated in a sample ascertained in Japan. Together, these observations support a new pathophysiological interpretation of preeclampsia and of its relation to some forms of essential hypertension.
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PMID:A molecular variant of angiotensinogen associated with preeclampsia. 851 28

The association between nulliparity and gestational hypertension was examined by analysis of the 1988 National Maternal and Infant Health Survey. Gestational hypertension was defined as the occurrence of two consecutive diastolic blood pressure readings > or = 90 mm Hg after 20 completed weeks gestation in the absence of proteinuria in subjects normotensive prior to pregnancy. Preeclampsia was defined as gestational hypertension in the presence of significant proteinuria. Using logistic regression, 110 subjects with gestational hypertension and 34 subjects with preeclampsia were compared with 4371 subjects free of all hypertensive disorders. Nulliparity was weakly associated with an increase in the risk of gestational hypertension among whites (odds ratio, 95% confidence interval: 1.58 [0.92-2.74]) and not associated with risk among blacks (1.09 [0.51-2.35]). Preeclampsia was strongly associated with increased risk among whites (2.86 [0.94-8.73]) and blacks (2.94 [0.94-9.18]). The small increase in risk of gestational hypertension associated with nulliparity in contrast with the large increase in risk of preeclampsia suggests that these disorders may have a different etiology.
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PMID:The association between nulliparity and gestational hypertension. 925 98


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