Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines

Abstract

Importance: Gestational hypertension and preeclampsia are leading causes of maternal and perinatal morbidity and mortality worldwide. Τhe lack of effective screening and management policies appears to be one of the main reasons.Objective: The aim of this study was to review and compare recommendations from published guidelines on these common pregnancy complications.

Loss of E-Cadherin Staining Continuity in the Trophoblastic Basal Membrane Correlates with Increased Resistance in Uterine Arteries and Proteinuria in Patients with Pregnancy-Induced Hypertension

“…Pre-eclampsia (PE) is a complication in 2-5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality in women, especially when it has an early onset. It is more common in developing countries due to older maternal age and obesity [1,2]. There is still no agreement on the definition of pre-eclampsia amongst many guidelines [2].…”

“…It is more common in developing countries due to older maternal age and obesity [1,2]. There is still no agreement on the definition of pre-eclampsia amongst many guidelines [2]. PE is defined by the International Society for the Study of Hypertension in Pregnancy (ISSHP) by hypertension (blood pressure ≥ 140/90 mmHg) developing after 20 weeks' gestation coexisting with newly occurring proteinuria and/or maternal kidney damage [2].…”

“…There is still no agreement on the definition of pre-eclampsia amongst many guidelines [2]. PE is defined by the International Society for the Study of Hypertension in Pregnancy (ISSHP) by hypertension (blood pressure ≥ 140/90 mmHg) developing after 20 weeks' gestation coexisting with newly occurring proteinuria and/or maternal kidney damage [2]. Modern definitions acknowledge other manifestations including maternal liver dysfunction, neurological symptoms, hemolysis, thrombocytopenia, and uteroplacental dysfunction, such as an abnormal umbilical artery Doppler [2][3][4][5][6].…”

“…PE is defined by the International Society for the Study of Hypertension in Pregnancy (ISSHP) by hypertension (blood pressure ≥ 140/90 mmHg) developing after 20 weeks' gestation coexisting with newly occurring proteinuria and/or maternal kidney damage [2]. Modern definitions acknowledge other manifestations including maternal liver dysfunction, neurological symptoms, hemolysis, thrombocytopenia, and uteroplacental dysfunction, such as an abnormal umbilical artery Doppler [2][3][4][5][6]. Some guidelines recommend a combined screening strategy including maternal blood pressure, maternal factors, uterine artery doppler, and placenta growth factor levels [2].…”

“…Modern definitions acknowledge other manifestations including maternal liver dysfunction, neurological symptoms, hemolysis, thrombocytopenia, and uteroplacental dysfunction, such as an abnormal umbilical artery Doppler [2][3][4][5][6]. Some guidelines recommend a combined screening strategy including maternal blood pressure, maternal factors, uterine artery doppler, and placenta growth factor levels [2]. Treatment recommendations vary on whether non-severe hypertension should even be treated, although there is an overall agreement on the drugs of choice (methyldopa, labetalol, and nifedipine), and the timing of delivery in uncomplicated gestational hypertension cases, which should be on or after 37 weeks of gestation [2].…”