Hypertension and haemodynamics in pregnant women – is a unified theory for pre‐eclampsia possible?

Dennis, A.T.; Castro, J.M.

doi:10.1111/anae.12832

Cited by 23 publications

(10 citation statements)

References 28 publications

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“… Fluid balance should aim for euvolemia as at all other times. Pre-eclamptic women have capillary leak (93) but may have either reduced or increased cardiac output (94,95) . To ensure euvolemia, insensible losses should be replaced (30ml/hr.)…”

Section: Notesmentioning

confidence: 99%

Hypertensive Disorders of Pregnancy

et al. 2018

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These recommendations from the ISSHP are based upon available literature and expert opinion. It is intended that this be a 'living' document, to be updated when needed as more research becomes available to influence good clinical practice. Unfortunately there is a relative lack of high quality randomised trials in the field of Hypertension in Pregnancy compared with studies in essential hypertension outside of pregnancy and ISSHP encourages greater funding and uptake of collaborative research in this field. Accordingly, the quality of evidence for the recommendations in this document has not been graded, though relevant references and explanations are provided for each recommendation. The document will be a 'living' guideline and we hope to be able to grade recommendations in the future.Guidelines and recommendations for management of hypertension in pregnancy are typically written for implementation in an ideal setting. It is acknowledged that in many parts of the world, it will not be possible to adopt all of these recommendations; for this reason, options for management in less-resourced settings are discussed separately in relation to diagnosis, evaluation, and treatment. This document has been endorsed by the International Society of Obstetric Medicine (ISOM) and the Japanese Society for the Study of Hypertension in Pregnancy (JSSHP). 5 KEY POINTS: All units managing hypertensive pregnant women should maintain and review uniform departmental management protocols and conduct regular audits of maternal & fetal outcomes.The cause(s) of pre-eclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain; therefore, we recommend that every hypertensive pregnant woman be offered an opportunity to participate in research, clinical trials and follow-up studies. Classification1. Hypertension in pregnancy may be chronic (pre-dating pregnancy or diagnosed before 20 weeks of pregnancy) or de novo (either pre-eclampsia or gestational hypertension).2. Chronic hypertension is associated with adverse maternal and fetal outcomes and is best managed by tightly controlling maternal blood pressure (BP 110-140/85 mmHg), monitoring fetal growth and repeatedly assessing for the development of pre-eclampsia and maternal complications. This can be done in an outpatient setting.3. White-coat hypertension refers to elevated office/ clinic (≥140/90mmHg) blood pressure but normal blood pressure measured at home or work (<135/85mmHg); it is not an entirely benign condition and conveys an increased risk for pre-eclampsia. 6 4. Masked hypertension is another form of hypertension, more difficult to diagnose, characterised by blood pressure that is normal at a clinic or office visit but elevated at other times, most typically diagnosed by 24 hour ambulatory BP monitoring (ABPM) or automated home blood pressure monitoring (HBPM). 5.Gestational hypertension is hypertension arising de novo after 20 weeks' gestation in the absence of proteinuria and without biochemical or haematological abnormalities. It...

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Section: Notesmentioning

confidence: 99%

Hypertensive Disorders of Pregnancy

et al. 2018

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“…5 On the basis of this study, it seems clear that women with chronic hypertension deserve the highest level of medical care antepartum, intrapartum, and postpartum. The retrospective nature allows only for associations, not for causation.…”

Section: Commentmentioning

confidence: 78%

Factors Associated With the Change in Prevalence of Cardiomyopathy at Delivery in the Period 2000 to 2009

Grotegut

Kuklina

Anstrom

et al. 2015

Obstetric Anesthesia Digest

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P regnancy-associated cardiomyopathy (CM) is uncommon, but is potentially life threatening. It now accounts for an increasing proportion of maternal deaths even as other etiologies such as hemorrhage and hypertensive disorders are decreasing. CM-related deaths during pregnancy increased from 11.5% of maternal mortality in 1998 to 2005 to nearly 13% in 2005 to 2006. CM can also contribute to other severe medical complications in pregnancy, including acute myocardial infarction, pulmonary edema, and acute respiratory distress syndrome. Women with underlying heart disease and baseline cardiac dysfunction may not be able to tolerate the strain associated with the cardiovascular changes of pregnancy. This population-based prevalence study was undertaken to identify preexisting medical conditions and medical and obstetric complications that might explain the increasing prevalence of CM in parturients.The Nationwide Inpatient Sample (NIS) was used to identify cases containing a pregnancy-related discharge for delivery from 2000 through 2009, and ICD-9-CM codes were used to find those delivery admissions that involved CM. The number of deaths occurring during the delivery admissions was determined for each study year. Only peripartum CMs and primary CMs that were diagnosed during the delivery hospitalization were included. Logistic regression was used to compute odds ratios and 95% confidence intervals (CI)s for age, race, preexisting medical conditions, and medical and obstetric complications in women with CM at delivery compared with women without CM. Rates of preexisting medical conditions and medical and obstetric complications among pregnant women with CM at delivery were calculated for each of the 10 years of the study.The prevalence of CM at delivery admission increased from 0.25/1000 deliveries in 2000 to 0.43/1000 deliveries in 2009 (P < 0.001). During the 10-year period, significant linear increases (P < 0.01) were noted in the prevalence of congenital heart disease, cardiac conduction disorders, history of ischemic heart disease, chronic hypertension, gestational diabetes, preeclampsia, and fetal growth restriction along with increases in other noncardiac conditions and diseases. Significant linear decreases (P < 0.01) were seen in the prevalence of valvular heart disease and fetal death during delivery admissions during the 10-year period. Significant linear increases (P < 0.01) Epidemiologic Reports, Surveys

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“…This includes elucidating the relationship between factors affecting cerebral vascular resistance and cerebral blood flow in association with cardiac output in pregnant women. 18,19 New approaches may be needed to be able to encompass this more challenging subset of cases and also to monitor women in the postpartum period. This group of women, for whom our traditional screening methods are inadequate, may very well be the cause of the reported unchanging or increasing rates of eclampsia.…”

Section: Discussionmentioning

confidence: 99%