Hypertension in pregnancy: New recommendations for managemen

Abstract

Hypertension in pregnancy is a frequent complication that has substantial adverse perinatal outcomes. Hypertension may be preexisting (chronic) essential or secondary hypertension; a second entity is pregnancy induced (gestational hypertension, preeclampsia). Recent advances have identified newer markers for pregnancy hypertension: several potential candidate genes may explain the apparent family inheritance of preeclampsia, and some thrombophilic markers have been associated with the condition. Management options for mild to moderate hypertension include a short hospital stay to exclude ongoing severe hypertension and to ascertain fetal well-being. Outpatient care with appropriate maternal and fetal surveillance, including umbilical artery doppler velocimetry, is recommended for better perinatal outcomes. Acute care for severe hypertension includes the use of magnesium sulfate to prevent eclampsia and antihypertensive medication. Expeditious delivery is recommended when the maternal or fetal states cannot be stabilized. Follow-up after delivery allows the uncovering of any other coexisting hypertensive or cardiovascular disorder.

Magnesium in disease

“…Pre-eclampsia is defined as a condition with hypertension, proteinuria [ 157 ], often accompanied by pathological oedema, occurring in about 6–8% of all gestations over 20 weeks [ 155 ]. It is seen more often in nulliparous women [ 155 ].…”

“…Although the use of magnesium sulphate for pre-eclampsia is well substantiated, there is little evidence supporting its routine use in gestational hypertension. Shear et al [ 157 ] mentioned that in their clinic, magnesium sulphate is often used in women with severe pre-eclampsia and in those who are at risk for becoming pre-eclamptic. In patients with proteinuria or with mild pre-eclampsia, magnesium sulphate should be given according to the specific clinical needs of the individual patient [ 58 ].…”

Magnesium: Effect on ocular health as a calcium channel antagonist

“…Magnesium tends to increase blood flow, and decreases vascular resistance in various vascular beds [6,9,12,14]. Hence magnesium has been shown to inhibit vasospasm in subarachnoid hemorrhages [15] and also induces vasodilation in pre-eclampsia clinically [16].…”