Diagnosis and Management of Gestational Hypertension and Preeclampsia

TLDR

Gestational hypertension and preeclampsia are common in pregnancy, with mild disease near term causing minimal morbidity, whereas severe disease before 35 weeks is linked to significant maternal and perinatal complications. The study calls for randomized trials to assess the safety and efficacy of antihypertensive drugs and magnesium sulfate in women with mild hypertension–preeclampsia. Management requires close maternal and fetal monitoring, with delivery versus expectant care chosen based on gestational age, fetal status, and disease severity; expectant management is feasible before 32 weeks and magnesium sulfate is used during labor and postpartum to prevent seizures. Administering steroids to women with severe disease between 24 and 34 weeks reduces neonatal mortality and morbidity.

Abstract

In Brief Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications. Women with diagnosed gestational hypertension–preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks' gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks' gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertension–preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia Management of gestational hypertension and preeclampsia depends on gestational age at onset, severity of the maternal condition, and fetalstatus at time of diagnosis; expectant management improves perinatal outcome in a select group of severely preeclamptic women remote from term.