Pregnancy-induced hypertension-reducing risk through rational diagnosis and therapy

Hypertensive disorders complicating pregnancy are a major cause of maternal and perinatal morbidity and mortality. Intensive ambulatory obstetric care is likley to achieve a risk reduction with the following topics: early ide ntification of typical signs of preeclampsia, detection of uteroplacental i nsufficiency and their consequences and early admission to a specialized ob stetric care unit or perinatal center. There are no established methods for the prevention of preeclampsia. Women who are at increased risk for having preeclampsia in subsequent pregnancies might be appropriate candidates for low-dose aspirin during pregnancy; prophylactic calcium supplementation is controversial. To prevent cerebrovascular complications anti-hypertensive therapy is mandatory. Alpha-Methyl-dopa is the initial drug of choice for o ral long-term treatment. In severe preeclampsia continuous monitoring and l aboratory evalution of the mother and the fetus are required. Immediate int roduction of therapy, including continuous infusion of magnesium sulfate to prevent convulsions, hydralzine to reduce blood pressure and careful volum e expansion, is necessary. Under intensive monitoring, prolongation of preg nancy in patients at 25 to 32 weeks' gestation is reasonable under the foll owing conditions: stable maternal condition, no suspected or manifest DIC a nd fetal well-being. Immediate delivery is indicated in cases of therapy-re fractary severe preeclampsia, imminent eclampsia, after an eclamptic convul sion, and signs of intrauterine fetal asphyxia.