Hypertensive syndromes during pregnancy - Pathophysiology, definitions andmaternofetal complications

A major concern: Hypertensive syndromes occur in approximately 10 to 15% of all pregnancies and are the cause of 30% of maternal deaths and 20% of fet al and neonatal deaths. Syndromes include gestational hypertension also cal led pregnancy-induced hypertension, chronic hypertension and preeclampsia. Definition: In pregnant women, hypertension is defined as blood pressure le vels above 140/90 mmHg at two successive measurements at a 4-hour interval. The primum mavens is the development, at about 16 weeks gestation, of seco ndary placental ischemia due to a defect in the second trophoblastic invasi on of the spiral arteries of the myometrium. This induces endothelial dysfu nction leading to pro-coagulation activation and inhibited physiological va sodilatation. Risk factors: The risk of vasculoplacental disease increases with age, body mass index, primiparity, stressful working conditions, and personal histor y of vascular events during pregnancy Maternal risks: Maternal complications include preeclampsia-eclampsia, retr o-placental hematoma, acute renal failure, and HELLP syndrome (hemolysis, e levated liver enzymes, low platelet count). Fetal risks: Hypotrophy, in utero death and prematurity may occur. The deve lopment of hypertension during pregnancy may also reveal a hypertensive bac kground which could progress to persistent high blood pressure. Preeclampsi a is an independent risk factor of cardiovascular disease requiring regular surveillance after delivery.