Hypertensive syndromes during pregnancy - Diagnostic and therapeutic management

Achieve precise diagnosis: Hypertensive syndromes during pregnancy secondar y to placental ischemia still cause threatening maternofetal complications. A precise differential diagnosis between gestational hypertension, chronic hypertension and preeclampsia must be achieved as the management protocols are quite different. Patient monitoring: Blood tests for urea, creatinine, platelet counts, coag ulation, and liver enzymes are required. Fetal monitoring, urine protein an d ambulatory blood pressure measurements are also helpful. Ultrasound-Duple x explorations allow an evaluation of the maternal vascular status and feta l development Therapeutic management: These patients should be managed in specialized cen ters, limiting the minimum the number of hospitalizations. Unlike good rule s of hygiene and dietetics, antihypertensive therapy has little effect on t he progression of the pregnancy. An antihypertensive therapy is only warran ted to avoid cardiovascular complications in the mother. In case of chronic hypertension, treatment should be tailored to the measured pressures. Prud ent antihypertensive therapy may be useful for severe gestational hypertens ion and preeclampsia. Because of their safety profile and pharmacologic pro perties, antihypertension drugs with central action and alph-beta-blockers should be preferred over other drug classes. Preventive treatment: Antiaggregates (aspirin 50 - 100 mg/d) starting at 16 weeks gestation should be reserved for high-risk pregnancies. Regular foll ow-up, both pre and post-natally, is essential, especially in light of the large number of women who can be expected to progress to established hypert ensive states.