Fortnightly Review: The hypertensive disorders of pregnancy

BMJ 1995;311:609-613 (2 September)

Education and debate

F Broughton Pipkin, professor of perinatal physiology ^a

^a Department of Obstetrics and Gynaecology, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH

Summary points

Pre-eclampsia remains the single most common cause of maternal death in the United Kingdom. Its cause is still unknown so it cannot be prevented or treated rationally
The rise in blood pressure that occurs in late pregnancy without other symptoms may initially be compensatory for fetoplacental hypoxia and therefore physiological. This compensatory mechanism may explain the high incidence of hypertension during pregnancy
In some women the compensation breaks down and severe multisystem disease occurs resulting in pregnancy induced hypertension and pre-eclampsia
Lipid peroxidation and consequent endothelial damage are probably involved in pathogenesis
Calcium excretion is reduced and intracellular free calcium concentrations increased, which could contribute to the greater pressor responsiveness
Most of the cardiovascular changes occur during the second half of pregnancy and are hormonally driven rather than mediated by the sympathetic nervous system
Women at risk of developing pre-eclampsia can be detected early in pregnancy by asking whether their mother developed the condition; by measuring blood pressure using a standardised method; and by checking for proteinuria

The hypertensive disorders of pregnancy: R G Priest and R W Beard
BMJ 1995 311: 1371. [Extract] [Full Text]

Greenwood, J. P., Scott, E. M., Stoker, J. B., Walker, J. J., Mary, D. A.S.G. (2001). Sympathetic Neural Mechanisms in Normal and Hypertensive Pregnancy in Humans. Circulation 104: 2200-2204 [Abstract] [Full text]
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Zeebregts, C. J.A.M., Schepens, M. A. (1998). Reply. Ann. Thorac. Surg. 65: 1512-1512 [Full text]
Priest, R G, Beard, R W (1995). The hypertensive disorders of pregnancy. BMJ 311: 1371b-1371 [Full text]