Hypertensive Disorders of Pregnancy: Preeclampsia
The hypertensive disorders of pregnancy are still the leading cause of maternal as well as perinatal morbidity and mortality. The working group that is concerned with High Blood Pressure during Pregnancy lists four categories of hypertension that are common with the women in pregnancy. Those categories include chronic hypertension, preeclampsia, gestation hypertension, and preeclampsia superimposed on chronic hypertension. In case the maternal blood pressure is found to be 140/90 mm Hg or higher on two occasions before the two weeks of gestation shows that there is chronic hypertension. To solve this problem, pharmacologic treatment is necessary as it prevents end-organ damage from the elevated blood pressure. In this article, there is the description of the preeclampsia disorder as one of the hypertensive disorders of pregnancy. Preeclampsia is the scenario when new-onset hypertension with proteinuria develops after 20 weeks of gestation.
Description of Disorder
According to Mammaro and his colleagues (2009), hypertensive disorders of pregnancy are the most common medical complications bedeviling women during pregnancy, and they affect 6 to 8 percent of women in the United States. Preeclampsia is one of those disorders, and it is a multiorgan disease process whose etiology is unknown, and its symptoms are hypertension and proteinuria that show up after 20 weeks or pregnancy. There are numerous theories of the pathogenesis of this disease the most common theory being immunologic. In a normal pregnancy, fetal syncytial trophoblasts are known to penetrate and even remodel the maternal spiral arteries thereby causing them to dilate and become flaccid. That remodeling accommodates the increased maternal circulation that is in required to ensure enough placental perfusion. That remodeling is however prevented in preeclamptic pregnancies whereby the placental cannot properly burrow into the maternal blood vessels resulting in intrauterine growth limitation and other fetal signs of disorder.
Studies have shown that the incomplete placentation results from maternal immunologic intolerance of some foreign genes of the fetus. The evidence supporting this theory is that preeclampsia is highly common during first pregnancies and it reduces as the length of time a woman lives with the father before she becomes pregnant decreases. Additionally, the risk of this disorder is also increased in the multiparous women who become pregnant by new partners. The other theories that support the pathogenesis of this disorder include angiogenic factors, cardiovascular maladaptation and vasoconstriction, platelet activation, genetic predisposition, and vascular endothelial damage. There are various factors associated with preeclampsia including antiphospholipid antibody syndrome, elevated body mass index, multiple gestations, nulliparity, and chronic hypertension, maternal age above 40 years, chronic renal disease, and pregestational diabetes mellitus.
Current Best Practices for Assessing and Managing Preeclampsia
The blood pressure of the women ought to be measured at every prenatal visit using a suitably sized cuff while the patient is in a seated position. The criterion for diagnosing a preeclampsia patient is performing systolic blood pressure or not less than 140 mm Hg or doing a diastolic blood pressure or not less than 90 mm Hg on two occasions of six hours or more apart. Preeclampsia is characterized by a mild or severe conditions based on the degree of hypertension or proteinuria as well as the presence of symptoms that result from the participation of the kidneys, liver, brain, and the cardiovascular system. Impending eclampsia can also be signaled by visual disturbances, hyperreflexia, and severe headache.
The mainstream for the treatment of preeclampsia is detecting it early enough and managing the delivery with the intention of minimizing both the maternal as well as the fetal risks. In case the gestation is at term, the baby should be delivered minus any problem. The decision for delivery involves the balancing of risks that can worsen preeclampsia against those of prematurity. Mammaro et al. (2009) also suggest the use of Magnesium sulfate as the drug of choice for the prevention and arrest of eclamptic seizures. That is because this drug has the additional advantage of reducing the progress of placental abruption. They also suggest the monitoring of the levels of serum Magnesium in the women with elevated levels of serum creatinine, decreased urine output, or absence of deep tendon reflexes. Lastly, intravenous hydration for oliguria should be administered cautiously so as to avoid pulmonary edema, cardiopulmonary overload, and ascites.
Comparison of the Best Practices Presented in the WHI Study and the Current Best Practices
Both the WHI and the article agree on the screening of women right from early pregnancy so as or identify the clinical risk markers. However, the WHI article suggests that there should be consultation with an obstetrician where necessary for those women with a history of previous preeclampsia markers and other strong clinical conditions like multiple pregnancies, significant proteinuria, antiphospholipid antibody syndrome at first antennal visit, the existence of a renal disease, or a preexisting condition of hypertension. These are symptoms that are also listed as the current best practices from the reference article. Both articles also reject the use of biomarkers or Doppler ultrasound velocimetry for women at mild or increased risk of preeclampsia except if that screening has been proven to improve outcome.
The differences in the best practices can greatly impact the health of pregnant women, and that can be fatal since they are the crucial time of their health. At this point is when women require being closely monitoring and assisting as appropriate because any disorder can lead to the death of the mother or the child, and in worst cases both the mother and the fetus may die. What was being considered as a best practice in the past may not work today since things do change and new ways of doing things are discovered from intense research. It is therefore of the paramount essence to make sure that the different researchers collaborate to determine the current best practices for the benefit of the women who are the victims of this disorder.
Whether the Current Best Practices should be used
According to me, the current best practices should be used in clinical practice because they have been thoroughly tested and proved to be working well. They are also supported by other researchers like Leeman and Fontaine (2008), Peters and Flack (2004), Zareian (2004), Marik (2009), and Shah (2007) among other researchers in the medical field. These best practices should also be applied because they are a result of intensive research with the collaboration of more than five renowned medical researchers who also compared their findings with other reliable sources from the relevant field.
Having a blood pressure that is higher than the normal in pregnant women can be very dangerous to not only the mother but also to the fetus. Therefore, it is crucial that they are diagnosed earlier and monitored for any deviations of the blood pressure from the normal so that they can be helped to prevent or properly manage preeclampsia. If not correctly monitored and managed, the impacts of high blood pressure can harm the kidneys and other internal organs of the pregnant mother and even result in low birth weight and even early delivery.
Leeman, L., & Fontaine, P. (2008). Hypertensive disorders of pregnancy. American family physician, 78(1).
Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E. M., … Pedata, R. (2009). Hypertensive Disorders of Pregnancy. Journal of Prenatal Medicine, 3(1), 1–5.
Marik, P. E. (2009). Hypertensive disorders of pregnancy. Postgraduate medicine, 121(2), 69-76.
Peters, R. M., & Flack, J. M. (2004). Hypertensive disorders of pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(2), 209-220.
Zareian, Z. (2004). Hypertensive disorders of pregnancy. International Journal of Gynecology & Obstetrics, 87(2), 194-198.