Introduction
High blood pressure or hypertension during pregnancy has been one of the leading
causes of prenatal mortality (death of mother, fetus or newborn). Pre-eclampsia (or
toxemia, as it was historically called) is the hypertensive disease that occurs only in
pregnancy. Almost 10 percent of pregnancies are complicated by pre-eclampsia.
Systolic and diastolic blood pressure decline in the first and second trimester of a
normal pregnancy, only in the third trimester blood pressure return to normal or
elevated.
Hypertension during pregnancy is defined as an increase in systolic blood pressure of
30 mm Hg or an increase in the diastolic blood pressure of 15 mm Hg over the base
line of pregnant hypertension.
Hypertension during pregnancy divided into four categories:
*Chronic hypertension
*Preeclampsia-eclampsia
*Preeclampsia superimposed on chronic hypertension
*Transient Hypertension
This classification is done to differentiate between women with chronic hypertension
from those with pregnancy induced or pregnancy specific hypertension.
Preeclampsia
is the presence of hypertension with proteinuria, edema or both occur after week 20
of pregnancy (proteinuria of 30mg/dl in a random urine selection).
If Preeclampsia happened in women with chronic hypertension, it may be termed
Preeclampsia superimposed on chronic hypertension. Preeclampsia ranged from mild
to severe and can lead to the development of Preeclampsia variant in which a women
exhibits hemolytic anemia, elevated liver enzymes, and has decreased platelet count
or to eclampsia which may be defined as convulsions or seizures that occur in a
patient with Preeclampsia.
All these cases required hospitalization, antihypertensive therapy, may be
anticonvulsant therapy.
Transient hypertension is the increase in blood pressure during pregnancy with out
signs and symptoms of Preeclampsia woman who did not have pre-existing
hypertension.
Definition:
Pre-eclampsia is an illness arising only in pregnancy, which can affect both the mother
and her unborn child. It affects as many as one in ten of all pregnancies making it the
most common serious antenatal complication.
It can develop at any time in the second half of pregnancy. In the mother the
condition causes a number of symptomless disturbances including raised blood
pressure and protein in the urine. The unborn baby may grow more slowly than
normal or suffer potentially dangerous oxygen deficiency.
Pre-eclampsia occurs more often among some groups of women. At higher
risk for the disease are women who:
•are under 20 years old, with a first pregnancy
•are over 35 years old, with a first pregnancy
•have chronic, or "essential" hypertension
•had hypertension in a previous pregnancy, other than the first
•have multiple gestation (twins, etc.)
•have diabetes
Signs AND Symptoms
Pre-eclampsia has been called the great imitator (تقليدي) because its symptoms are
often much like many other diseases. Characteristic signs and symptoms occur after
the 20th week of pregnancy and include:
1.High Blood Pressure: BP of at least 140 over 90 is considered hypertension (160
over 110 is "severe"). If the woman's normal (pre-pregnant or very early pregnancy)
blood pressure is not known, it's very hard to distinguish pre-eclampsia from chronic
hypertension. Pre-eclampsia is more dangerous to the mother and baby. About 20
percent of women with chronic hypertension will develop pre-eclampsia too.
2.Swelling, or "edema": This is a common sign and may go along with a rapid weight
gain. Swelling is a confusing symptom. It is normal to have some swelling of the feet
or ankles, especially late in pregnancy and some women with pre-eclampsia will have
no edema. Swelling is not a reliable symptom of pre-eclampsia.
3.Protein in the urine: The presence of protein in the urine is considered to be an
important factor for making the diagnosis of pre-eclampsia.
The disease causes damage to the filtering function of the kidneys (repairs itself after
delivery), which allows protein to "spill" into the urine. Even though it is a reliable sign
of pre-eclampsia, protein in the urine very often does not occur until the disease has
progressed to a later stage.
The majority of women with pre-eclampsia feel perfectly well. It can only be detected
by the routine screening tests carried out at ante-natal visits.
Pre-eclampsia differs from a normal pregnancy in the following:
Many adjustments in the mother's body happen during a pregnancy to allow the fetus
to grow normally, and to help the mother's systems handle the additional "work"
required by the pregnancy. Some adjustments do not happen the same way in the
woman with pre-eclampsia.
1.In a normal pregnancy the fluid part of the mother's blood increases dramatically,
resulting in a 35-50% increase in the total volume. This helps serve the added needs
of the uterus and placenta, among other functions. In the woman with pre-eclampsia,
the blood volume increases only a small amount or not at all.
2.The "resistance", or stiffness of the blood vessels throughout the mother's body
normally decreases, allowing free flow of blood to the placenta and uterus. Pregnancy
hormones and changes in the blood vessel regulating mechanisms "relax" the vessel
walls. With pre-eclampsia, instead of relaxing, the blood vessels spasm.
3.Normally, the pregnant woman's blood pressure drops a little in mid-pregnancy,
partly because of the increase in volume of blood, and partly due to the relaxing of
the blood vessels. With pre-eclampsia, the blood pressure does not drop in mid-
pregnancy, and the blood pressure increases in the last weeks.
4.With the increase in blood volume and relaxed vessels, the normal pregnant woman
gets extra blood flow to the uterus, kidneys, liver and other organs. In the woman
with pre-eclampsia, the vessels are in spasm, and this blood flow is decreased
instead.
The spasm in the small vessels of the body is believed to cause the organ damage
that happens with the disease. Kidney damage is one example - protein in the urine is
what results from the damage. Other organs, especially the liver can also be
damaged. Except in the most severe cases, organ damage heals by itself after
delivery of the baby.
5.In the normal pregnancy, blood clotting is affected very slightly. With severe pre-
eclampsia, platelets (clotting factors in the blood) can be very low, and the blood does
not clot normally. This results in a life threatening risk of internal bleeding.
Etiology of Pre-eclampsia
Genetic factors are probably involved since women whose mothers and sisters have
suffered pre-eclampsia are more likely to get it themselves.
What is known is that pre-eclampsia originates in the placenta. The placenta needs a
large and efficient blood supply from the mother to sustain the growing baby.
In pre-eclampsia the placenta runs short of blood either because its demands are
unusually high - as with twins - or because the arteries in the womb (الرحم) did not
enlarge as they should have done when the placenta was being formed in the first half
of pregnancy. This shortage of blood has serious consequences for mother and baby.
It is not known what causes this disease.
A current theory holds that pre-eclampsia is a process that begins early in the
pregnancy as the developing embryo implants in the wall of the uterus to form the
placenta. Normally, a complex series of events causes changes in the blood vessels of
the uterus which allow them to remain relaxed to nourish the growing baby. In pre-
eclampsia, this process does not occur or is incomplete very early. The chemical
imbalances that result are believed to lead to the spasm and "stiffness" of the blood
vessels throughout the mother's body. It is this spasm that causes the complications
of pre-eclampsia - namely organ damage.
The etiology of Preeclampsia is may be associated with increased maternal
vasoconstrictor tone, prostaglandin imbalance and immunological problem
during pregnancy.
Increased Vasoconstrictor Tone
Women with Preeclampsia appear to have markedly increased vasoconstrictor tone
and this increase in the response to vasoconstrictors can be detected before the
clinical development of prteeclampsia; thus, Preeclampsia may be a chronic problem
during pregnancy that persist when the fetus is delivered.
Prostaglandin imbalance
The development of Preeclampsia may reflect a deficiency of certain prostaglandins
that can occur as a result of prostaglandin precursor deficiency, defective
prostaglandin activity, or lowered prostaglandin synthetase enzyme action.
The imbalance in the process of enoperoxides conversion to prostaglandins E2 and
F2, prostacycline, thromboxane occurs in woman with Preeclampsia. The reduction in
the vasodilator prostaglandins induce blood vessel constriction. Also prostacycline is a
potent vasodilator and oppose platelet aggregation process in the pregnant woman.
Complication of Preeclampsia in the mother and her baby
Damage to organs, such as the kidney and liver, and swelling or fluid in the lungs are
dangerous complications of pre-eclampsia. These problems are caused by the
decreased flow of blood and vessels in spasm. Since the uterus also gets less blood
flow, often the placenta is damaged. The baby may not grow well, and may be overly
stressed during labor.
Many women with pre-eclampsia will deliver an essentially healthy baby. Some women
will experience only an anxious nurse-midwife or doctor, and maybe delivery a week or
so earlier. Some women, however, progress rapidly to more severe forms of the
disease.
Two very serious consequences are:
1.Eclampsia is when the mother has convulsions. Serious complications such as brain
injury as a result of the convulsion are uncommon but do occur. The fetus is deprived
(يستنفذ) of oxygen during the convulsion, and damage or separation of the placenta can
occur. Preventing eclampsia is one of the major goals of treating pre-eclampsia.
2.HELLP Syndrome stands for hemolysis (destruction of red blood cells), elevated liver
enzymes (indicating liver damage), and low platelets (internal bleeding risk). HELLP
Syndrome is a life threatening condition for both mother and fetus.
Prevention of Preeclampsia:
The search for something to predict or prevent pre-eclampsia has continued since the
time of Hippocrates. Most suggestions have not helped much. Considering the current
theory of early placenta development problems, it seems unlikely that prevention will
be a simple matter.
Among the suggestions, several have involved dietary changes. Calcium intake
appears to play some role in reducing pre-eclampsia. Adequate amounts of calcium
(1,200 - 1,500 mg per day) can be obtained from a balanced diet which includes 3 to
4 servings of milk or dairy products daily. If the diet is not adequate, a supplement
may be recommended.
Low dose aspirin therapy is being studied as one possible way to prevent the chemical
imbalances at the placenta, which are believed to be a cause of pre-eclampsia.
Obstetricians and Gynecologists recommends that aspirin be used only in women at
very high risk for pre-eclampsia. There isn't enough evidence of its benefits to
recommend it for all pregnant women.
Although the disease may not be prevented, the serious complications from pre-
eclampsia can be. Women can be aware of the danger signs of pre-eclampsia, and
report them promptly to their care provider or clinic
There is no hard evidence that pre-eclampsia can be caused or prevented by what the
mother eats, or whether the mother smokes or drinks, how hard she works or how
much rest she has.
The best plan is to have regular antenatal check-ups, which can detect the
earliest signs of pre-eclampsia and other complications.
Take an active interest in your ante-natal checks, never miss an appointment, and
make sure you have your blood pressure and urine checked regularly. Of course, any
worrying signs or symptoms should be reported to your doctor.
Vitamins C, E and A for Eclampsia
Research suggests that vitamin C and possibly vitamin E and betacarotene may be
instrumental in preventing Preeclampsia. When researchers measured the levels of
these antioxidants in the blood of 30 women with Preeclampsia and 44 women
without, they found those with Preeclampsia had much lower levels.
The body relies on vitamin C to fend off the free radicals that injure blood vessels in
the uterus and placenta and trigger the high blood pressure and swollen tissues that
accompany the disease. Antioxidants may be more important in prevention than in
treatment; adequate levels going into pregnancy could keep free radicals a way.
Treatment of Preeclampsia
Delivery of the placenta and baby is the only known treatment. When the disease
occurs in the last weeks of pregnancy, bed rest and observation for worsening of pre-
eclampsia may be attempted, but often labor must be induced, or in severe cases,
cesarean birth performed.
Generally, the earlier signs of the disease are seen, the more severe it is likely to
become. Even with mild pre-eclampsia near full term, however, a significant decrease
in placental blood flow has already occurred, and delivery is recommended.
Treatment should first involve non-pharmacological means (restricted activity,
nutritional diet.). If that approach fails, then drug therapy may be necessary. The
most commonly used drugs to treat hypertension in pregnancy are the beta-blockers,
calcium channel blockers, methyldopa, and hydralazine.
Beta-blockers are very effective and seem to be safe. If a beta-blocker is to be used,
the newer cardioselective (beta-1) agents should be considered. This reduces the
likelihood of hypoglycemia and respiratory problems caused by beta-2 blockade. Some
sources state that beta-blockers should not be used for the entire pregnancy
because use during the first and second trimester is associated with intrauterine
growth retardation. Beta-blockers may cause fetal bradycardia. The most commonly
used agent is labetalol, however the use of metoprolol is increasing.
The calcium channel blockers have not been used extensively in pregnancy, but seem
to be safe and effective. The Dihydropyridine (i.e. nifedipine) class of calcium channel
blockers has been the most frequently used. They are associated with a low incidence
of maternal adverse effects.
Methyldopa is the golden standard of treatment. It has been extensively studied and
is proven safe to the fetus. However, it is not tolerated as well as beta-blockers or
calcium channel blockers. Methyldopa is not as efficient at lowering blood pressure as
the newer agents.
Hydralazine is another golden standard of treatment. It also is basically proven safe to
the fetus but is associated with a high maternal adverse effect profile. Hydralazine can
lower maternal blood pressure rapidly which can reduce intrauterine perfusion.
ACE inhibitors and diuretics should not be used during pregnancy. ACE inhibitors can
cause renal failure and death to the fetus. Diuretics should not be used because they
can cause depletion of fluid volume and electrolyte deficiencies which can be harmful to
the fetus.
High blood pressure or hypertension during pregnancy has been one of the leading
causes of prenatal mortality (death of mother, fetus or newborn). Pre-eclampsia (or
toxemia, as it was historically called) is the hypertensive disease that occurs only in
pregnancy. Almost 10 percent of pregnancies are complicated by pre-eclampsia.
Systolic and diastolic blood pressure decline in the first and second trimester of a
normal pregnancy, only in the third trimester blood pressure return to normal or
elevated.
Hypertension during pregnancy is defined as an increase in systolic blood pressure of
30 mm Hg or an increase in the diastolic blood pressure of 15 mm Hg over the base
line of pregnant hypertension.
Hypertension during pregnancy divided into four categories:
*Chronic hypertension
*Preeclampsia-eclampsia
*Preeclampsia superimposed on chronic hypertension
*Transient Hypertension
This classification is done to differentiate between women with chronic hypertension
from those with pregnancy induced or pregnancy specific hypertension.
Preeclampsia
is the presence of hypertension with proteinuria, edema or both occur after week 20
of pregnancy (proteinuria of 30mg/dl in a random urine selection).
If Preeclampsia happened in women with chronic hypertension, it may be termed
Preeclampsia superimposed on chronic hypertension. Preeclampsia ranged from mild
to severe and can lead to the development of Preeclampsia variant in which a women
exhibits hemolytic anemia, elevated liver enzymes, and has decreased platelet count
or to eclampsia which may be defined as convulsions or seizures that occur in a
patient with Preeclampsia.
All these cases required hospitalization, antihypertensive therapy, may be
anticonvulsant therapy.
Transient hypertension is the increase in blood pressure during pregnancy with out
signs and symptoms of Preeclampsia woman who did not have pre-existing
hypertension.
Definition:
Pre-eclampsia is an illness arising only in pregnancy, which can affect both the mother
and her unborn child. It affects as many as one in ten of all pregnancies making it the
most common serious antenatal complication.
It can develop at any time in the second half of pregnancy. In the mother the
condition causes a number of symptomless disturbances including raised blood
pressure and protein in the urine. The unborn baby may grow more slowly than
normal or suffer potentially dangerous oxygen deficiency.
Pre-eclampsia occurs more often among some groups of women. At higher
risk for the disease are women who:
•are under 20 years old, with a first pregnancy
•are over 35 years old, with a first pregnancy
•have chronic, or "essential" hypertension
•had hypertension in a previous pregnancy, other than the first
•have multiple gestation (twins, etc.)
•have diabetes
Signs AND Symptoms
Pre-eclampsia has been called the great imitator (تقليدي) because its symptoms are
often much like many other diseases. Characteristic signs and symptoms occur after
the 20th week of pregnancy and include:
1.High Blood Pressure: BP of at least 140 over 90 is considered hypertension (160
over 110 is "severe"). If the woman's normal (pre-pregnant or very early pregnancy)
blood pressure is not known, it's very hard to distinguish pre-eclampsia from chronic
hypertension. Pre-eclampsia is more dangerous to the mother and baby. About 20
percent of women with chronic hypertension will develop pre-eclampsia too.
2.Swelling, or "edema": This is a common sign and may go along with a rapid weight
gain. Swelling is a confusing symptom. It is normal to have some swelling of the feet
or ankles, especially late in pregnancy and some women with pre-eclampsia will have
no edema. Swelling is not a reliable symptom of pre-eclampsia.
3.Protein in the urine: The presence of protein in the urine is considered to be an
important factor for making the diagnosis of pre-eclampsia.
The disease causes damage to the filtering function of the kidneys (repairs itself after
delivery), which allows protein to "spill" into the urine. Even though it is a reliable sign
of pre-eclampsia, protein in the urine very often does not occur until the disease has
progressed to a later stage.
The majority of women with pre-eclampsia feel perfectly well. It can only be detected
by the routine screening tests carried out at ante-natal visits.
Pre-eclampsia differs from a normal pregnancy in the following:
Many adjustments in the mother's body happen during a pregnancy to allow the fetus
to grow normally, and to help the mother's systems handle the additional "work"
required by the pregnancy. Some adjustments do not happen the same way in the
woman with pre-eclampsia.
1.In a normal pregnancy the fluid part of the mother's blood increases dramatically,
resulting in a 35-50% increase in the total volume. This helps serve the added needs
of the uterus and placenta, among other functions. In the woman with pre-eclampsia,
the blood volume increases only a small amount or not at all.
2.The "resistance", or stiffness of the blood vessels throughout the mother's body
normally decreases, allowing free flow of blood to the placenta and uterus. Pregnancy
hormones and changes in the blood vessel regulating mechanisms "relax" the vessel
walls. With pre-eclampsia, instead of relaxing, the blood vessels spasm.
3.Normally, the pregnant woman's blood pressure drops a little in mid-pregnancy,
partly because of the increase in volume of blood, and partly due to the relaxing of
the blood vessels. With pre-eclampsia, the blood pressure does not drop in mid-
pregnancy, and the blood pressure increases in the last weeks.
4.With the increase in blood volume and relaxed vessels, the normal pregnant woman
gets extra blood flow to the uterus, kidneys, liver and other organs. In the woman
with pre-eclampsia, the vessels are in spasm, and this blood flow is decreased
instead.
The spasm in the small vessels of the body is believed to cause the organ damage
that happens with the disease. Kidney damage is one example - protein in the urine is
what results from the damage. Other organs, especially the liver can also be
damaged. Except in the most severe cases, organ damage heals by itself after
delivery of the baby.
5.In the normal pregnancy, blood clotting is affected very slightly. With severe pre-
eclampsia, platelets (clotting factors in the blood) can be very low, and the blood does
not clot normally. This results in a life threatening risk of internal bleeding.
Etiology of Pre-eclampsia
Genetic factors are probably involved since women whose mothers and sisters have
suffered pre-eclampsia are more likely to get it themselves.
What is known is that pre-eclampsia originates in the placenta. The placenta needs a
large and efficient blood supply from the mother to sustain the growing baby.
In pre-eclampsia the placenta runs short of blood either because its demands are
unusually high - as with twins - or because the arteries in the womb (الرحم) did not
enlarge as they should have done when the placenta was being formed in the first half
of pregnancy. This shortage of blood has serious consequences for mother and baby.
It is not known what causes this disease.
A current theory holds that pre-eclampsia is a process that begins early in the
pregnancy as the developing embryo implants in the wall of the uterus to form the
placenta. Normally, a complex series of events causes changes in the blood vessels of
the uterus which allow them to remain relaxed to nourish the growing baby. In pre-
eclampsia, this process does not occur or is incomplete very early. The chemical
imbalances that result are believed to lead to the spasm and "stiffness" of the blood
vessels throughout the mother's body. It is this spasm that causes the complications
of pre-eclampsia - namely organ damage.
The etiology of Preeclampsia is may be associated with increased maternal
vasoconstrictor tone, prostaglandin imbalance and immunological problem
during pregnancy.
Increased Vasoconstrictor Tone
Women with Preeclampsia appear to have markedly increased vasoconstrictor tone
and this increase in the response to vasoconstrictors can be detected before the
clinical development of prteeclampsia; thus, Preeclampsia may be a chronic problem
during pregnancy that persist when the fetus is delivered.
Prostaglandin imbalance
The development of Preeclampsia may reflect a deficiency of certain prostaglandins
that can occur as a result of prostaglandin precursor deficiency, defective
prostaglandin activity, or lowered prostaglandin synthetase enzyme action.
The imbalance in the process of enoperoxides conversion to prostaglandins E2 and
F2, prostacycline, thromboxane occurs in woman with Preeclampsia. The reduction in
the vasodilator prostaglandins induce blood vessel constriction. Also prostacycline is a
potent vasodilator and oppose platelet aggregation process in the pregnant woman.
Complication of Preeclampsia in the mother and her baby
Damage to organs, such as the kidney and liver, and swelling or fluid in the lungs are
dangerous complications of pre-eclampsia. These problems are caused by the
decreased flow of blood and vessels in spasm. Since the uterus also gets less blood
flow, often the placenta is damaged. The baby may not grow well, and may be overly
stressed during labor.
Many women with pre-eclampsia will deliver an essentially healthy baby. Some women
will experience only an anxious nurse-midwife or doctor, and maybe delivery a week or
so earlier. Some women, however, progress rapidly to more severe forms of the
disease.
Two very serious consequences are:
1.Eclampsia is when the mother has convulsions. Serious complications such as brain
injury as a result of the convulsion are uncommon but do occur. The fetus is deprived
(يستنفذ) of oxygen during the convulsion, and damage or separation of the placenta can
occur. Preventing eclampsia is one of the major goals of treating pre-eclampsia.
2.HELLP Syndrome stands for hemolysis (destruction of red blood cells), elevated liver
enzymes (indicating liver damage), and low platelets (internal bleeding risk). HELLP
Syndrome is a life threatening condition for both mother and fetus.
Prevention of Preeclampsia:
The search for something to predict or prevent pre-eclampsia has continued since the
time of Hippocrates. Most suggestions have not helped much. Considering the current
theory of early placenta development problems, it seems unlikely that prevention will
be a simple matter.
Among the suggestions, several have involved dietary changes. Calcium intake
appears to play some role in reducing pre-eclampsia. Adequate amounts of calcium
(1,200 - 1,500 mg per day) can be obtained from a balanced diet which includes 3 to
4 servings of milk or dairy products daily. If the diet is not adequate, a supplement
may be recommended.
Low dose aspirin therapy is being studied as one possible way to prevent the chemical
imbalances at the placenta, which are believed to be a cause of pre-eclampsia.
Obstetricians and Gynecologists recommends that aspirin be used only in women at
very high risk for pre-eclampsia. There isn't enough evidence of its benefits to
recommend it for all pregnant women.
Although the disease may not be prevented, the serious complications from pre-
eclampsia can be. Women can be aware of the danger signs of pre-eclampsia, and
report them promptly to their care provider or clinic
There is no hard evidence that pre-eclampsia can be caused or prevented by what the
mother eats, or whether the mother smokes or drinks, how hard she works or how
much rest she has.
The best plan is to have regular antenatal check-ups, which can detect the
earliest signs of pre-eclampsia and other complications.
Take an active interest in your ante-natal checks, never miss an appointment, and
make sure you have your blood pressure and urine checked regularly. Of course, any
worrying signs or symptoms should be reported to your doctor.
Vitamins C, E and A for Eclampsia
Research suggests that vitamin C and possibly vitamin E and betacarotene may be
instrumental in preventing Preeclampsia. When researchers measured the levels of
these antioxidants in the blood of 30 women with Preeclampsia and 44 women
without, they found those with Preeclampsia had much lower levels.
The body relies on vitamin C to fend off the free radicals that injure blood vessels in
the uterus and placenta and trigger the high blood pressure and swollen tissues that
accompany the disease. Antioxidants may be more important in prevention than in
treatment; adequate levels going into pregnancy could keep free radicals a way.
Treatment of Preeclampsia
Delivery of the placenta and baby is the only known treatment. When the disease
occurs in the last weeks of pregnancy, bed rest and observation for worsening of pre-
eclampsia may be attempted, but often labor must be induced, or in severe cases,
cesarean birth performed.
Generally, the earlier signs of the disease are seen, the more severe it is likely to
become. Even with mild pre-eclampsia near full term, however, a significant decrease
in placental blood flow has already occurred, and delivery is recommended.
Treatment should first involve non-pharmacological means (restricted activity,
nutritional diet.). If that approach fails, then drug therapy may be necessary. The
most commonly used drugs to treat hypertension in pregnancy are the beta-blockers,
calcium channel blockers, methyldopa, and hydralazine.
Beta-blockers are very effective and seem to be safe. If a beta-blocker is to be used,
the newer cardioselective (beta-1) agents should be considered. This reduces the
likelihood of hypoglycemia and respiratory problems caused by beta-2 blockade. Some
sources state that beta-blockers should not be used for the entire pregnancy
because use during the first and second trimester is associated with intrauterine
growth retardation. Beta-blockers may cause fetal bradycardia. The most commonly
used agent is labetalol, however the use of metoprolol is increasing.
The calcium channel blockers have not been used extensively in pregnancy, but seem
to be safe and effective. The Dihydropyridine (i.e. nifedipine) class of calcium channel
blockers has been the most frequently used. They are associated with a low incidence
of maternal adverse effects.
Methyldopa is the golden standard of treatment. It has been extensively studied and
is proven safe to the fetus. However, it is not tolerated as well as beta-blockers or
calcium channel blockers. Methyldopa is not as efficient at lowering blood pressure as
the newer agents.
Hydralazine is another golden standard of treatment. It also is basically proven safe to
the fetus but is associated with a high maternal adverse effect profile. Hydralazine can
lower maternal blood pressure rapidly which can reduce intrauterine perfusion.
ACE inhibitors and diuretics should not be used during pregnancy. ACE inhibitors can
cause renal failure and death to the fetus. Diuretics should not be used because they
can cause depletion of fluid volume and electrolyte deficiencies which can be harmful to
the fetus.
Cardiovascular Diseases
 |  |