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24 - Management of mild pre-eclampsia

from Part II - Clinical Practice

Published online by Cambridge University Press:  03 September 2009

By
Tracey Glanville  and
James J. Walker
Edited by
Fiona Lyall  and
Michael Belfort
Fiona Lyall
Affiliation:
University of Glasgow
Michael Belfort
Affiliation:
University of Utah
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Summary

Introduction

The hypertensive disorders of pregnancy affect more than 10% of the antenatal population. Each year they complicate 80,000 pregnancies in the United Kingdom and account for between 12 and 24% of antenatal admissions (Twaddle and Harper, 1992). Frequent outpatient measurement of blood pressure and urinalysis for proteinuria are the basis of routine antenatal care. The purpose of these tests is to screen for the development of pre-eclampsia, which remains one of the largest causes of maternal and perinatal mortality and morbidity (Walker, 2000). In order to make sure that potential at-risk cases are not missed, the thresholds for diagnosis are kept low and there is a high false positive rate. This means that a further assessment system needs to be in place as a further filter. Many women, especially late in the third trimester, develop transient hypertension that is not sustained, and, therefore, does not contribute to adverse perinatal or maternal outcome. This method of stepwise care helps to diagnose those at-risk of severe pre-eclampsia early, allowing management and intervention which has done much to reduce the maternal mortality rate in the last 30 years (Walker, 2000).

Walker (1987) and Walker et al. (1989) in separate studies examined the progression of hypertension in women attending an outpatient Antenatal Day Unit (ADU) setting from 28 weeks of gestation. These women attended because of a diastolic blood pressure (DBP) greater than 90 mmHg recorded at the antenatal clinic.

Type
Chapter
Information
Pre-eclampsia
Etiology and Clinical Practice
 , pp. 357 - 368
Publisher: Cambridge University Press
Print publication year: 2007

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