Editors Sabaratnam Arulkumaran MD PhD DSc FRCS FRCOG
Professor Emeritus of Obstetrics and Gynecology St George's University of London Cranmer Terrace
London, United Kingdom
Sanjay A Gupte MD DGO FICOG FRCOG (Honoris Causa) LLB
Consultant Obstetrician and Gynecologist Director, Gupte Hospital and Center for Research in Reproduction
Pune, Maharashtra, India
Evita Fernandez FRCOG
Consultant Obstetrician and Managing Director Fernandez Hospital Pvt Ltd
Hyderabad, Andhra Pradesh, India
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Hypertensive Disease in Pregnancy
First Edition: 2014
9789350909515
Printed at:
5Contributors
- Anthony Addei mbchb frca
- Consultant Obstetric Anesthetist
- St George's Healthcare, NHS Trust
- London, United Kingdom
- Gita Arjun facog
- Obstetrician and Gynecologist
- Director, EV Kalyani Medical
- Foundation Pvt Ltd
- Chennai, Tamil Nadu, India
- Nishkantha Arulkumaran mbbs mrcp
- Specialist Registrar in Critical Care
- and Nephrology, Wellcome Trust
- Research Fellow University College
- London, United Kingdom
- Sabaratnam Arulkumaran md phd dsc frcs frcog
- Professor Emeritus of Obstetrics and Gynecology
- St George's University of London
- Cranmer Terrace
- London, United Kingdom
- Michael A Belfort md phd
- Professor of Obstetrics and Gynecology
- Chairman of the Department of Obstetrics and Gynecology
- Baylor College of Medicine
- Houston, Texas, USA
- Nirmala Chandrasekaran mrcog
- Clinical Fellow
- Fetal Medicine Unit
- St George's Hospital
- NHS Trust, London, United Kingdom
- Rana Choudhary dnb (Obs & Gyne) dgo fcps dfp mnams
- Project Research Officer
- Department of Clinical Research
- National Institute for Research in Reproductive Health (NIRRH)
- Indian Council of Medical Research (ICMR)
- Parel, Mumbai, Maharashtra, India
- Jarita Deb dgo md (Obs/Gyn)
- Research Consultant
- Divakars Speciality Hospital
- Bengaluru, Karnataka, India
- Hema Divakar dgo md (Obs/Gyn)
- Consultant Obstetrician and Gynecologist
- Divakars Speciality Hospital
- Bengaluru, Karnataka, India
- Evita Fernandez frcog
- Consultant Obstetrician and Managing Director
- Fernandez Hospital Pvt Ltd
- Hyderabad, Andhra Pradesh, India
- Sirisha Rao Gundabattula md
- Consultant Gynecologist
- Fernandez Hospital Pvt. Ltd.
- Hyderabad, Andhra Pradesh, India
- Sanjay A Gupte md dgo ficog frcog (Honoris Causa) llb
- Consultant Obstetrician and Gynecologist
- Director, Gupte Hospital and Center for Research in Reproduction
- Pune, Maharashtra, India
- Boon H Lim mbbs frcog franzcog
- Associate Professor and Director
- Department of Obstetrics and Gynecology
- Royal Hobart Hospital
- Hobart, Tasmania, Australia
- Gorakh G Mandrupkar mbbs dgo fcps
- Incharge, High Risk Pregnancy Unit
- Prakash Memorial Clinic
- Islampur, Maharashtra, India
- Isaac T Manyonda bsc phd mrcog ficog (Hon)
- Professor and Consultant
- Department of Obstetrics and Gynecology
- St George's Hospital
- NHS Trust, London, United Kingdom
- Hiten D Mistry bsc (Hons) phd
- Division of Women's Health
- Women's Health Academic Center
- KHP King's College
- London School of Medicine
- North Wing
- St Thomas’ Hospital
- Westminster, London
- United Kingdom
- Suchitra N Pandit md frcog dnb dfp ficog B Pharma mnams
- Senior Consultant
- Obstetrics and Gynecology
- Kokilaben Dhirubhai
- Ambani Hospital and Research Center
- Mumbai Maharashtra, India
- President, Mumbai Society of OBS/GYN
- President Elect FOGSI 2014
- Fellow of Executive Council
- West Zone RCOG, India
- Fiona Broughton Pipkin ma dphil frcog ad eundem
- Emeritus Professor of Perinatal Physiology
- Department of Obstetrics and Gynecology
- Maternity Unit, City Hospital
- Nottingham, United Kingdom
- Lavanya Rai md dgo
- Professor and Head
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal, Bengaluru
- Karnataka, India
- PK Shah md fcps ficog ficmu dgo dep
- Professor
- Department of Obstetrics and Gynecology
- Seth GS Medical College and King Edward VII
- Memorial Hospital
- Mumbai, Maharashtra, India
- Vikram Sinai Talaulikar md mrcog
- Clinical Research Fellow
- Department of Obstetrics and Gynecology
- Clinical Sciences Jenner 1
- St George's University of London, Cranmer Terrace
- London, United Kingdom
- Parikshit D Tank md dnb fcps dgo dfp mnams micog mrcog
- Consultant, Ashwini Maternity and Surgical Hospital
- Center for Endoscopy and Assisted Reproduction
- Honorary Clinical Associate
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Basky Thilaganathan md frcog
- Professor and Director
- Fetal Medicine Unit
- St George's Hospital
- NHS Trust, London
- United Kingdom
- Alex C Vidaeff md mph
- Professor
- Division of Maternal-Fetal Medicine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital
- Pavillion for Women
- Maine Street
- Suite F 1020 Houston
- Texas, USA
- Girija Wagh md ficog Dip Endoscopy
- Professor and Head
- Obstetrics and Gynecology
- Bharati Vidyapeeth University
- Medical College
- Pune, Maharashtra, India
- Consultant, Girija
- Hospital and Meera Hospital
- Pune, Maharashtra, India
- Adele Zito B Med Sci mbbs (Hons)
- Specialist Registrar
- Department of Obstetrics and Gynecology
- Royal Hobart Hospital
- Hobart, Tasmania, Australia
Out of the eight the Millennium Development Goals, the fifth goal had an ambitious target of reducing the maternal mortality of 540,000 per year in the 1990s by 75% by the year 2015. The 2010 estimates suggest that the mortality has reduced to 280,000 per year, i.e. less than the target but substantial reduction. Hypertensive disorders in pregnancy is the second highest direct cause of maternal deaths globally. Maternal death is the tip of the iceberg—for every death, twenty mothers suffer morbidity. The perinatal wastage due to preterm birth, intrauterine growth restriction, stillbirths and early neonatal deaths are far greater in magnitude than the maternal problems.
Although hypertensive disease in pregnancy is common, it carries major morbidity and mortality in the mother and the offspring. Very few texts are available to cover the entire spectrum of this bizarre illness. Hence, seventeen chapters are dedicated to this enigmatic condition. Chapter 1 deals with the classification with a practical approach useful to the clinician. Chapter 2 provides information on the etiology and the pathophysiology that is essential to understand the nature of the illness. Biochemical and biophysical prediction, maternal vascular differences and possible prevention strategies are discussed in Chapters 3,4 and 5. If it cannot be prevented, it need to be treated and is discussed in Chapter 6 followed by fetal (Chapter 7) and maternal assessment (Chapter 8). Medical disorders can give rise to hypertension and may mimic or complicate pregnancy-induced hypertension. The different conditions that can give rise to hypertension are discussed in Chapter 9. Complications that lead to severe morbidity could be typical like the HELLP syndrome (Chapter 10) or atypical (Chapter 11) and are discussed in detail. Timing and mode of delivery need to consider several factors and similar consideration is essential for analgesia and anesthesia and is tackled in Chapters 12 and 13.
Management of second and third stage poses special problems in hypertensive disease and are described in Chapter 14 followed by care of the critically ill hypertensive mother (Chapter 15). Mothers who have hypertensive disease in pregnancy may develop hypertension after the delivery and slowly progress to become candidates with cardiac and hypertensive cerebrovascular complications. Regular follow-up should be arranged and any hypertension and its complications properly treated. This important aspect is discussed in Chapter 16. Despite good knowledge and facilities, still we loose mothers. Confidential inquiries into maternal deaths identify two-thirds of the deaths to have had substandard care and teach us very valuable lessons. These are provided in Chapter 17. These chapters should provide the comprehensive knowledge needed by a health care professional to provide the best of care for a pregnant mother with hypertension.
This book may not be perfect and may have inadvertent mistakes or points of confusion or contention. The editors would be grateful if the readers could contact any of the editors or publishers so that we can correct factual errors and clarify any misunderstanding.
Sabaratnam Arulkumaran
Sanjay A Gupte
Evita Fernandez
9Acknowledgments
The editors are privileged to have internationally renowned experts to contribute chapters to this comprehensive book. We are most grateful to them. Our publishers M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, deserve a special mention for their patience and hard work. To our families we are indebted for the time away from them. Our gratitude to all our patients, as we learn from the experiences of providing the care and interacting with colleagues.