Hypertensive Disease in Pregnancy Sabaratnam Arulkumaran, Sanjay A Gupte, Evita Fernandez
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1Hypertensive Disease in PREGNANCY2
3Hypertensive Disease in PREGNANCY
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
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7Preface
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
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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.