[Hypertensive syndromes in pregnancy. Diagnosis and therapy]

ACHIEVE PRECISE DIAGNOSIS: Hypertensive syndromes during pregnancy secondary to placental ischemia still cause threatening matemofetal complications. A precise differential diagnosis between gestational hypertension, chronic hypertension and preeclampsia must be achieved as the management protocols are quite different. PATIENT MONITORING: Blood tests for urea, creatinine, platelet counts, coagulation, and liver enzymes are required. Fetal monitoring, urine protein and ambulatory blood pressure measurements are also helpful. Ultrasound-Duplex explorations allow an evaluation of the maternal vascular status and fetal development.

These patients should be managed in specialized centers, limiting the minimum the number of hospitalizations. Unlike good rules of hygiene and dietetics, antihypertensive therapy has little effect on the progression of the pregnancy. An antihypertensive therapy is only warranted to avoid cardiovascular complications in the mother. In case of chronic hypertension, treatment should be tailored to the measured pressures. Prudent antihypertensive therapy may be useful for severe gestational hypertension and preeclampsia. Because of their safety profile and pharmacologic properties, antihypertension drugs with central action and alph-beta-blockers should be preferred over other drug classes. PREVENTIVE TREATMENT: Antiaggregates (aspirin 50-100 mg/d) starting at 16 weeks gestation should be reserved for high-risk pregnancies. Regular follow-up, both pre- and post-natally, is essential, especially in light of the large number of women who can be expected to progress to established hypertensive states.