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Renal vascular hypertension during pregnancy
T R Easterling1, D Brateng, M L Goldman
1Departments of Obstetrics and Gynecology, University of Washington, Seattle.
Obstetrics and Gynecology
|November 1, 1991
Summary
Renal artery stenosis in pregnancy can cause severe hypertension. Transluminal angioplasty effectively treated hypertension in one pregnant patient, allowing for a full-term delivery without complications.
Area of Science:
- Nephrology
- Cardiology
- Obstetrics
Background:
- Renal artery stenosis (RAS) is a significant cause of secondary hypertension.
- Pregnancy can exacerbate or unmask RAS, leading to severe maternal and fetal complications.
- Management of RAS during pregnancy requires careful consideration of maternal and fetal well-being.
Observation:
- Two cases of pregnant women with severe hypertension due to RAS are presented.
- The first patient experienced severe hypertension refractory to medical management, with extremely high vascular resistance.
- The second patient's hypertension improved during pregnancy but recurred postpartum.
Findings:
- Transluminal angioplasty at 20 weeks' gestation successfully resolved severe hypertension in the first patient, enabling uncomplicated term delivery.
- While angioplasty reduced vascular resistance, it did not normalize to typical pregnancy levels.
- The second patient required postpartum angioplasty for recurrent severe hypertension.
Implications:
- Transluminal angioplasty is a viable and effective treatment for severe renal artery stenosis in pregnancy.
- Early intervention can prevent adverse pregnancy outcomes associated with uncontrolled hypertension.
- RAS management may require ongoing postpartum surveillance and treatment.