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Hypertension is a sign, not a disease. As with other signs, its appearance may be attributable to a variety of causes. Whenever possible, a cause should be sought. Guidelines for the rational management of hypertension in pregnancy include appropriate use of hospitalization, avoidance of medications not contributing directly to the amelioration of the problem without physiologic handicap, appropriate fetal assessment for continued well-being and appropriately timed and designed intervention when maternal or fetal compromise due to continuation of the pregnancy occurs. Since maternal and fetal morbidity and mortality can be linearly related to maternal blood pressure, particularly maternal diastolic values, a certain threshold for intervention must be established that bears a rational relationship to the risk:benefit ratio of intervention versus nonintervention. Arbitrarily, a persistent maternal diastolic blood pressure of 110 torr or more would seem to demand some control. This is particularly true if the woman also has thrombocytopenia, since in the modern era the leading cause of maternal death from hypertensive diseases is intracranial hemorrhage. If maternal blood pressures cannot be adequately controlled below this value with the appropriate medications or if uncorrectable fetal distress is observed, delivery becomes mandatory. In modern perinatal centers, delivery after 26 to 28 weeks' gestation should generally be expected to be associated with a good overall outcome for mother and baby.
Hypertension is a sign, not a disease. As with other signs, its appearance may be attributable to a variety of causes. Whenever possible, a cause should be sought. Guidelines for the rational management of hypertension in pregnancy include appropriate use of hospitalization, avoidance of medications not contributing directly to the amelioration of the problem without physiologic handicap, appropriate fetal assessment for continued well-being and appropriately timed and designed intervention when maternal or fetal compromise due to continuation of the pregnancy occurs. Since maternal and fetal morbidity and mortality can be linearly related to maternal blood pressure, particularly maternal diastolic values, a certain threshold for intervention must be established that bears a rational relationship to the risk:benefit ratio of intervention versus nonintervention. Arbitrarily, a persistent maternal diastolic blood pressure of 110 torr or more would seem to demand some control. This is particularly true if the woman also has thrombocytopenia, since in the modern era the leading cause of maternal death from hypertensive diseases is intracranial hemorrhage. If maternal blood pressures cannot be adequately controlled below this value with the appropriate medications or if uncorrectable fetal distress is observed, delivery becomes mandatory. In modern perinatal centers, delivery after 26 to 28 weeks' gestation should generally be expected to be associated with a good overall outcome for mother and baby.