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Reversible hypertension in pregnancy caused by obstructive uropathy
A J Satin1, G L Seiken, F G Cunningham
1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center Dallas.
Obstetrics and Gynecology
|May 1, 1993
Summary
Urinary obstruction can cause reversible hypertension in pregnancy, mimicking preeclampsia. Prompt relief of this obstruction can normalize blood pressure and extend gestation, avoiding premature delivery.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Urology
Background:
- Hypertension and declining renal function in mid-pregnancy often indicate preeclampsia, necessitating delivery.
- Preeclampsia is a serious pregnancy complication characterized by high blood pressure and potential organ damage.
Observation:
- Three pregnant women (21-30 weeks gestation) presented with severe hypertension and elevated serum creatinine.
- Initial assessment suggested pregnancy-induced hypertension, but preeclampsia was ruled out by other clinical indicators.
- Radiographic confirmation revealed ureteral obstruction, linked to uterine overdistention or congenital urinary anomalies.
Findings:
- Intervention for urinary obstruction, via ureteral stenting or percutaneous nephrostomy, led to diuresis.
- Following obstruction relief, hypertension resolved in all three cases.
- Pregnancies were successfully extended by over six weeks after intervention.
Implications:
- Urinary obstruction is an uncommon but treatable cause of hypertension during pregnancy.
- Relieving urinary obstruction can restore normal blood pressure and potentially prevent the need for immediate delivery.
- This highlights the importance of considering obstructive uropathy in pregnant patients with unexplained hypertension and renal dysfunction.