The treatment of hypertension in pregnancy

Hypertension is the commonest medical condition encountered in pregnancy and pre-eclampsia/eclampsia is the second leading cause of maternal mortality in the UK. The precise cause of pre-eclampsia is unknown but the pathophysiology involves abnormal placentation with an exaggerated inflammatory response causing a multisystem disorder. The very presence of rising blood pressure in a pregnant woman should alert the clinician to look for the development of pre-eclampsia. Diagnosis and treatment of hypertensive disorders in pregnancy is vital as they are associated with both worse maternal and fetal outcome. One of the ‘top 10’ recommendations of the most recent report on the Confidential Enquiry into Maternal and Child Health (CEMACH 2003–05), is that all pregnant women with a systolic blood pressure greater than 160 mmHg must have immediate antihypertensive therapy and treatment should be initiated at lower pressures if the overall clinical picture suggests rapid deterioration. Regional anaesthesia is recommended for both labour analgesia and operative delivery. In the presence of compromised placental function and intrauterine growth restriction (IUGR), regional blockade has the beneficial effect of improving placental blood flow.