Hypertension and renal disease in pregnancy

Hypertension is the most frequently encountered medical disorder. It affects 10-12% of all pregnancies. Worldwide, hypertensive disorders of pregnancy, particularly pre-eclampsia, result in around 100,000 maternal deaths per year. In the UK, hypertensive disease in pregnancy remains one of the leading causes of direct maternal deaths. The fetus may be affected by hypertension, either directly as a consequence of placental insufficiently or indirectly through iatrogenic preterm delivery, overall accounting for 25% of all very low-birthweight infants. Hypertension in pregnancy may be caused by the pregnancy itself as part of the syndrome of pre-eclampsia or it may be a chronic problem present before pregnancy. Women with chronic hypertension are up to 5-times more likely to develop pre-eclampsia than normotensive women. We describe the clinical features and pathogenesis of hypotension in pregnancy and pre-eclampsia and the investigations, fetal surveillance and management of these conditions. Renal disease may have a profound effect on both the mother and fetus during pregnancy, and on the longterm prognosis. The urinary tract undergoes marked anatomical and functional changes in response to pregnancy. Ideally, women with chronic renal disease should be assessed pre-pregnancy. Pregnancy may accelerate a decline in renal function, and the risks to the pregnancy include miscarriage, superimposed pre-eclampsia, intrauterine growth restriction and preterm delivery. Pregnancy outcome is dependent on the degree of renal impairment and degree of hypertension and proteinuria. We describe its management of chronic renal disease in pregnancy and management of pregnancy in renal transplant patients.