A 22-year-old primagravida woman develops hypertension at 32 weeks. She reports no vision change, headache, shortness of breath, or abdominal symptoms. Her pregnancy is uneventful until now. She has no significant past medical history and is not on any medications except vitamins.On examination the blood pressure is 160/100 mm Hg, heart rate is 100/min, and the rest of the examination is normal except for 1+ pedal edema. Her complete blood count, liver enzymes, and electrolytes are normal. The urinalysis is positive for proteinuria. Which of the following is true for this type of hypertension?
This patient has preeclampsia and needs treatment of her hypertension and close follow-up. In the past, there was concern that rigorous drug treatment would harm the fetus. Approximately 5%- 1% of all pregnant women develop preeclampsia which is defined as new-onset hypertension with BP > 140/90 mmHg and proteinuria > 300 mg/24h after 20 weeks of gestation.Studies now show benefit in controlling blood pressure with drugs, but ACE inhibitors and angiotensin receptor blockers (ARB) are contraindicated because they cause renal abnormalities in the fetus. Women who develop hypertension during pregnancy have a higher risk of developing hypertension in later life.Preeclampsia does not improve during the third trimester, it leads to premature birth or low- birth-weight babies, and injures the placenta.
improves in the third trimester
leads to large-birth-weight babies
should be controlled with medications
spares the placenta
C.V.S.