Hypertensive diseases in pregnancy

Hypertensive diseases in pregnancy (HDP) are one of the most frequent causes of maternal death and perinatal mortality. However, chronic hypertension without complications has a more favorable prognosis than preeclampsia. Apart from a familial predisposition, mutations of various genes may also be responsible; among these, APC resistance is of particular clinical significance. The insufficient endovascular invasion of trophoblast in the spiral aterioles is still considered to represent the pathogenetic basis of preeclampsia. Increased lipid oxidation, deported membrane components of syncytiotrophoblasts, and increased invasion of fetal cells in the maternal circulation triggering immunological reactions are discussed as the causes. The result is an endothelial imbalance between vasoconstrictory-aggregating and vasodilatatory-antiaggregating compounds. The results of studies on the relevance of NO synthase are controversial. Currently, neither reliable methods for the early detection nor certain preventative measures to avoid the disease are available. Intensive care monitoring and therapy are essential for pregnant women with severe HDP. The obstetric procedure depends on the severity and dynamics of the disease as well as the state of development of the baby. When the pregnancy is continued defined guidelines for its termination for maternal or fetal indications must be taken into consideration. After delivery, the mother must be intensively monitored for at least 24 to 48 hours (postpartal eclampsia/HELLP syndrome). The risk for recurrence-of the preec lampsia is between 20 and 26 % or when it occurred in the second trimester up to 65 % while that of HELLP syndrome is between 3.5 and 24%.