Pregnancy-induced hypertension: a review about management

Abstract

Background: It is estimated that hypertensive disorders in pregnancy affect 6-8% of pregnant women in the United States, and they are considered one of the main factors of maternal mortality. In Brazil, according to DATASUS, if consider the categories of O13 to O16 ICD-10, hypertensive disorders accounted for about 20.22% of maternal deaths in the period of 2004 to 2014. Objectives: This review aims to present the most current treatments for the management of hypertensive disorders during pregnancy. Methodology: The Medline/Pubmed, LILACS/SciELO, Cochrane library and Scopus databases were consulted, looking for national and international articles published between 2006 and 2016, in English and Portuguese, as well as consensuses set by the World Health Organization and DATASUS government statistics. Results: The recommended managements to prevent preeclampsia (PE) were calcium supplementation for pregnants with low dietetic ingestion and the administration of low doses of aspirin. In front of PE, if it happens on term, the procedure is to induce the delivery, but if it occurs pre-term, is to monitore, administrate magnesium sulfate (MS), antihypertensive and corticoid. In case of eclampsia, the MS is very effective to reduce eclamptic seizures. The drugs used in treatment of severe chronic hypertension (HY) is methyldopa in association or not, with nifedipine or hydralazine. The acute HY is treated with first line drugs, nifedipine and hydralazine, and alternatively with sodium nitroprusside. Conclusion: The main worldwide protocols basically follow the same orientation, only changing specific details of conduct according to each country’s health system resources. The control of maternal blood pressure shows satisfactory results for both, the mother and the fetus, since it reduces the risk of PE and eclampsia. The definitive treatment for PE and eclampsia is the induction of delivery, because they have no cure, only therapeutic measures to control.