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Chapter 007. Medical Disorders during Pregnancy (Part 3)

Gestational Hypertension This is the development of elevated blood pressure during pregnancy or in the first 24 h post partum in the absence of preexisting chronic hypertension and other signs of preeclampsia. Uncomplicated gestational hypertension that does not progress to preeclampsia has not been associated with adverse pregnancy outcome or adverse long-term prognosis. Renal Disease (See also Chaps. 272 and 280) Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance. This occurs secondary to a rise in renal plasma flow and increased glomerular filtration pressures. Patients with underlying renal disease and hypertension may expect a worsening of hypertension. | Chapter 007. Medical Disorders during Pregnancy Part 3 Gestational Hypertension This is the development of elevated blood pressure during pregnancy or in the first 24 h post partum in the absence of preexisting chronic hypertension and other signs of preeclampsia. Uncomplicated gestational hypertension that does not progress to preeclampsia has not been associated with adverse pregnancy outcome or adverse long-term prognosis. Renal Disease See also Chaps. 272 and 280 Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance. This occurs secondary to a rise in renal plasma flow and increased glomerular filtration pressures. Patients with underlying renal disease and hypertension may expect a worsening of hypertension during pregnancy. If superimposed preeclampsia develops the additional endothelial injury results in a capillary leak syndrome that may make the management of these patients challenging. In general patients with underlying renal disease and hypertension benefit from aggressive management of blood pressure. Preconception counseling is also essential for these patients so that accurate risk assessment can occur prior to the establishment of pregnancy and important medication changes and adjustments can be made. In general a prepregnancy serum creatinine level 133 mol L 1.5 mg dL is associated with a favorable prognosis. When renal disease worsens during pregnancy close collaboration between the nephrologist and the maternal-fetal medicine specialist is essential so that decisions regarding delivery can be weighed in the context of sequelae of prematurity for the neonate versus long-term sequelae for the mother with respect to future renal function. Cardiac Disease Valvular Heart Disease See also Chap. 230 This is the most common cardiac problem complicating pregnancy. Mitral Stenosis This is the valvular disease most likely to cause death during pregnancy. The pregnancy-induced increase in blood volume cardiac