Clinical management of pregnancy-induced hypertension

This article is devoted to a discussion of the diagnostic and management of pregnancies complicated by pregnancy-induced hypertension. It is important to realize that the understanding of the pathophysiology and management of this long-known complication of pregnancy has advanced rapidly during the past 7-10 years, and several changes in diagnosis and management have occurred. Not the least of these changes has been a move away from use of the term toxemia of pregnancy, which is at present less widely accepted. This is true because a definite toxin has not been identified even in the most severe cases. Because the etiology of hypertension complicating pregnancy remains unknown it seems more logical to use the descriptive phrase pregnancy-induced hypertension rather than an etiologic term such as toxemia. Even the European designation EPH gestosis has not gained widespread acceptance in the United States because significant and even lethal hypertension may develop during pregnancy without the presence of edema or proteinuria. At Parkland Memorial Hospital the clinical management of pregnancy complicated by pregnancy-induced hypertension is based upon consideration of both maternal and fetal well-being. The therapeutic approaches outlined in Table 1 have proven to be extremely effective, and diagnosis and management of each clinical condition will be described in detail.