Hypertension in pregnancy in 21 years old woman!
Hello, my 21-year-old pregnant friend is suffering from hypertension and proteinuria at 20 weeks of gestation. She had a history of pre-eclampsia in her first pregnancy one year ago. During that pregnancy, at 39 weeks of gestation, she developed high blood pressure, proteinuria, and deranged liver function. She eventually delivered by emergency caesarean section following failed induction of labour. Blood pressure returned to normal post-partum and she received no further medical follow-up. Family history was remarkable for her mother's diagnosis of hypertension in her fourth decade. Her father and five siblings, including a twin sister, were healthy. She did not smoke nor drink any alcohol. She was not taking any regular medications, health products, or herbs. How to treat this condition, please elaborate.
@santanu Goals for the treatment of hypertension in pregnancy differ from those for the general hypertensive population. The benefit of treatment of mild diastolic hypertension, blood pressure of 90 to 99 mm Hg, has been clearly established and documented for the general population, while in pregnancy it remains an area of controversy in the absence of well-designed clinical trials. The choice of antihypertensive medication in pregnancy is limited by concerns for fetal safety. In addition to proven safety, an ideal antihypertensive agent should gradually reduce blood pressure without compromising uteroplacental blood flow to the fetus. If administered intravenously, a short-acting formulation that permits rapid reversal of hypotension is preferred. According to the Working Group report of the NHBPEP, first-line oral and intravenous treatment is methyldopa and hydralazine, respectively. Methyldopa is the only antihypertensive agent with a proven record of safety in pregnancy, established by follow-up studies of children exposed to the drug in utero. Because of its long history of efficacy and acceptable side-effect profile, intravenous hydralazine is recommended for the treatment of severe hypertension in women who are near term. Other antihypertensive medications are now being used more often, particularly if blood pressure control cannot be achieved with first-line agents or in the presence of intolerable adverse effects. Some of the newer agents have demonstrated efficacy and safety comparable to those of methyldopa and hydralazine.