Obstetrics and Gynaecology Forum - latest Issue
Volume 26, Issue 3, 2016
Author J. MoodleySource: Obstetrics and Gynaecology Forum 26 (2016)More Less
Hypertensive disorders of pregnancy (HDP) are the commonest direct cause of maternal deaths in South Africa. The Saving Mothers Report (2011-2013) indicates that 14.8% of all deaths are due to HDP. The International Society for the study of Hypertension in Pregnancy has recently revised the categories of HDP. These categories include chronic hypertension, gestational hypertension, pre-eclampsia (denovo or super-imposed on chronic hypertension), eclampsia and white coat hypertension.
Source: Obstetrics and Gynaecology Forum 26, pp 5 –8 (2016)More Less
Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality. The current recommended screening approach is to identify risk factors from maternal history and demographic characteristics. Blood pressure and urinary proteins must be determined at every ante-natal visit. Patients with gestational hypertension and/or gestational proteinuria require increased antenatal surveillance because they have an increased risk for developing pre-eclampsia during pregnancy. We recommend that these patients be considered for management at District level. Local protocols must in place for emergency treatment and referral of patients who develop a sudden acute hypertensive emergency.
Author G.J. HofmeyrSource: Obstetrics and Gynaecology Forum 26, pp 11 –15 (2016)More Less
Pre-eclampsia is strikingly more common in low- than high-income countries. Understanding the mechanisms responsible for these differences may provide clues to strategies to prevent the condition. One possible factor is dietary deficiency. Calcium supplementation in the second half of pregnancy for women with low dietary calcium intake has a limited effect on the incidence of pre-eclampsia, but an important 20% reduction in its severe manifestations. The World Health Organization recommends calcium supplementation with 1.5 to 2 g calcium daily for pregnant women with low dietary calcium intake. Tentative evidence suggests that a lower dose (e.g. 500 mg daily) may be adequate. Research is ongoing to determine whether pre-and early pregnancy supplementation with calcium may reduce the incidence of pre-eclampsia more effectively. There is insufficient evidence of effectiveness at this stage to recommend other dietary supplements such as Vitamin D, anti-oxidants (Vitamin C and E), magnesium and marine oils, but further research is justified. Low dose aspirin (75mg daily) has a modest protective effect and is recommended from 12 weeks to delivery for women at high risk of pre-eclampsia.
Author M.G. SchoonSource: Obstetrics and Gynaecology Forum 26, pp 17 –20 (2016)More Less
Hypertension continuing into, or developing in the puerperium have not received adequate attention in the health sector resulting in inadequate reliable data to advise appropriate management. The principles of management of hypertension remain the same focusing on prevention of complications relating to severe hypertension. Practitioners need to be alert for maternal complications developing in women with elevated blood pressure, especially signs and symptoms that may be associated with thrombosis or cardiac complications. Advice regarding long term follow-up is suggested due to association with an increased risk of hypertension and cardiovascular events later in life.
Author D.R. HallSource: Obstetrics and Gynaecology Forum 26, pp 22 –27 (2016)More Less
Hypertensive diseases are important causes of maternal and perinatal mortality and morbidity globally and particularly in South Africa. Sentinel studies performed in South Africa have assessed the risks and benefits of expectant management and provided recommendations for evaluation, management and delivery. Expectant management of appropriately selected cases of early pre-eclampsia in a dedicated, tertiary in-patient setting with intensive but noninvasive maternal and fetal surveillance, prolongs pregnancy, improves the perinatal outcome and mitigates the impact of maternal complications.
Author D. NelSource: Obstetrics and Gynaecology Forum 26, pp 28 –34 (2016)More Less
Morbidity and mortality due to hypertensive disorders remain a health issue worldwide. Intimate knowledge is needed on how to try and prevent complications but also on how to manage them when they do arise as to minimize their impact. Anaesthetists may feel that their role in the management of these patients is limited to the intra-operative course. The truth is that anaesthetists are often called upon to help with the management of the patients. In addition, the intra-operative period can never stand alone from the pre- and post-operative periods. What happens pre-operative have bearing on the intra-operative situation and both these will influence the post-operative path.
Blood pressure measurement and rapid acting antihypertensives for severe hypertension in pregnancy : reviewSource: Obstetrics and Gynaecology Forum 26, pp 35 –40 (2016)More Less
The use of an inappropriate device and or technique for blood pressure (BP) measurement in pregnancy results in inaccurate BP readings. Under or over-estimation of the BP will influence clinical decisions and compromise patient safety. Additionally, severe hypertension in pregnancy may be detected during a BP measurement. In such situations, incremental doses of a single rapid acting antihypertensive agent and even a change to other agents may be required. The availability of different rapid acting antihypertensive agents leads to different practices concerning choice, dosage interval and dose of the drugs. In this article, the authors have succinctly discussed issues concerning: (i) BP measurement in pregnancy and (ii) the use of rapid-acting antihypertensive agents in a dynamic algorithm for the management of severe hypertension in pregnancy. The authors define dynamic algorithm as a management sequence that is apt to change within an hour based on predetermined schedules.