Hypertensive disorders of pregnancy: term and conditions.

Abstract

Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal morbidity and mortality. Prophylactic low dose aspirin reduces the risk of preterm preeclampsia but does not prevent disease at term (Rolnik et al. N Engl J Med 2017;377:613-22). The ultimate – and unsophisticated – “cure” for preeclampsia is delivery. In the context of preterm disease, there is a balancing act between the protective effect of delivery on the mother versus the potential adverse effect of exposing the infant to the major determinant of neonatal morbidity, namely, prematurity. However, for disease at term, delivery reduces risks to the mother and is much more benign for the infant, particularly if effected at 39 weeks of gestational age (wkGA) or later. Hence, the low hanging fruit in screening and prevention of HDP is disease manifesting at term (Smith GCS. PLoS Med 2012;9:e1001274).