Dangers to Mothers and Babies in Early Onset Hypertensive Disorders

Objective: To know the present status of etiology, pathology and outcome in women with EO and LO HDsP.

Current status-etiopathogy: Women with LO HDsP are believed to be related to maternal constitution. EO HDsP probably has placental origin with interplay between maternal constitution, placental factors, and inappropriate adaptive changes in pregnancy, predominantly involving cardiovascular and inflammatory system. EO are believed to be associated with increased arterial stiffness that extends beyond pregnancy, leading to adverse vascular outcomes, not so in LO HDsP. Studies are being done about relationship to genetic variations, immune system and association between hCG and a variety of thrombophilia disorders.

Feto-maternal outcome: When HDsP are diagnosed before 34 weeks, mothers and clinicians are faced with difficult decision of early delivery of extremely premature infant, with slim chance of survival, may be with major neurological dysfunction, more so when the baby is immature or continue with pregnancy with major risks to mother and even baby, especially in low resource settings. Conservative management may improve fetal outcome, but maternal mortality, morbidity even intra uterine death are real concerns. Most of EO cases present with severe rapidly progressive disease with significantly higher risk of obstetric interventions, with dangers to mother, baby. However LO HDsP can also become dangerous for the mother as well as baby.

Prevention: Role of aspirin, calcium has been documented in prevention of LO HDsP but continues to be surrounded by controversies. Not much is known about the role in relation to differences in EO or LO HDsP. Studies are also being done about supplementation with vitamins C and E. Some have shown benefits, others not so. Low-molecular-weight heparin has also been studied with no effect in onset of EO or severe pre-eclampsia.

Conclusion: There are controversies about many issues about EO/LO cases of HDsP. A lot of research is needed about their etiology, pathology, management, outcome and prevention.

Author(s): Shakuntala Chhabra and A Singh

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