Taylor / Roberts / Cunningham Chesley's Hypertensive Disorders in Pregnancy

4. Auflage 2014
ISBN: 978-0-12-407945-8
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 484 Seiten

Chesley's Hypertensive Disorders in Pregnancy continues its tradition as one of the beacons to guide the field of preeclampsia research, recognized for its uniqueness and utility. Hypertensive disorders remain one the major causes of maternal and fetal morbidity and death. It is also a leading cause of preterm birth now known to be a risk factor in remote cardiovascular disease. Despite this the hypertensive disorders remain marginally studied and management is often controversial. The fourth edition of Chesley's Hypertensive Disorders in Pregnancy focuses on prediction, prevention, and management for clinicians, and is an essential reference text for clinical and basic investigators alike. Differing from other texts devoted to preeclampsia, it covers the whole gamut of high blood pressure, and not just preeclampsia. - Features new chapters focusing on recent discoveries in areas such as fetal programming, genomics/proteomics, and angiogenesis - Includes extensive updates to chapters on epidemiology, etiological considerations, pathophysiology, prediction, prevention, and management - Discusses the emerging roles of metabolic syndrome and obesity and the increasing incidence of preeclampsia - Each section overseen by one of the editors; each chapter co-authored by one of the editors, ensuring coherence throughout book

Autoren/Hrsg.

Taylor, Robert N.

Roberts, James M.

Cunningham, Gary F.

Lindheimer MD, Facp

Inhaltsverzeichnis

1;Front Cover;1
2;Chesley's Hypertensive Disorders in Pregnancy;4
3;Copyright Page;5
4;Contents;6
5;List of Contributors;8
6;Preface;10
7;1 Introduction, History, Controversies, and Definitions;12
7.1;History (Fig. 1.1);12
7.2;Signs;15
7.2.1;Edema;15
7.2.2;Proteinuria;15
7.2.3;Hypertension;16
7.3;Hypotheses and Rational Management;17
7.4;Prophylaxis;19
7.5;Classification of the Hypertensive Disorders in Pregnancy;20
7.6;Editors’ Update;22
7.6.1;Measurement of Blood Pressure;22
7.6.2;Classifications and Definitions: The American College of Obstetricians and Gynecologists Hypertension in Pregnancy Hyperten ...;24
7.7;Denouement;25
7.7.1;False Steps in the Study of Preeclampsia;25
7.8;References;31
8;2 The Clinical Spectrum of Preeclampsia;36
8.1;Introduction;36
8.2;Clinical Manifestations of Preeclampsia Syndrome;37
8.2.1;Cardiovascular System;37
8.2.2;Loss of Pregnancy Hypervolemia;38
8.2.3;Blood and Coagulation;39
8.2.4;The Kidney;39
8.2.5;The Liver;40
8.2.6;The Brain;43
8.2.7;Uteroplacental Perfusion;44
8.3;Differential Diagnosis;45
8.4;References;45
9;3 Epidemiology of Pregnancy-Related Hypertension;48
9.1;Introduction;48
9.2;Definitions of the Hypertensive Disorders of Pregnancy;48
9.3;Prevalence of Hypertensive Disorders of Pregnancy;49
9.3.1;Eclampsia;49
9.3.2;Preeclampsia;49
9.3.3;Discussion of Differential Frequency Estimates;51
9.4;Risk Factors for Preeclampsia;52
9.4.1;Cardiovascular Risk Factors;52
9.4.2;Body Mass Index;53
9.4.3;Physical Activity;53
9.4.4;Diet;54
9.4.5;Vitamin D;54
9.4.6;Smoking;54
9.4.7;Family Patterns;54
9.5;First Birth and Other Placental Factors;55
9.6;Clinical Predictors;56
9.7;Natural History;56
9.7.1;Maternal Morbidity Immediately Related to Preeclampsia;56
9.7.2;Recurrence of Preeclampsia in Subsequent Pregnancies;56
9.7.3;Reduced Risk of Later-Life Breast Cancer;56
9.7.4;Increased Risk of Later Life Cardiovascular Disease;56
9.7.5;Physiological Mechanisms Linking Preeclampsia to Maternal CVD Risk;57
9.8;Impact on Children;58
9.8.1;Perinatal Outcomes;58
9.8.2;Remote Impact on Cardiovascular Function in Offspring of Preeclamptic Pregnancies;59
9.9;Critique of Studies;59
9.10;Conclusion;59
9.11;Acknowledgment;59
9.12;References;59
10;4 Genetic Factors in the Etiology of Preeclampsia/Eclampsia;68
10.1;Dedication;68
10.2;Introduction;68
10.3;Biological Pathways of Preeclampsia;72
10.3.1;Fetal/Placental Components of Preeclampsia;73
10.3.2;Immunogenetic Factors (see also Chapter 8);73
10.4;Types of Genetic Studies Conducted;74
10.4.1;Family Reports;74
10.4.2;Twin Studies;74
10.4.3;Segregation Analyses;75
10.4.4;Linkage Analyses;76
10.4.5;Association Studies;77
10.4.6;Genome-Wide Association Studies (GWAS);80
10.4.7;Next-Generation Sequencing;81
10.5;A Genomics Approach to Preeclampsia;81
10.6;Essential Variables to Consider;83
10.6.1;Interacting Genomes;83
10.6.2;Subgroups;83
10.6.3;Genomic Ethnicity;83
10.6.4;Population Size;84
10.6.5;Gene–Gene Interactions;84
10.6.6;Epigenetics;85
10.6.7;Gene–Environment Interactions;85
10.6.8;Confounding Variables;85
10.7;High-Dimensional Biology;86
10.8;A Predictive Genetic Test;86
10.9;Pharmacogenomics;86
10.10;The Future of Preeclampsia Genetic Research;86
10.11;Conclusions;86
10.12;References;87
11;5 The Placenta in Normal Pregnancy and Preeclampsia;92
11.1;APPENDIX: Trophoblast Gene Expression in Normal Pregnancy and Preeclampsia;106
12;6 Angiogenesis and Preeclampsia;124
12.1;Introduction;124
12.2;Placental Vascular Development in Health;124
12.2.1;Placental Vasculogenesis;124
12.2.2;Maternal Vascular Remodeling;125
12.2.3;Fetal Circulation and Placental Villous Angiogenesis;125
12.2.4;Angiogenic Factors and Placentation;127
12.2.5;Natural Killer Cells and Placental Vascular Development;128
12.3;Angiogenic Imbalance in Preeclampsia;129
12.3.1;Soluble Antiangiogenic Factors in Preeclampsia;129
12.3.2;Upstream Pathways and Mechanisms of Preeclampsia;134
12.3.3;Angiogenesis and the Remote Consequences of Preeclampsia;135
12.3.4;Role of Angiogenic Biomarkers in Preeclampsia;135
12.3.5;Therapeutic Strategies for Preeclampsia;135
12.3.6;Anti-Angiogenic Versus Normal Angiogenic Forms of Preeclampsia;136
12.4;Perspectives;136
12.5;References;137
13;7 Metabolic Syndrome and Preeclampsia;144
13.1;Introduction;144
13.2;Metabolic Syndrome;145
13.3;Metabolic Syndrome and Cardiovascular Disease;146
13.3.1;Obesity;146
13.3.2;Free Fatty Acids and TNF-a;147
13.3.3;Renin-Angiotensin System;149
13.3.4;Adipocyte Hypertrophy and Endoplasmic Reticulum Stress;150
13.4;Pregnancy-Induced Metabolic Changes;150
13.4.1;Carbohydrate and Lipid Metabolism;150
13.4.2;Maternal Weight Gain in Pregnancy;151
13.5;Preeclampsia and Metabolic Syndrome;152
13.5.1;Obesity and Insulin Resistance;152
13.5.2;Inflammation;153
13.5.3;Dyslipidemia;155
13.5.4;Angiogenic Factors;156
13.5.5;Uric Acid and ADMA;157
13.5.6;Lifestyle Factors;157
13.5.7;Later-Life Cardiovascular Risk (also see Chapter 3);158
13.6;Metabolic Syndrome: a Cause of Placental Dysfunction?;159
13.7;Summary and Perspectives;161
13.8;References;162
14;8 Immunology of Normal Pregnancy and Preeclampsia;172
14.1;Introduction;172
14.2;Maternal Adaptation to a Foreign Fetus;172
14.3;Innate and Adaptive Immunity;173
14.4;Nature’s Transplant;173
14.5;Classical Two-Stage Model of Preeclampsia;174
14.6;Stage 1 Preeclampsia, Interface 1 and Maternal Immune Responses to Trophoblast;176
14.7;Stage 2 Preeclampsia and Interface 2;176
14.8;Endothelial Cells are Inflammatory Cells;177
14.9;Inflammation and the Integrated Stress Response;177
14.10;Widespread Implications of Vascular Inflammation;177
14.11;Cytokines, Chemokines, Growth Factors, Adipokines and Angiogenic Factors;178
14.12;Metabolism and Vascular Inflammation;178
14.13;Acute-Phase Response;179
14.14;Vascular Inflammation in Normal Pregnancy and Preeclampsia;179
14.15;The Continuum Between Normal Pregnancy and Preeclampsia;180
14.16;Immunoregulation;180
14.17;T Regulatory Cells, Th17 and T-Cell Memory;180
14.17.1;Normal Pregnancy;180
14.18;Angiotensin II (Ang II), the Immune System and Preeclampsia;181
14.19;Systemic Immunoregulation in Normal Pregnancy and Preeclampsia;181
14.20;Acute Atherosis: A Second Inflammatory Lesion of Preeclampsia;182
14.21;The Role of the Placenta and Non-Placental Factors;182
14.22;Trophoblast Extracellular Vesicles;184
14.23;Maternal Predisposing Factors;184
14.24;Conclusions;186
14.25;References;186
15;9 Endothelial Cell Dysfunction;192
15.1;Introduction;192
15.2;Part I: Endothelial Cell Function and Preeclampsia;193
15.2.1;Endothelial Cell Dysfunction in Preeclampsia;193
15.2.2;Circulating Markers of Endothelial Cell Activation;194
15.2.3;Growth Factor Binding Proteins in Preeclampsia;195
15.3;Part II: Circulating Factors Induce Endothelial Cell Dysfunction;195
15.3.1;Formed Elements in Blood as Activators of Endothelium;195
15.3.2;Placental Membrane Microvesicles;196
15.3.3;Endothelial Progenitor Cells (EPCs);196
15.3.4;Immune Complexes: Antiphospholipid and Antiendothelial Cell Antibodies;196
15.3.5;Cytokines;197
15.3.6;Circulating Lipids and Lipoproteins;198
15.3.7;Non-Esterified Fatty Acids;198
15.3.8;Peroxisome Proliferator-Activated Receptors (PPARs);199
15.3.9;Angiogenic Factors;200
15.3.10;Matrix Metalloproteinases;200
15.3.11;Endothelin;201
15.3.12;Relaxin;202
15.3.13;Angiotensin II;202
15.3.14;Toll-Like Receptors;202
15.4;Part III: Oxidative Stress: A Point of Convergence for Endothelial Cell Dysfunction;202
15.4.1;Oxidative Stress as a Mediator of Endothelial Cell Dysfunction;202
15.4.2;Eicosanoid/Prostacylin Production;203
15.4.3;Nitric Oxide;204
15.4.4;Endothelium-Derived Hyperpolarization;205
15.4.5;Other Vasodilators;205
15.5;Part IV: Clinical Trials;206
15.5.1;Aspirin;206
15.5.2;L-Arginine;206
15.5.3;Fish Oil;206
15.5.4;Calcium;207
15.5.5;Anticoagulants;207
15.5.6;Summary;207
15.6;Part V: Speculations and Directions of Future Investigations;207
15.7;References;208
16;10 Animal Models for Investigating Pathophysiological Mechanisms of Preeclampsia;220
16.1;Introduction;220
16.2;Models Used to Investigate Links Between Placental Ischemia and Endothelial and Cardiovascular Dysfunction;220
16.3;Animal Models Used to Study Role of Angiogenic Factors (See Also Chapter 6);223
16.4;Models Used to Investigate the Role of Immune Mechanisms in Preeclampsia;224
16.5;Genetic Models;225
16.5.1;BPH/5;225
16.5.2;Genetic Modification of the Renin-Angiotensin System;226
16.5.3;STOX1 Overexpression;226
16.5.4;COMT Knockout;227
16.5.5;Potential Models with Placental Abnormalities;227
16.6;Summary;228
16.7;References;228
17;11 Tests to Predict Preeclampsia;232
17.1;Introduction;232
17.2;Assessing the Quality of Tests to Predict Disease;232
17.3;Placental Perfusion and Vascular Resistance Dysfunction-Related Tests;234
17.3.1;Roll-Over Test, Isometric Exercise Test, and Angiotensin II Sensitivity Test;234
17.3.2;Blood Pressure;235
17.3.3;Transcranial Doppler Velocimetry;235
17.3.4;Uterine Artery Doppler Velocimetry;236
17.4;Fetal and Placental Unit Endocrinology Dysfunction-Related Tests;237
17.4.1;Human Chorionic Gonadotropin;237
17.4.2;Alpha Fetoprotein;237
17.4.3;Estriol;237
17.4.4;Inhibin A;239
17.4.5;Pregnancy-Associated Plasma Protein A;239
17.4.6;Activin A;239
17.4.7;Placental Protein 13;239
17.4.8;A Disintegrin and Metalloprotease 12;239
17.5;Renal Dysfunction-Related Tests;240
17.5.1;Serum Uric Acid;240
17.5.2;Microalbuminuria;240
17.5.3;Urinary Calcium Excretion;240
17.5.4;Urinary Kallikrein;240
17.5.5;Podocyturia (See Chapter 16);240
17.6;Endothelial Dysfunction and Oxidant Stress-Related Tests;241
17.6.1;Fibronectin;241
17.6.2;Homocysteine;241
17.6.3;Endothelial Cell Adhesion Molecules;241
17.6.4;Circulating Angiogenic Factors;242
17.7;Other Tests;243
17.7.1;Cell-Free Fetal Deoxyribonucleic Acid;243
17.7.2;Proteomic, Metabolomic, and Transcriptomic Markers;245
17.8;The Use of Combined Tests;246
17.9;Multivariable Prediction Models Derived from Combinations of Maternal Characteristics and Tests;249
17.10;Perspectives and Conclusions;252
17.11;Acknowledgement;255
17.12;References;255
18;12 Prevention of Preeclampsia and Eclampsia;264
18.1;Introduction;264
18.2;Dietary Manipulations;265
18.2.1;Low-Salt Diet;265
18.2.2;Fish Oil;265
18.2.3;Calcium Supplementation;266
18.3;Physical Activity;267
18.4;Diuretics and Antihypertensive Drugs;267
18.5;Antioxidant Vitamins;268
18.6;Antithrombotic Agents;268
18.6.1;Low-Dose Aspirin;269
18.6.2;Low-Dose Aspirin Plus Heparin;270
18.6.3;Statins;270
18.7;Prevention of Eclampsia;270
18.7.1;Magnesium Sulfate for Mild Preeclampsia;270
18.7.2;Magnesium Sulfate for Severe Preeclampsia;271
18.7.3;Effects of Magnesium Sulfate on Maternal Mortality and Morbidity;272
18.7.4;Effects of Magnesium Sulfate on Perinatal Mortality and Morbidity;273
18.8;Treatment for Eclampsia (See Chapter 20);273
18.8.1;Side Effects and Toxicity;274
18.8.2;Initiation, Dose, Duration, and Route of Administration;274
18.8.3;Prevention of Long-Term Maternal Health Risks Following Preeclampsia;275
18.9;References;276
19;13 Cerebrovascular Pathophysiology in Preeclampsia and Eclampsia;280
19.1;Introduction;280
19.2;Neuroanatomical Findings with Eclampsia;281
19.3;Neuroimaging in Eclampsia;281
19.3.1;Computed Tomography (CT);281
19.3.2;Magnetic Resonance Imaging (MRI);282
19.3.3;Diffusion-Weighted MRI and Apparent Diffusion Coefficient;283
19.4;Pathogenesis of Cerebral Manifestations in (PRE)eclampsia;284
19.5;Eclampsia as Posterior Reversible Encephalopathy Syndrome (PRES);285
19.6;Cerebral Blood Flow Autoregulation;285
19.7;Cerebral Blood Flow Autoregulation and Hemodynamics in Pregnancy;286
19.7.1;Animal Studies;286
19.7.2;Human Studies;287
19.8;Mechanisms of Seizure During Pregnancy and Preeclampsia;290
19.9;Role of Circulating Factors in Eclampsia;291
19.9.1;Blood–Brain Barrier;291
19.9.2;Aquaporins and Cerebral Edema During Pregnancy;293
19.9.3;Effect of Magnesium Sulfate Treatment;293
19.9.4;Cerebral Hemorrhage;294
19.9.5;Cortical Blindness;294
19.10;Remote Cerebrovascular Health Following Preeclampsia and Eclampsia;294
19.10.1;Visual Functioning;294
19.10.2;Brain White Matter Lesions;294
19.10.3;Neurocognitive Functioning;296
19.10.4;Epilepsy;296
19.10.5;Stroke;296
19.11;References;296
20;14 Cardiovascular Alterations in Normal and Preeclamptic Pregnancy;302
20.1;Introduction;302
20.2;Hemodynamics and Cardiac Function in Normal Pregnancy;302
20.2.1;Systemic Arterial Hemodynamics in Normal Pregnancy;302
20.2.2;Venous System in Normal Pregnancy;304
20.2.3;Systemic Arterial Properties in Normal Pregnancy;305
20.2.4;Left Ventricular Properties in Normal Pregnancy;306
20.2.5;Coupling between Left Ventricle and Systemic Arterial Circulation in Normal Pregnancy;308
20.3;Hemodynamics and Cardiac Function in Preeclampsia;308
20.3.1;Systemic Arterial Hemodynamics in Preeclampsia;308
20.3.2;Systemic Arterial Properties in Preeclampsia;311
20.3.3;Left Ventricular Properties in Preeclampsia;313
20.4;Factors that May Explain Vascular Changes in pregnancy;315
20.4.1;Normal Pregnancy;315
20.4.2;Preeclampsia;317
20.5;Pregnancy-Associated Responses and the Assessment of Cardiovacular Disease Risk Later in Life;317
20.6;Summary;318
20.7;References;319
21;15 The Renin-Angiotensin System, its Autoantibodies, and Body Fluid Volume in Preeclampsia;326
21.1;Introduction;326
21.2;Body Fluid Volumes;327
21.2.1;Preeclampsia;328
21.2.2;“Normal Fill” or Resetting of the “Volumestat”;328
21.2.3;Primary Arterial Vasodilatation (“Underfill”);329
21.2.4;Excessive Expansion or “Overfill”;329
21.3;Plasma Volume in Normal Pregnancy and Preeclampsia;330
21.3.1;Novel Salt Concept;331
21.3.2;Mineralocorticoids and the Renin-Angiotensin-Aldosterone Axis;332
21.3.3;Antinaturetic Peptides in Pregnancy;334
21.3.4;Preeclampsia;334
21.3.5;Agonistic Anti-AT1 Receptor Antibodies;335
21.3.6;Agonistic Anti-AT1 Receptor Antibodies in Preeclampsia (AT1-AA);336
21.3.7;Signal Transduction and Pathophysiological Role of AT1-AA;336
21.3.8;AT1-AA in Animal Models of Hypertension During Pregnancy (See also Chapter 10);337
21.3.9;AT1-AA Induced Hypertension;339
21.3.10;Presence of AT1-AA in Other Diseases;340
21.4;Concluding Perspectives;341
21.5;References;341
22;16 The Kidney in Normal Pregnancy and Preeclampsia;346
22.1;Introduction;346
22.2;Renal Hemodynamics and Glomerular Filtration Rate During Normal Pregnancy;346
22.2.1;Renal Clearances of para-Aminohippurate and Inulin;347
22.2.2;Creatinine Clearance;348
22.2.3;Postural Influences on Renal Function;349
22.2.4;Mechanisms for Alterations of Renal Hemodynamics and GFR;349
22.2.5;Cellular and Molecular Mechanisms of Renal Vasodilatation;352
22.3;Osmoregulation in Normal Pregnancy;356
22.4;Renal Hemodynamics and Glomerular Filtration Rate in Preeclampsia;357
22.4.1;Summary;361
22.5;Renal Handling of Uric Acid;362
22.5.1;Normal Pregnancy;362
22.5.2;Preeclampsia;363
22.5.3;Summary;367
22.6;Renal Handling of Proteins;368
22.6.1;Normal Pregnancy;368
22.6.2;Preeclampsia;369
22.6.3;Summary;373
22.7;Renal Morphology in Pregnancy and Preeclampsia;373
22.7.1;Introduction;373
22.7.2;Gross Morphology;374
22.7.3;Indications for Renal Biopsy in Pregnancy;378
22.8;References;379
23;17 Platelets, Coagulation, and the Liver;390
23.1;Introduction;390
23.2;Platelets;390
23.2.1;Platelets in Normal Pregnancies and with Preeclampsia;391
23.2.2;Platelet Activation In Vivo;393
23.2.3;Summary of Platelet Activation;393
23.2.4;Platelet Behavior In Vitro;394
23.2.5;Expression of Platelet Receptors in Pregnancy and Preeclampsia;394
23.2.6;Platelet Second Messengers;395
23.2.7;Platelet Angiotensin II-Binding Sites;395
23.3;Coagulation;396
23.3.1;Coagulation Cascade Factors;396
23.3.2;Regulatory Proteins and Thrombophilia;397
23.3.3;Fibrinolytic System;398
23.3.4;Fibrinolysis in Normal Pregnancy;399
23.3.5;Fibrinolysis in Preeclampsia;399
23.4;The Liver in Preeclampsia;399
23.4.1;Clinical Aspects of Liver Involvement;400
23.4.2;The Liver in HELLP Syndrome;401
23.4.3;Corticosteroid Therapy for HELLP Syndrome;402
23.5;References;402
24;18 Chronic Hypertension and Pregnancy;408
24.1;Introduction;408
24.2;Background;408
24.2.1;Definition;408
24.2.2;Diagnosis;409
24.2.3;Cardiac and Hemodynamic Alterations;409
24.2.4;Effect of Chronic Hypertension on the Mother;410
24.2.5;Effects of Chronic Hypertension on Fetal/Neonatal Outcome;411
24.2.6;Chronic Hypertension with Superimposed Preeclampsia;411
24.2.7;Effects of Superimposed Preeclampsia on the Mother and Fetus/Neonate;412
24.3;Specific Hypertensive Disorders;413
24.3.1;Essential Hypertension;413
24.3.2;Physiology and Pathophysiology of Essential Hypertension During Pregnancy;414
24.3.3;Blood Pressure Patterns and Hemodynamic Measurements;414
24.3.4;Hormonal and Biochemical Alterations;415
24.3.5;Pathophysiology of Superimposed Preeclampsia;415
24.3.6;Secondary Hypertension;416
24.3.7;Renal Disease;416
24.3.8;Renovascular Hypertension;416
24.3.9;Primary Aldosteronism;417
24.3.10;Pheochromocytoma;419
24.3.11;Cushing Syndrome;420
24.3.12;Postpartum Hypertension;420
24.4;Management Principles;421
24.4.1;Preconception Counseling;421
24.4.2;Non-Pharmacologic Management;422
24.4.3;Pharmacologic Management (see Chapter 19);422
24.5;References;423
25;19 Antihypertensive Treatment;430
25.1;Introduction;430
25.2;Goals of Antihypertensive Drug Therapy;430
25.3;General Principles in the Choice of Antihypertensive Agents;431
25.4;Fetal Safety and Drug use in Pregnant Women;432
25.5;Choice of an Antihypertensive Drug for use in Pregnancy;433
25.5.1;Sympathetic Nervous System Inhibition;433
25.5.2;Centrally Acting a2-Adrenergic Agonists;433
25.5.3;Peripherally Acting Adrenergic-Receptor Antagonists;435
25.5.4;Diuretics;436
25.5.5;Calcium-Channel Antagonists;437
25.5.6;Direct Vasodilators;438
25.5.7;Modulators of the Renin–Angiotensin–Aldosterone Axis;439
25.6;Drug use While Breastfeeding;440
25.7;Evidence from Randomized Trials;441
25.7.1;Evidence for Antihypertensive Treatment in Mild to Moderate Hypertension;441
25.7.2;Evidence for Antihypertensive Treatment in Severe Hypertension;443
25.8;Conclusion;443
25.9;References;445
26;20 Clinical Management;450
26.1;Introduction;450
26.2;Preeclampsia;450
26.2.1;Early Diagnosis and Evaluation;450
26.2.2;Hospitalization Versus Outpatient Management;451
26.2.3;Antihypertensive Therapy for Mild to Moderate Hypertension;452
26.2.4;Indications for Delivery;454
26.2.5;Delayed Delivery with Early-Onset Preeclampsia;455
26.3;Eclampsia;458
26.3.1;Immediate Management of Seizure;459
26.3.2;Medical Treatment of Eclampsia;459
26.4;Management of Severe Hypertension;463
26.4.1;Commonly Used Antihypertensive Agents;463
26.4.2;Other Antihypertensive Agents;465
26.4.3;Diuretics;465
26.4.4;Fluid Therapy;465
26.4.5;Pulmonary Edema;465
26.4.6;Plasma Volume Expansion;466
26.5;Neuroprophylaxis – Prevention of Eclampsia;466
26.5.1;Who Should Be Given Magnesium Sulfate?;467
26.6;Delivery;468
26.6.1;Blood Loss at Delivery;468
26.6.2;Analgesia and Anesthesia;469
26.7;Persistent Severe Postpartum Hypertension;470
26.7.1;Furosemide;470
26.8;References;471
27;Index;476