HYPERTENSION IN PREGNANCY

High blood pressure during pregnancy occurs under two different circum¬stances : a woman with established hypertension may become pregnant; or a patient with a normal blood pressure may in the course of pregnancy develop a toxeemia of which hypertension is a sign.
If a patient known to have hypertension becomes pregnant she must be kept under close observation throughout its course. Apart from the dangers of hypertension itself, the risk of a superimposed toxaemia of pregnancy is greatly increased in hypertensive patients, nearly half of whom develop toxaemia. With close ante-natal supervision any tendency for the pressure to rise as the pregnancy progresses can be detected, and appropriate measures instituted. In the milder cases enforcement of rest, restriction of sodium in the diet and the use of reserpine usually suffice to maintain the pressure at a safe level. The persistence of a high pressure, above, sav 150/100 for several weeks at a time, leads to deterioration in the health of the mother and commonly results in the death of the fcetus, so that it is important that the hypertension should be vigorously treated. The ganglion-blocking agents are contraindicated in this condition, as they tend to increase foetal mortality, but treatment with reserpine and chloro-thiazide should be continued for the remainder of the pregnancy. The advisability of terminating pregnancy should be considered when persisting hypertension is associated with albuminuria and a progressive gain in weight due to fluid retention, particularly if the foetus is viable.
Hypertension may persist into the puerperium and occasionally dangerous acute hypertensive episodes occur during that stage. These demand treatment along similar lines.