Hypertensive disorders in pregnancy

This article describes a pattern of management for women who are either at risk of, or suffering from, a hypertensive disorder during pregnancy. The reasons for concern about these conditions are described and the problems of predicting and preventing the serious hypertensive disorders discussed. The place of prophylactic agents, such as aspirin, is examined and their use evaluated. The management of mild to moderate problems is briefly discussed but the main focus is on serious problems. What can be learnt from the changes in incidence of the serious sequelae associated with these disorders will be specifically considered by examining changes in maternal mortality and eclampsia. The difficulties faced with timing of delivery are considered, together with important evidence concerning the benefits of magnesium sulphate in eclampsia. A way to improve the care of these seriously ill women in line with the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1991–1993 (Department of Health, 1996) will be described.