Management options

The management of chronic and gestational hypertension consists of antihypertensive drugs and close monitoring for development of pre-eclampsia or intra-uterine growth retardation.

The Report on Confidential Enquiries into Maternal Deaths in the United Kingdom strongly recommends that every obstetric unit should have written guidelines for the management of pre-eclampsia and eclampsia. There have also been recommendations that every obstetric unit should have an 'eclampsia pack' containing everything necessary to treat eclamptic women with magnesium.

Women with mild to moderate disease and without major fetal compromise are usually offered a trial of vaginal delivery, whilst those with severe pre-eclampsia (especially at less than 37 weeks' gestation) are likely to be delivered by Caesarean section (although some evidence exists to support expectant care). The anaesthetist should assess the mother, paying particular attention to any symptoms of pre-eclampsia, drug treatment, the airway, level of hypertension, results of haematological and biochemical investigations and proposed mode of delivery.

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