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ABSTRACT
Severe hypertension in pregnancy is a medical emergency. It’s responsible for polymorphic maternal and fetal complications. The authors report a case of malignant hypertension with superimposed preeclampsia in a 26 years old patient. She was admitted in the intensive care unit at 23 weeks and she was operated of a cesarean section at 37 weeks with a favorable outcome. Their purpose is to explain it’s clinical, therapeutic and prognosis particularities. This case reveals us early diagnosis and management of malignant hypertension in pregnancy can prevent the onset of visceral damage, death of patient and or her fetus.
RÉSUMÉL’hypertension artérielle (HTA) sévère pendant la grossesse est une urgence médicale responsable de complications materno-fœtales, polymorphes. Les auteurs rapportent le cas d’une HTA maligne avec prééclampsie surajoutée chez une patiente âgée de 26 ans. Elle a été hospitalisée à 23 semaines d’aménorrhées (SA) en service de réanimation, puis opérée d’une césarienne à 37 SA, avec issue favorable. Leur but est d’exposer ses particularités cliniques, thérapeutiques et pronostiques. Ce cas nous révèle que, la prise en charge rapide de l’HTA maligne en grossesse peut permettre d’éviter les atteintes viscérales, le décès de la patiente et ou du fœtus.
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References
- The Task Force on Hypertention in Pregnancy. Hypertension in Pregnancy ACOG; 2013.
- Mboudou E.T. Hypertension au cours de la grossesse: Aspects cliniques et épidémiologiques à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, Cameroun. Clin Mother Child Health 2009; Vol 6, N° 2: 1087-1093.
- Committee on Obstetric Practice. Committee Opinion N° 623: Emergent therapy for acute-onset, severe hypertension during pregnacy and the postpartum period. Obstet Gynecol. 2015 Feb. 125 (2): 521-5.
- Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2014 Feb 6. CD002252.
- Girerd XMS. Urgence hypertensive : définition, classement, physiopathologie. Réan Urg 1994; 3:509–11.
- Cremer A, Amraoui F, Lip GY et al. From malignant hypertension-MOD: a modern definition for an old but still dangerous emergency. J Hum Hypertens. 2015 Nov 19.
- Krzesinski JM. Epidémiologie de l’hypertention artérielle. Revue Médicale de Liège 2002 ; 57:3:142-147.
- Krieglsteiner S, Nussbaumer K, Haring HP, Aichner F. Hypertensive emergencies. Lancet 2000; 356:1443
- Cove DH, Seddon M, Fletcher RF, Dukes DC. Blindness after treatment for malignant hypertension. Br Med J 1979; 2:245–6.
- Gifford Jr RW. Management of hypertensive crises. Jama 1991;266: 829–35.
- Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356: 411–7
- Blumenfeld JD, Laragh JH. Management of hypertensive crises: the scientific basis for treatment decisions. Am J Hypertens 2001;14: 1154–67.
- Pergolini MS. The Management of hypertensive Crisis: a clinical review. Clin Ter. 2009 Mar-Apr 160 (2): 151-7.
- Magee LA, Pels A, Helewa M, Rey E, Von Dadelszen P. Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, Evaluation and management of the hypertensive disorders of pregnancy: Executive summary. J Obstet Gynaecol Can. 2014 May. 36 (5): 416-41.
- The sixth report of the Joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157:2413–46.
- Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354: 2443–51.
- Committee on Obstetric Practice. Committee Opinion N° 692: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2017 Apr. 129 (4): e90-e95.
- Kitiyakara C, Guzman NJ. Malignant hypertension and hypertensive emergencies. J Am Soc Nephrol 1998; 9:133–42.
- Gonzalez R, Morales E, Segura J, Reulope LM, Praga M. Long-term renal survival in malignant hypertension. Nephrol Dial Transplant. 2010 Oct. 25 (10): 3266-72.
References
The Task Force on Hypertention in Pregnancy. Hypertension in Pregnancy ACOG; 2013.
Mboudou E.T. Hypertension au cours de la grossesse: Aspects cliniques et épidémiologiques à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, Cameroun. Clin Mother Child Health 2009; Vol 6, N° 2: 1087-1093.
Committee on Obstetric Practice. Committee Opinion N° 623: Emergent therapy for acute-onset, severe hypertension during pregnacy and the postpartum period. Obstet Gynecol. 2015 Feb. 125 (2): 521-5.
Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2014 Feb 6. CD002252.
Girerd XMS. Urgence hypertensive : définition, classement, physiopathologie. Réan Urg 1994; 3:509–11.
Cremer A, Amraoui F, Lip GY et al. From malignant hypertension-MOD: a modern definition for an old but still dangerous emergency. J Hum Hypertens. 2015 Nov 19.
Krzesinski JM. Epidémiologie de l’hypertention artérielle. Revue Médicale de Liège 2002 ; 57:3:142-147.
Krieglsteiner S, Nussbaumer K, Haring HP, Aichner F. Hypertensive emergencies. Lancet 2000; 356:1443
Cove DH, Seddon M, Fletcher RF, Dukes DC. Blindness after treatment for malignant hypertension. Br Med J 1979; 2:245–6.
Gifford Jr RW. Management of hypertensive crises. Jama 1991;266: 829–35.
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356: 411–7
Blumenfeld JD, Laragh JH. Management of hypertensive crises: the scientific basis for treatment decisions. Am J Hypertens 2001;14: 1154–67.
Pergolini MS. The Management of hypertensive Crisis: a clinical review. Clin Ter. 2009 Mar-Apr 160 (2): 151-7.
Magee LA, Pels A, Helewa M, Rey E, Von Dadelszen P. Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, Evaluation and management of the hypertensive disorders of pregnancy: Executive summary. J Obstet Gynaecol Can. 2014 May. 36 (5): 416-41.
The sixth report of the Joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157:2413–46.
Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354: 2443–51.
Committee on Obstetric Practice. Committee Opinion N° 692: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2017 Apr. 129 (4): e90-e95.
Kitiyakara C, Guzman NJ. Malignant hypertension and hypertensive emergencies. J Am Soc Nephrol 1998; 9:133–42.
Gonzalez R, Morales E, Segura J, Reulope LM, Praga M. Long-term renal survival in malignant hypertension. Nephrol Dial Transplant. 2010 Oct. 25 (10): 3266-72.