Pregnancy outcome of intensive therapy in severe hypertension in first trimester.

The purpose of the present clinical investigation was to determine the maternal and perinatal outcome associated with continuing pregnancy in 44 consecutive patients with severe chronic hypertension in the first trimester. Each patient was observed closely throughout pregnancy with frequent prenatal visits and intensive monitoring of the clinical status of both mother and fetus. There were no maternal deaths, but morbidity was very significant. Most patients required repeated hospitalizations and on many occasions parenteral medications were used to reduce blood pressure. Nineteen had transient and one permanent renal deterioration. These results confirm that pregnancy in women with severe hypertension is beset with considerable morbidity, but with expert intensive care, gestations can be concluded successfully in those women who refuse termination. Twenty-three patients (52%) developed superimposed preeclampsia, one patient developed pleural effusion, and one patient had postpartum hypertensive encephalopathy. In addition, there was no evidence of late puerperal maternal cardiovascular or renal damage on long-term follow-up. There were ten stillbirths and one neonatal death for an overall perinatal mortality of 25%. Seventy percent of the infants were delivered before 37 weeks' gestation, and 19 infants (43%) were small for gestational age. However, all the perinatal deaths and most of the neonatal morbidity occurred among the 23 patients with superimposed preeclampsia.