====Hypertension in pregnancy====

[[https://www.bmj.com/content/366/bmj.l2381|BMJ review 2019]]\\ 
[[https://www.ahajournals.org/doi/10.1161/hypertensionaha.106.075895#d3e214|Antihypertensives in pregnancy AHA 2008]]\\ 
  *very difficult to define and there have been many loose definitions
  *the diagnosis endorsed by the **International Society for the Study of Hypertension in Pregnancy (ISSHP)** embraces new onset hypertension (sBP>140mmHg & dBP>90mmHg) plus ≥1
    *proteinuria
    *other maternal organ dysfunction including liver, kidney, neurological or hematological
    *uteroplacental dysfunction, such as fetal growth restriction
    *abnormal Doppler ultrasound findings of uteroplacental blood flow

The **National Institute of Health and Care Excellence (NICE)** defines pre-eclampsia as **new onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:**
  *Proteinuria, or
  *Other maternal organ dysfunction:
    *Renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100 ml or more).
    *Liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain).
    *Neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata.
    *Haematological complications such as thrombocytopenia (platelet count below 150,000/microlitre), disseminated intravascular coagulation or haemolysis.
    *Uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery doppler waveform analysis, or stillbirth.

  *Methyldopa remains one of the most widely used drugs for the treatment of hypertension in pregnancy.
  *