Management of hypertension in pregnancy in rural areas
- Consultant Obstetrician, St Mary’s Hospital for Women and Children, Manchester M13 0JH, UK; michael.maresh@cmmc.nhs.uk
If we are to develop national guidelines, they must encompass all regions of the country and make allowances for rural areas.
Hypertension in pregnancy remains one of the leading causes of maternal deaths with approximately 1 in 100 000 women in the UK dying from complications associated with it.1 In other parts of the world the figure is higher. Maternal and perinatal morbidity is relatively common in the 0.5–1% of women who have severe hypertension, with eclamptic fits occurring in about 1 in 2000 pregnancies.2 However, hypertension in pregnancy is also a common complication with up to 10% of pregnant women having a significant rise in blood pressure in the third trimester. Furthermore, complications may develop rapidly with a minimal rise in blood pressure. Encouraging pregnant women to have as much antenatal care as possible in the community therefore produces challenges for health professionals. They have to be able to predict the small number who may develop severe complications so that they can be appropriately managed to minimise the risk of maternal and perinatal morbidity and mortality.
Such challenges are even more marked in rural areas with poor routes of communication. Studies in other medical specialties have shown a tendency for more patients to be referred to central hospitals from rural areas because of anxieties that complications may occur in non-ideal settings. Local guidelines have often been produced to assist in the process. In Scotland a guideline for the management of non-proteinuric hypertension in pregnancy has been …
