especially with documented end-organ damage (Czeizel, 2011; Odibo, 2013). In a study of pregnancy outcomes in nearly 30,000 chronically hypertensive women, Gilbert and associates (2007) reported markedly increased rates of maternal morbidity that included stroke, pulmonary edema, and renal failure. hese observations were verified in the report from the Nationwide Patient Sample by Bateman and colleagues (2012). In this latter study, hypertension complications included stroke-2.7 per 1000, acute renal failure-5.9 per 1000, pulmonary edema-1.5 per 1000, mechanical ventilation-3.8 per 1000, and in-house maternal mortality-O.4 per 1000. he contribution of hypertension to pregnancy-related strokes is discussed in Chapter 60 (p. 1160) and to hypertensive and idiopathic peripartum cardiomyopathy in Chapter 49 (p. 963).
Pregnancy-aggravated hypertension may be due to gestational hypertension or to superimposed preeclampsia. In either instance, blood pressures can be dangerously elevated. As emphasized by Clark and Hankins (2012), systolic pressure :::160 mm Hg or diastolic pressure :::110 mm Hg will rapidly cause renal or cardiopulmonary dysfunction or cerebral hemorrhage. With superimposed severe preeclampsia or eclampsia, the maternal prognosis is poor unless the pregnancy is ended. Placental abruption is a common and serious complication (Chap. 41, p. 767). In addition to hypertensive heart failure mentioned above, aortic dissection was described by Weissman-Brenner and coworkers (2004) and is discussed in Chapter 49 (p. 967).
In aggregate, chronic hypertension is associated with a fivefold risk for maternal death (Gilbert, 2007). his is emphasized by the report by Creanga and colleagues (2015) describing 3358 pregnancy-related deaths in the United States from 2006 through 2010. Hypertensive disorders, including chronic hypertension and preeclampsia syndrome, accounted for 9.4 percent of these deaths. Undoubtedly related were other causes of death such as cardiovascular conditions-14.6 percent, cerebrovascular conditions-6.2 percent, and cardiomyopathy-11.8 percent. Moodley (2007) reported similar indings with 3406 maternal deaths from South Africa.