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Hypertensive disorders of pregnancy

Occurrence, recurrence, and management
PhD ceremony:Mr T.P.C.H. (Thomas) Pereira Bernardes
When:November 06, 2019
Supervisors:prof. dr. H.M. Boezen, prof. dr. B.W. Mol, prof. dr. P.P. van den Berg
Co-supervisor:dr. H. (Henk) Groen
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

Hypertensive disorders of pregnancy (HDP) are found in up to 10% of the more than 200 million annual pregnancies worldwide. Approximately 14% of maternal deaths and 10% of stillbirths have HDP as their cause. The first part of this thesis asked: who are the women most likely to benefit from effective HDP prevention? These disorders invariably still occur and need to be managed. This thesis’ second part was dedicated to studying outcomes of immediate delivery (ID) versus expectant management (EM).Part I investigates the importance of maximum diastolic arterial blood pressure (MaxDBP) for pre-eclampsia risk evaluation in a subsequent pregnancy. Higher MaxDBP pressure increased pre-eclampsia risk. We also show that delivery of an small-for-gestational-age infant increases pre-eclampsia risk in the following pregnancy and vice-versa.Part II describes results obtained by meta-analysis of individual data from participants in different studies in the Netherlands and abroad. Results show ID reduces HELLP syndrome and eclampsia risks, but increases respiratory distress syndrome rates. Part II also shows that cesarean section and adverse neonatal outcome rates are comparable in IDxEM for women presenting with unripe cervixes. Women at high risk of pre-eclampsia should be promptly identified, allowing preventive measures. When HDP eventually occur, effective management is of paramount importance. This thesis contributes towards both these goals.