Optimizing pregnancy management of chronic hypertension: A case report of cerebrovascular accident in a pregnant woman and literature review.

rationaleThe prevalence of chronic hypertension among pregnant women is steadily increasing worldwide. Besides chronic hypertension is a major risk factor for preeclampsia (PE). Therefore, the standardization of monitoring and management - focusing on early identification and the judicious use of antihypertensive medications to improve maternal and fetal outcomes - has become a critical concern for clinicians. PATIENT CONCERNS: A 31-year-old pregnant woman with chronic hypertension exhibited repeated blood pressure of 160/110 mm Hg or higher throughout her pregnancy, and there were no laboratory or clinical signs indicative of PE. Fluctuations in her blood pressure resulted in an acute cerebrovascular accident during the period of expectant management. DIAGNOSES: Chronic hypertension with severe PE.

interventionsThe patient was admitted due to acute severe hypertension and received corticosteroids for fetal lung maturation. Expectant management was initially considered due to relatively stable condition during the first 3 days of hospitalization. However, on the 4th day, despite treatment with both oral and intravenous antihypertensive agents, blood pressure remained uncontrolled, even reaching 200/105 mm Hg or higher. Unfortunately, the persistent severe hypertension resulted in an acute stroke, necessitating emergency cesarean section and neurosurgical intervention at 31 + 5 weeks of gestation. OUTCOMES: The neonate was transferred to the Neonatal Intensive Care Unit and remained there for 38 days before discharge. The patient was discharged by postoperative day 19 and continued with rehabilitation treatment. At the latest follow-up, muscle strength in her left limb remained at grade 1, with no significant recovery observed. LESSONS: Pregnant women with chronic hypertension who present persistently elevated and uncontrollable blood pressure should be diagnosed with severe PE. Treatment regimens for hypertensive disorders of pregnancy typically involve oral antihypertensive medications, which should be administered judiciously based on clinical guidelines and trial evidence. For chronic maintenance treatment, labetalol and extended-release nifedipine are recommended as 1st-line agents by most international guidelines, with nifedipine being a viable initial option for severe hypertension. For women with severe PE, after corticosteroids have been administered for fetal lung maturation, an overall assessment of maternal and placental-fetal conditions should guide whether expectant management is feasible or if prompt delivery is required to minimize severe complications.