Leon C. Chesley and hypertension in pregnant women

Leon C. Chesley’s first paper opened with the title ‘Pregnancy in the patient with hypertensive disease’11Presented by invitation, at the 57th annual meeting of the American Association of Obstetricians, Gynecologists and Abdominal Surgeons, Hot Springs, VA, USA, 5–7 September, 1946.. Leon C. Chesley PhD, John E. Annitto, MD, MSc (Med), Jersey City, NJ, USA (from the Margaret Hague Maternity Hospital) [Am J Obstet Gynecol 1947;53:372–381]. We quote some lines from this important paper and pioneering work: “We have thought it worth while to survey our experience with pregnancy in women with hypertensive disease. There are relatively few such studies based upon any considerable series, and in most studies extant there has been a selective factor in that therapeutic abortion has been done in the more severely hypertensive patients. It has not been our policy to abort such women, and our large material therefore offers an almost unique opportunity for the study of the natural history of pregnancy in hypertensive women. From the opening of the hospital in October 1931 through to 1944 there were a total of 218 patients in whom recorded blood pressures established the diagnosis of ‘hypertensive toxemia,’ as defined by the American Committee on Maternal Welfare. A detailed analysis has been made of the 301 pregnancies in which these patients have been seen. The gross fetal loss: in prior pregnancies, 35%; in first hypertensive pregnancy, 38%; in subsequent pregnancies, 40%. Of 47 sisters of these hypertensive patients, who delivered here, 45% had at least one toxic pregnancy. Nearly 40% of the hypertensive patients showed drops in the blood pressure in midpregnancy. Proteinuria of some degree occurred in half of the pregnancies. Renal function was normal in 93% of the pregnancies. Premature separation of the placenta occurred in 5.6% of the pregnancies. Fetal loss increased with: higher initial blood pressure, second trimester rises in blood pressure, higher pressures near delivery, decreased renal function, proteinuria, and superimposed toxemia. There were six immediate maternal mortalities (2.0%) and seven late puerperal deaths. Thus the mortality was 20 times that of the whole hospital experience.” From here we will start our “hypertensive journey”.