Hypertensive Disorder in Pregnancy Classifications I Pregnancy induced

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Hypertensive Disorder in Pregnancy

Hypertensive Disorder in Pregnancy

�Classifications I. Pregnancy induced Hypertension HTN that develops as a consiequence of pregnancy. Includes:

�Classifications I. Pregnancy induced Hypertension HTN that develops as a consiequence of pregnancy. Includes: a. b. Gestational hypertension: which is elevation of B. P. without Pathological edema, proteinurea hematological/ or biochemical changes Pre-eclampsia: Which is elevation of BP with proteinuria and or patholigical edema, biochemical and or hematogical changes.

�Pre-eclampsia could be: a. b. Mild Severe c. Eclampsia. Convulsions II. Pregnancy aggravated HTN.

�Pre-eclampsia could be: a. b. Mild Severe c. Eclampsia. Convulsions II. Pregnancy aggravated HTN. Which is pre existing hypertension that got worse during pregnancy. a. Superimposed pre-eclampsia b. Superimposed eclampsia

III. HELLP Syndrome: Hemolysis Low platelets Elevated liver enzyme Physiological Changes in Blood pressure

III. HELLP Syndrome: Hemolysis Low platelets Elevated liver enzyme Physiological Changes in Blood pressure during pregnancy Slight drop in 1 st trimester which continuous through the 2 nd trimester, then gradual rise to pre-pregnancy level in the 3 rd trimester * HTN is never normal in pregnancy.

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�Definition: �BP > 140/90 after 20 weeks gestation in the sitting position an of

�Definition: �BP > 140/90 after 20 weeks gestation in the sitting position an of 30 systolic, 15 diastolic is no longer used.

• Risk factors: Nulliparity Extremes of age Multifetal pregnancy Hydrops fetalis Diabetes Renal

• Risk factors: Nulliparity Extremes of age Multifetal pregnancy Hydrops fetalis Diabetes Renal disease Auto immune disorders

�Pathophysiology: �Vaso spasms: � Vascular constriction causes resistance to blood flow and accounts for

�Pathophysiology: �Vaso spasms: � Vascular constriction causes resistance to blood flow and accounts for the development of arterial HTN

Vaso spam is due to the • production of thromboxane and production of prostocycline

Vaso spam is due to the • production of thromboxane and production of prostocycline •

�Dietary dificiency of Ca.

�Dietary dificiency of Ca.

�Different scopes of the disease have maternal and fetal manifestations to different extents. �I.

�Different scopes of the disease have maternal and fetal manifestations to different extents. �I. Gestational HTN - May be asymptomatic - No edema - No protein urea - No hematological abormalities - No biochemical abnormalities - + Fetal involvement e. g. IUGR, oligohydramios in fetal heart tracing and BPP depending on the duration of the diseases. placental abruption, fetal death

�II. Pre-eclampsia: - Mild : BP < 160/110. Edema of the face and upper

�II. Pre-eclampsia: - Mild : BP < 160/110. Edema of the face and upper extremities. - Proteinuria > 300 mg /12 24 hours (trace to +1) - Severe : BP > 160/110 Proteinuria 4 -5 gm / hours (+ 2 or more) Headache Visual disturbance Epigastric pain Oliguria Pulmunary edema Platelets LFTS

�Fetal Involvement as previously mentioned. III. Eclampsia * Generalized tonic, clonic seizures * R/O

�Fetal Involvement as previously mentioned. III. Eclampsia * Generalized tonic, clonic seizures * R/O epilepsy * Considered as a severe form IV. Pregnancy aggravated HTN with: * Super-imposed pre-eclampsia * Super-imposed eclampsia with fetal involvement

�V. HELLP SYNDROME �Severe form with rapid deterioration. �Active aggressive management regardless of gestation

�V. HELLP SYNDROME �Severe form with rapid deterioration. �Active aggressive management regardless of gestation age. • Management: • Prevention : ANC • Aspirin • Diet • BP control in HTN patients

�Investigations: �CBC �U/A, 24 hour collection �LFTS �KFTS �Coagulation profile n. TREATMENT DEPENDS ON:

�Investigations: �CBC �U/A, 24 hour collection �LFTS �KFTS �Coagulation profile n. TREATMENT DEPENDS ON: 1. 2. Severity of the condition Fetal maturity

�In mild cases with prematurity conservative management is recommended with close fetal and maternal

�In mild cases with prematurity conservative management is recommended with close fetal and maternal monitoring and administration of steroids. �In severe cases : Stabilization and delivery regardless of the fetal age is indicated �Mode of delivery depends on how much time you have.

�BASIC RULES: �Use on antihypertensive to prevent maternal CVA commonly used is I. V.

�BASIC RULES: �Use on antihypertensive to prevent maternal CVA commonly used is I. V. hydralazine �Lasix should not be used �ACE inhibitors are contraindicated �Aldomet is used incases of chronic HTN �Use Mg, SO 4, for seizure prevention intrapartum and 24 hours postpartum �Dosage : 4 gm IV load followed by 2 gm/m postpartum infusion. �Continuous fetal monitoring �Ins, outs

�Monitoring of patients on Mg, SO 4 �Mg levels �U/O volume �Reflexes �Respiratory rate

�Monitoring of patients on Mg, SO 4 �Mg levels �U/O volume �Reflexes �Respiratory rate

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