PREGNANCY INDUCED HYPERTENSION : PREGNANCY INDUCED HYPERTENSION DR. DHRUMAN DESAI, DM
BSES HOSPITAL
HOLY FAMILY HOPSITAL
Hypertensive Disorders in Pregnancy - Classification : Hypertensive Disorders in Pregnancy - Classification Gestational Hypertension (formerly PIH)
Preeclampsia
Chronic hypertension
Chronic hypertension with superimposed preeclampsia
Transient hypertension
Gestational Hypertension : Gestational Hypertension Hypertension after 20 weeks gestation
Absence of proteinuria
BP returns to normal by 12 weeks PP
Temporary diagnosis
May evolve to preeclampsia
Preeclampsia : Preeclampsia Minimum criteria
Hypertension after 20 weeks gestation
Proteinuria > 300 mg/24 hours or > +1 on urine dipstick
Increased certainty of Dx
BP > 160/110
Proteinuria 2.0 g/24 hours or +2 dipstick
Elevated creatinine (1.2 mg/dL)
Thrombocytopenia (<100,000)
Microangiopathic hemolysis (LDH)
Elevated SGOT or SGPT
Chronic Hypertension : Chronic Hypertension SBP > 140 or DBP > 90 prior to pregnancy or before 20 weeks gestation
Persists > 12 weeks post partum
Superimposed preeclampsia (on chronic hypertension) : Superimposed preeclampsia (on chronic hypertension) New onset proteinuria
Sudden increase in proteinuria or blood pressure or thrombocytopenia
Eclampsia : Eclampsia Seizures that cannot be attributed to other causes in women with preeclampsia
Risk factors : First pregnancy
Extremes of age; < 18 yrs & > 35 yrs
Obesity
Prior h/o preeclampsia
Pre-existing DM and renal disease
Chronic hypertension
Multiple gestations Risk factors
Etiology : Endothelial dysfunction with vasospasm
Placental insufficiency
Immunologic intolerance
Maternal maladaptation
Abnormal trophoblastic invasion of endometrium
Genetic / Dietary factors Etiology
Symptoms : Asymptomatic & raised BP noted
Pedal edema or increase in edema
Headache
Nondependent edema (face)
Epigastric / RHC pain of hepatic congestion
Rapid weight gain
Visual disturbances
Breathlessness Symptoms
Workup : CBC (look for Hb > 13gm%; platelets < 1lac)
Urinalysis (1+ acceptable)
S Electrolytes
S Creatinine (< 0.8mg%)
24 hr urinary protein (> 300mg/24hrs)
Blood sugars & Glyc HbA1c
S Uric Acid (> 5mg% is abnormal)
SGOT & SGPT, LDH (hemolysis)
XR Chest – PA (with abd shield)!!
CT Scan of brain
USGs & Fetal monitoring Workup
Gestational hypertension Management : Gestational hypertension Management Weekly antepartum visits
Pregnancy monitoring: Biophysical profile & NST
Severe HT: Treat with medications to reduce risk
of maternal stroke.
Delivery by 40 weeks gestation.
Most become normotenstive within first week PP
All should be normotensive by 12th week
15 percent will be dx with chronic htn
Chronic hypertension Treatment : Stg 1: Low risk; Lifestyle modification
(Reduce salt, ? Weight reduction)
May need to stop prev anti HT
No evidence that medications
improve neonatal outcome
Stg 2: Medications must for patients with
end organ affection or BP > 160/100
Methyldopa, Labetolol, Calcium
antagonists, diuretics, hydrallazine.
ACEI & ARBs, Atenolol
Higher risk of developing preeclampsia and
therefore delivered earlier Chronic hypertension Treatment
Pre-eclampsia Treatment : Hospitalize
Oral methydopa/Labetolol if delivery is > 48 hrs)
iv. Labetolol / Nitroprusside / hydrallizine / Nifedipine po if delivery is imminent
Improve maternal safety & not perinatal outcome
Seizure prophylaxis
Timely delivery
Urgent delivery (irrespec of gest age): for fetal distress, IUGR, Severe HT, hemolysis, raised liver enzymes, low platelets, worsening renal function Pre-eclampsia Treatment
Hypertension during lactation : All antihypertensives are excreted in human
breast milk
Stage I hypertension: Prudent to withold
and later restart
Methyldopa or hydralazine preferred
Labetolol if BB indicated
ACEI & ARBs to be avoided (neonatal renal SE)
Avoid diuretics Hypertension during lactation
Slide 16: All antiHT agents should be assumed to cross the placenta & reach the fetal circulation
None of the commonly used classes of antihypertensive drugs has been shown to be teratogenic when taken in early pregnancy
ACE I & ARBs: Only agents contraindicated in pregnancy.
Any antihypertensive agent may increase the risk of SGA infants by lowering BP and, presumably, placental perfusion
However as a result of a lack of sufficient information, no reliable conclusions can be made about the impact of antihypertensive agents (even methyldopa) on long-term child development Which antihypertensive Agent(s) ?
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