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; 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 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) ?


THANK YOU :THANK YOU