MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY

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An evidence based approach to the management of Hypertensive disorders in Pregnancy. Based on the NICE Guidelines for the same. (August 2010, Number 107)

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MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY - An evidence based approach:

MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY - An evidence based approach Dr. Mohammed Sadiq Azam M.D. ( Int Med) Senior Resident, Department of Medicine, Osmania General Hospital Physician, Princess Esra Hospital

What are we dealing with?:

What are we dealing with?

Is it Gestational HTN.. Or Chronic HTN?:

Is it Gestational HTN.. Or Chronic HTN?

Routine investigations:

Routine investigations

Proteinuria – How to assess??:

Proteinuria – How to assess??

Prevention strategy – Do s:

Prevention strategy – Do s

and Don’t s…:

a nd Don’t s… NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN THIS REGARD

Chronic hypertension:

Chronic hypertension

PRE PREGNANCY ADVICE:

PRE PREGNANCY ADVICE

GESTATIONAL HYPERTENSION:

GESTATIONAL HYPERTENSION Once upon a time called PIH, now known as...

PowerPoint Presentation:

Decide on Timing of birth

PowerPoint Presentation:

Mild Hypertension Moderate Hypertension Severe Hypertension

Pre ecclampsia:

Pre ecclampsia

PowerPoint Presentation:

Pre ecclampsia – Who are at risk?

Signs of Severe Pre-ecclampsia:

Signs of Severe Pre- ecclampsia

PowerPoint Presentation:

Decide on Timing of birth

PowerPoint Presentation:

Mild Hypertension Moderate Hypertension Severe Hypertension not requiring referral to a level 2 setup

ecclampsia:

ecclampsia

Antihypertensives – WHAT NOT TO USE:

Antihypertensives – WHAT NOT TO USE

Antihypertensives used - Pharmacology:

Antihypertensives used - Pharmacology

Antihypertensives used – Beta Blockers:

Antihypertensives used – Beta Blockers

Antihypertensives used - Pharmacology:

Antihypertensives used - Pharmacology

Antihypertensives used – Methyldopa:

Antihypertensives used – Methyldopa

Antihypertensives used - Pharmacology:

Antihypertensives used - Pharmacology

Antihypertensives used - Nifedipine:

Antihypertensives used - Nifedipine

Antihypertensives used - Pharmacology:

Antihypertensives used - Pharmacology

Antihypertensives used - Hydralazine:

Antihypertensives used - Hydralazine

Antihypertensives used - Thiazides:

Antihypertensives used - Thiazides

Methyldopa vs Labetolol – The King vs the Challenger?:

Methyldopa vs Labetolol – The King vs the Challenger?

“Can I feed the baby while on my antihypertensive meds?”:

“Can I feed the baby while on my antihypertensive meds?”

Lifestyle advice:

Lifestyle advice

What next?:

What next?

Conclusions:

Conclusions Hypertensive disorders complicating pregnancy are one of the major causes of maternal and foetal mortality and morbidity. Early diagnosis and management can help in circumventing many of the complications of the same. Both labetolol and methydopa have been recommended as first-line drugs in various studies. Final use depends on a careful assessment of risk benefit ratio and clinician judgement. Nifidipine sustained release should be used as a second line drug and SUBLINGUAL NIFIDIPINE should NEVER be used.

Conclusions:

Conclusions Watch for and screen for pre- ecclampsia in high risk individuals at regular intervals. Test of choice for proteinuria is an automated reagent strip reading device or urinary spot protein:creatinine ratio. Aspirin is the ONLY PROVEN method of primary prevention of hypertensive disorders in high risk individuals. Patient counselling and education regarding nature of illness and informed consent prior to initiating treatment is mandatory. With early detection and appropriate management, the journey with hypertension can be made a smooth one for both mother and child.

Thank you:

Thank you Any questions?? Download the presentation online at: www.drmdsadiq.in

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