Hypertension in Pregnancy Flashcards
definition of hypertension in pregnancy
s a sustained systolic BP ≥140 mmHg and/or
diastolic BP ≥ 90 mmHg
definition of severe hypertension in pregnancy
y is defined as systolic BP ≥ 160mmHg or diastolic BP ≥
110mmHg.
values for significant proteinuria in pregnancy
as ≥300mg in a 24-hr
urine collection or urinary protein creatinine (Pr:Cr) ratio of ≥30 mg/mmol on a single
specimen. On urine dipstick testing, this translates to proteinuria of 2+ or more
Classification of hypertensive disorders
Gestational hypertension
Pre-eclampsia
Pre-gestational hypertension
Define pre-eclampsia
This is hypertension with proteinuria and /or end organ damage which occurs
after 20 weeks of gestation in a previously normotensive, non-proteinuric woman
When is pre-eclampsia said to be superimposed on chronic hypertension?
• Resistant hypertension (i. e hypertension that requires 3 concurrent medications
for control)
• New or worsening proteinuria
• One or more features of end organ damage
Criteria for severe pre-eclampsia
BP ≥ 160/110 on two occasions 6 hrs apart
• Proteinuria > 2g per 24hr urine specimen
or 2–4+ on dipstick testing
• Oliguria (urine output < 500 ml / 24hr)
• HELLP syndrome
• Cerebral or visual disturbances
• Epigastric pain
• Persistent headache
• Blurred vision
• Retinal changes, such as haemorrhages,
exudates, papilledem
Risk factors for pre eclampsia
- Nulliparity
- Afro-Caribbean ethnicity
- Extremes of maternal age: < 20 yrs, >35 yrs
- Low socio-economic status
- Large placental mass (as occurs in multiple gestation)
- Renal disease
- Molar pregnancy
- Polyhydramnios
- Obesity
- Diabetes mellitus
- Chronic hypertension
Complications of preeclampsia
Eclampsia • IUGR • Prematurity and dysmaturity • Maternal mortality and morbidity . Perinatal mortality and morbidity
what is the specific and curative treatment of pre-eclampsia
delivery of fetus and placenta dependent on severity and viabiility of pregnancy.
treatment of mild pre-eclampsia
Bed rest and expectant management
• Maternal monitoring: 4-hrly BP; daily weight measurement, urine testing and
monitoring for protein; weekly LFTs, RFTs.
• Antihypertensive medication are given when the diastolic blood pressure >100
mmHg
• Fetal monitoring: daily kick count, FH; twice weekly non-stress test
when do you deliver a baby in mild pre-eclampsia
Deliver the woman when the gestation reaches 37 weeks even if the monitored parameters
are good.
In what cases must a woman be delivered earlier than 37 weeks
- Worsening BP and proteinuria
- Deranged lab parameters—Uric acid, LFTs, RFTs, etc
- Development of HELLP syndrome
- Persistent headache, epigastric pain, visual disturbances
- Fetal compromise
- Severe pre-eclampsia
- Eclampsia
Treatment of severe pre-eclampsia
• Prevent convulsions by giving MgSO4
• Control BP with anti-hypertensives (Nifedipine, α-methyldopa, hydralazine)
• End the pregnancy by delivery of the woman. Carefully assess the woman for
induction and vaginal delivery if no contraindication is present and an easy
vaginal delivery can be expected; otherwise perform caesarean sections
Why seizure in eclampsia
Cerebral cortical hypoxia due to platelet microthrobi and foci of hemorrhages in the brain.
