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.
presence of aura in eclampsia?
no
Treatment principles in eclampsia
Provision of life support during and after the fits: Airway, Breathing, Circulation
(ABC)
• Control of the seizure and prevention of further seizures using MgS04
• Control of hypertension
• Resuscitation and assessment of the woman for delivery
• Special care for the peri-delivery period
