Hypertension Pregnancy Flashcards
Hypertensive Disorders of Pregnancy Incidence and mortality
- 10-25% incidence
- 18% mortality
Maternal and Fetal Complications due to Hypertension
- Maternal complications: end organ damage
- Fetal complications (now and later): prematurity, growth restriction, death
Chronic Hypertension during Pregnancy definition
- Known hypertension prior to pregnancy
- Hypertension developing before the 20th week of gestation
- New onset of hypertension during pregnancy that persists >12wks post partum
Preeclampsia definition
- New onset of hypertension and proteinuria during the latter half of gestation (after 20wks)
- BP >140/90 at rest on 2 occasions, in a sitting position, 6hrs apart
- Proteinuria: >0.3g protein in a 24hr urine collection
Preeclampsia Onset
- May be assoc. w/ edema, headache, visual changes, and or epigastric pain
- Usually in the primigravida
- Later in pregnancy (after 20wks)
- If sooner then 20wks, think Molar Pregnancy
*molar pregnancy has a “snow-storm” pattern
Categories of Preeclampsia
- Mild and Severe
Severe Preeclampsia definition
Requires one or more of the following according to the data from ACOG
- Severe hypertension (systolic BP >160 or diastolic BP >110mmHg) at rest, on 2 occasions at least 6hrs apart
- Heavy proteinuria (at least 5g in a 24hr collection or a qualitative value of 3+ in urine samples collected 4hrs apart)
- Oliguria (<500ml in 24hrs)
Severe Preeclampsia Onset
- Cerebral or visual disturbances
- Pulmonary edema or cyanosis
- Epigastric or RUQ pain
- Impaired liver function (elevated liver enzymes)
- Thrombocytopenia
- Fetal growth restriction
Eclampsia definition
- New onset of tonic-clonic seizures in a women w/ preeclampsia
*25% develop seizures before labor
*50% develop seizures during labor
*25% develop seizures post partum
Other causes of Eclampsia in pregnancy
- A-V malformations
- Idiopathic seizure disorders
- Ruptured aneurysm
- Usually occur 24-48hrs post delivery
Etiology of Chronic Hypertension
- Primary cause: “Essential Hypertension”
- Secondary causes:
*metaboli disorders including renal disease, vascular disease and endocrine disorders
- Stress of pregnancy may exacerbate underlying disease processes
Management of Chronic Hypertension
Obtain lab data base including:
- CBC, BUN, creatinine, LFT’s, 24hr urine for protein and creatinine, urinalysis
- EKG
- Observe for superimposed preeclampsia (20%)
- Observe for Intrauterine growth restriction (IUGR)
- Control BP: 140-150/90-100
*want BP to stay in relative range of pts normal BP whether hypertensive or not so that there are no detrimental effects to the fetus by changing it
- Deliver at term if no complications
- Earlier delivery as dictated by maternal and/or fetal well-being
- Vaginal delivery
- No exacerbation of chronic hypertension caused by pregnancy
*the pregnancy may only unmask an underlying disease process
Chronic Hypertension with Superimposed Preeclampsia
- Defined as chronic hypertension w/ new-onset proteinuria (0.3g in a 24hr collection) after 20th week of gestation
- Sudden increase of blood pressure, proteinuria or any signs or symptoms consistent w/ sever preeclampsia
Gestational Hypertension
- Post partum diagnosis
- Defined as hypertension occurruing after the 20th week of gestation w/o proteinuria
- May occur 48-72hrs post partum, but will resolve by the 12th post partum week
*if it doesn’t resolve by 12wks = chronic hypertension
- If pregnancy has been completed w/o the development of proteinuria and the BP is normal after the 12th post partum week you may then diagnose gestational hypertension
- These women are more prone to develop chronic hypertension later in life
HELLP Syndrome
- Variation of severe preeclampsia
- “H” = hemolysi
- “EL” = elevated liver enzymes
- “LP” = low platelets
- Multiparous
- >25yrs of age
- <36wks gestation
- Occurs in ~20% w/ severe preeclampsia
