Hypertensive Disorder in pregnancy _ ساجده الربيعي Flashcards
what’re the hypertensive disorders in pregnancy ?
1- chronic hypertension 2- Gestationl hypertension 3- preeclampsia 4- eclampsia 5- Heelp syndrom
whats the chronic hypertension ?
increase in the blood pressure about (140/90)
Before 20 week of gestation
or it persistent hypertension 12 week after the delivery
what’s the gestational hypertension ?
when the blood pressure increase (more or equal 140/90) after 20 week without proteinuria and the BP will return to normal after 12 weeks of delivery
pt with Gestational hypertension can develop preeclampsia ?
yes , half of pt with gestational HT develop preclampsia
what’s the superimposed preeclampsia ?
when the pt have chronic HT and develop preeclampsia
(preeclampsia means have high BP with proteinuria after 20 weeks )
BP is 140/80 which is mild or 160/100 is sever before 20 week
Proteinuria more or equal 300mg/24 h after 20 week
+ with some decrease amount in the pallet because of the destruction less than 100,000/cmm
what’s the definition of the preeclampsia ?
(high BP(140/90) with proteinuria (>=300) after 20 week with or without edema )
but everything should return to normal after 12 week of delivery
what’s the eclampsia ?
preeclampsia signs
(high BP + proteinuria after 20 weeks )with coma and seizure during the pregnancy or postpartum
but the pt shouldn’t have any previous neurological disorders
what’re the risk factor of the preeclampsia ?
maternal cause -------------------------- 1- happen in nulliparity 2- advance age 3- obesity BMI >35 double the risk 4-hypertension 5-diabetes 6-thrombovascular disease
7- previous history of the preeclampsia
8- family history of preeclampsia
9- history of placental abroption ,IUGR, fetal death
10- non hispanic black raceالعرق الاسود غير اللاتيني
11- father may be cause of this by limit exposure of the paternal sperm
12- when the HCG is high in molar pregnancy and twins
13- smoking prevent from the preeclampsia
what’s the theory for the preeclampsia ?
its unknown mechanism
normal there will be trophoblast invasion that lead to vasodilation more nutrient to the baby
but if failure of the trophoblast invasion and lead to release of inflammatory mediatory by
decrease the PGI2 and increase the TXA2 which lead to vasoconstriction ,platelet aggregation , increase the vasopressor response(is a physiological nervous system response to increased intracranial pressure (ICP) ) & increase the uterine activity
1- abonormal placentation
2- inflammatory mediators as high TXA2 and low PGI2
3-Genetic
from family history by mutation in the complement
regulatory protein gene
4- Immunological
-as exposure of sperm from different partner
but when expose to paternal antigen in sperm of same gene is protective
- active antibody to Angiotensin receptor 1(AAAT1)
which activates AT1 receptors increase the sensivity to angiotensin and lead to hypertension
What the risks of the preeclampsia ?
Maternal risks -------------------------- 1- CNS problem as seizures and stroke 2-renal failure 3- hepatic failure or rupture 4-DIC (Disseminated intravascular coagulation) 5- CS 6- death
Fetal risks ------------------ 1- prematurity 2- IUGR 3- oligohydraminos 4-placental infract 5-placental abroption 3- uretroplacental insufficiency 4- prenatal death
whats happen to the blood picture to pt with preeclampsia ?
because the inflammatory mediators lead to vascular damage this lead to fibrosis so the blood component will destruct so the pt will have
- high hematocrit (but if pt with anemia have normal hematocrit )
- decrease the WBC thrombocytopenia
- low platelet count (numbers correlate to the severity and abruption of the placenta )
-DIC due to the activation of the coagulation
or because over consumption of the coagulant lead to spuntaous heamorrge
what’s happen to the liver in the preeclampsia ?
1- hellps syndrom ( is a complication of pregnancy characterized by hemolysis, elevated liver enzymes, and a low platelet count.)
2- periportal heamorrhge
3- sub capsular bleeding
4- hepatic rupture __32% lead to mortality
what’s happen to the kidney in preeclampsia ?
decrease the GFR lead to -oliguria - renal failure - uric acid and creatinine will elevated in the serum will the albumen will decrease
- proteinuria
what’s the effect of the preeclampsia on the uteroplacental circulation ?
- lead to uteroplacental insufficient
-fetal complication as
1- hypoxia
2- IUGR
3-prematurity
4- placental abruption
what’s the symptoms and the signs of the preeclampsia ?
preeclampsia is sign disease
- high PB
- proteinuria (kidney)
- edema of the face and hands
- headache (CNS vascular damage Become leaky and lead to brain edema )
- Exaggurated reflexes (CNS)
- blurred vision
- epigastric pain (liver )
what’re the preventive measures of the preeclampsia ?
1- Regular Antenatal checkups
- see the weight if rapid gain
- check PB
- check for edema
- liver na renal function test for proteinuria
2- Give the pt some of supplement as
- low dose of acorn in high risk group to increase the prostaglandin and decrease the TXA2
- calcium supplement
- Vit C & A as antioxidant
- zinc , mg , fish oil , low slat diet
how to manage pt with gestational HTN at term ?
- normal term is 40 weeks
- delivery of the pt if pt in term
- if the cervix is unfavorable and maternal disease is mild so close observation
how to mange pt with gestational HTN and she is not in term ?
- we should make sure if pt don’t have any sever disease
- lab tests for the mother
- antenatal fetal surveillance
- then do conservative TRT
- visit become twice a week
- outpatient versus inpatient
Outpatient care is defined as hospital or medical facility care that you receive without being admitted or for a stay of less than 24 hours
Inpatient care refers to medical treatment that is provided in a hospital or other facility and requires at least one overnight stay. … For the purposes of healthcare coverage, health insurance plans require you to be formally admitted to a hospital for a stay for a service to be considered inpatient.
what’r the indication of serger of pt with gestational HTN ?
1- the PB become worse
2- develop sever Pregnancy-Induced HypertensionPIH
3-if the fetal condition is not good
4- if the lung of fetus is mature
5- favorable cervix mean the cervix is dilated
give oxytocin
6- unfavorable and less than 32 week so CS
when we do CS section or vaginal delivery in gestational HTN ?
- If favorable cervix mean the cervix is dilated
we give oxytocin and PG for cervix dilation
-if unfavorable cervix mean the cervix isn’t dilated so we do CS especially if the gestational age is les than 32 weeks
is the prostaglandin contradicted ?
NO
what’s the management of the preeclampsia ?
@ our goal or objective is to terminate the pregnancy with least danger to the mother or the fetus
1- we do first maternal investigation for
- the hemoglobin and the hematocrit
- platelet count which less100,000
- liver function test
- kidney function test raised urea and creatinine which normally decrease
- urine test : proteinuria
2- then we do the management
or admitting the pt to the hospital especially
a) pt who develop high BP more or equal to 140/90
b) develop proteinuric with high BP
c) if the BP become more worse
- then we stabilize the pt condition by
a- anticonvulsant
b- antihypertensive
c- terminate the pregnancy
what’re the anticovalsent thereby ?
Magnisum sulfate is commonly used
we give it with the onset of labor until 24h postpartum
and if CS will give her 2hr before the surgery until 12h postpartum
whats the side effect of anticovalsent thereby ?
MgSO4 lead to maternal side effect -------------------------------------------- 1- flushing 2- headache 3-muscle weakness 4-pulmanary edema 5- respiratory depression 6- decrease the patellar reflex 7- cardiac arrest
fetal side effect ---------------------------- 1- lethargy 2- hypotonia 3-respiratory depression
