Pregnancy Induced Hypertension Flashcards
ESC: Incidence of PIH
5-10%
Maternal Risk factors
Placenta abruption
Stroke
Multi organ failure
DIC
Risk factors to the fetus
IUGR 25%
Prematurity 27%
IUFD 4%
Diagnosis: using blood pressure?
EBP > 140/90 or 160/110 severe
On 2 occasions >15min apart
ambulatory vs routine BP measurement
ambulatory BP monitoring is superior to routine BP measurement for the prediction of pregnancy outcome
Diagnosis: lab tests
Urinalysis Blood count Hematocrit Serum creatinine Serum Uric acid
Diagnosis: urinalysis
Proteinuria
• > 1+ distick
• 24hr urine >30mg/mmol
• Albumin creat ratio >30mg/mmol >0.3
Diagnosis: ultrasound
Adrenals
Diagnosis: plasma
Metanephrine exclude pheochromocytoma
Diagnosis: Doppler
Uterine arteries @ 20 weeks
Diagnosis: markers
sFlt:PIGF (placentalgrowth factor) > 38
Definition of HPT
BP [systolicBP(SBP)>_140mmHg and/or DBP >_90mmHg]
mildly (140–159/ 90–109mmHg)or
severely (>_160/110mmHg) elevated BP
Classification of HPT in pregnancy
Preexisting HPT Gestational Pre-eclampsia Preexisting HPT + superimposed gestational HPT with proteinuria Antenatally unclassifiable HPT
Definition: pre-existing HPT
precedes pregnancy or develops before 20 weeks of gestation. It usually persists formore than 42days post-partum and maybe associated with proteinuria.
Definition: Gestational HPT
develops after 20weeks of gestation and usually resolves within 42 dayspost-partum.
Definition: Pre-eclampsia
gestational hypertension with significant proteinuria(>0.3g/24hor ACR >_30mg/mmol).
● It occurs more frequently during the first pregnancy,
• in multiple pregnancy,
• in hydatidi form mole,
• in antiphospholipid syndrome,or with
• preexisting hypertension,
• renal disease,
• diabetes. It is often associated with foetal growth restriction due toplacental insufficiency and is a common cause of prematurity.The only cure is delivery. As proteinuria maybe a late manifestation of preeclampsia,it should be suspected when denovo hypertension is accompanied by headache,visual disturbances, abdominal pain, or abnormal laboratory tests, specifically low platelets and/or abnormal liver function.
Definition: Antenatally unclassifiable hypertension
this term is used when BP is first recorded after 20weeks of gestation and hypertension is diagnosed; re-assessment i s necessary after 42days post-partum.
Prevention/ prophylaxis for PIH
Aspirin 100-150mg/d from 12 weeks to 36/37
Calcium 1,5- 2g/day
Which patients are at High risk of Pre-eclampsia?
- hypertensive disease during a previous pregnancy
- chronic kidney disease
- autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome
- type1or type 2 diabetes
- chronic hypertension.
Moderate Risk of pre-eclampsia
- first pregnancy
- age 40 years or older
- pregnancy interval of more than 10 years
- BMI of >_35kg/m2 at first visit
- family history of pre-eclampsia
- multiple pregnancy.
Can Vit C & E be used for Pre-eclampsia prevention/prophylaxis?
Both do not decrease pre-eclampsia risk;on the contrary, they are more frequently associated with a birth weight <2.5kg and adverse perinatal outcomes.
Management of PIH: what non pharmacological interventions can be advised?
Regular exercise might be continued with caution and obese women (>_30kg/m2)are advised to avoid a weight gain of more than 6.8kg.
with randomized studies of dietary and lifestyle interventions showing minimal effects on pregnancy outcome.
Pharmacological management : what level of HPT is an indications for admission?
SBP>_170mmHg or DBP>_110mmHg in a pregnant woman an emergency,and hospitalization is indicated
Pharmacological management: severe HPT drugs
Labetalol Oral methylphenidate Nifedipine IV hydralazin Sodium nitroprusside last resort
