pregnancy induced hypertension

Question 1

Definition

Answer 1

Pregnancy induced hypertension or gestational hypertension is multsyste,
disorder occuring in a pregnant woman with gestational age > 20 weeks and
characterised by hypertension.

Question 2

Classification

Answer 2

i) preeclampsia - Mild PE
- Severe PE

ii) Eclampsia

iii) Chronic hypertension- HT present by conception of before 20 weeks of
pregnancy without mala pregnancy and which
persists for 6 months post partum.

iv) Chronic hypertension with super-imposed PE – PE developing in women
with chronic hypertension.

v) Transient hypertrension – development of hypertension after 20 weeks
gestation or in the first 24hrs post partum
without any other signs of PE.

vi) HELLP Syndrome

Question 3

risk factors

Answer 3

i) Nulliparity – most common (first pregnancy)
ii) Age extremes > 35 yrs or <20 yrs 🡪 underdeveloped CNS exposure to
aggression and hormonal disbalance
iii) Multiple gestations
iv) Hydatiform mole
v) DM, Obesity
vi) Chronic Hypertension
vii) Preexisting renal disease
viii) Nonimmune fetal hydrops and polyhydroamnios
ix) Family history of PE
x) Severe RH sensitization, antiphospholipid syndrome
xi) Black race
xii) Low socioeconomic status
xiii) Genital infertilism

Question 4

Etiopathogenesis

Answer 4

The exact cause is unknown however,

i) hyper reaction of mother to fetal antigens resulting in immune complex
deposition on endothelium and its damage and generalized vasospasm.

ii) Immunologic disturbances causes abnormal placental implantation with
incomplete invasion of trophoblasts into maternal spinal artery. Therefore,
abnormal perfusion 🡪 stimulate production of endothelium damaging
disturbances.

iii) Disbalance between platelet derived thromboxane (vasoconstrictor) and
endothelium derived prostocyclin (dilator).

iv) Alteration sin levels of endothelial derived relaxing factor endothelin I or
NO.

v) Disblance in lipid metabolism (dyslipidemia) 🡪 abnormal antioxidant
mechanisms and increase thromboxane production.

vi) Increased circulatory volume in blood causes activation of renin
angiotensin system and increased renin production 🡪 peripheral vasospasm
🡪 ↓ perfusion.

Question 5

prevention

Answer 5

A) To prevent PE:
i) Intake of low dose Aspirin (50-150mg/day). This inhibits thrombocytic
cyclogenase. Therefore, ↓ production of thromboxane A2 and has antiaggregant
activity so it prevents thrombi formation.
ii) Ca2+ supplementation 🡪↓ maternal blood pressure.
iii) Fish oil intake.

B) For Chronic Hypertension – maintenance of stable blood pressure at diastolic <90- 100mm Hg and ↓ salt intake 🡪 ↑ exercise

C) In preexisting renal Hypertension 🡪 Anti inflammatory drugs. Usage of special herbs for kidney function.

D) Electrosleep by using sedative drugs.