Seyed Morteza Mahmoodi

Gestational Hypertension

Pre eclampsia and Eclampsia

Chronic Hypertension

Contents

Complications

Gestational Hypertension

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

Gestational Hypertension

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

Hypertension Pregnancy-induced hypertension Gestational hypertension Transient hypertension of pregnancy Chronic hypertension Pre-eclampsia Eclampsia Increment of 30 mm Hg systolic or 15 mm Hg

diastolic blood pressure (Levine, 2000; North and colleagues, 1999)

Abnormality Nonsevere Severe

Diastolic blood pressure <110 mm Hg 110 mm Hg

Systolic blood pressure <160 mm Hg 160 mm Hg

Proteinuria 2+ 3+

Headache Absent Present

Visual disturbances Absent Present

Upper abdominal pain Absent Present

Oliguria Absent Present

Convulsion (eclampsia) Absent Present

Serum creatinine Normal Elevated

Thrombocytopenia Absent Present

Serum transaminase elevation Minimal Marked

Fetal-growth restriction Absent Obvious

Pulmonary edema Absent Present

-Defective trophoblastic invasion-Immunological maladaptive tolerance-Maternal maladaptation to CV changes in normal

pregnancy-Abnormal placentation.-Genetic and nutritional factors

Residual HTRecurrent pre-eclampsiaChronic renal disease

Injuries Pulmonary:-Edema-pneumonia, aspiration-ARDS-Embolism Hyperpyrexia LVF RF

Hepatic necrosis Subcapsular haematoma Cerebral hemorrhage Disturbed vision Haematological, DICPostpartum-Shock-Sepsis-Psychosis

Insidious, slow course. Mild symptoms:Mild symptoms:-Ankle edema-Extend to be generalized Alarming symptoms:Alarming symptoms: Acute onset-Headache-Disturbed sleep-Oliguria-Epigastric pain-Eye symptoms, restlessness.

Raised BP Abnormal weight gain, Oedema. Pulmonary oedema Retinal, Neurological examination, Abdominal examination, Secondary and end organ damage,

EpilepsyEpilepsy HysteriaHysteria EncephalitisEncephalitis MeningitisMeningitis Puerperal cerebral thrombosis.Puerperal cerebral thrombosis. PoisoningPoisoning Cerebral malariaCerebral malaria Intra-crainal tumours.Intra-crainal tumours.

Blood values: CBC, serum sodium, potassium, creatinine, and glucose levels, LFT, coagulation profile creatinine.

Urine Serum uric acid, biochemical marker of pre-biochemical marker of pre-

eclampsiaeclampsia. Serum lipids Radiological ECG, EEG Fetal monitoring

More than 100 clinical, biophysical, and biochemical tests have been reported to predict preeclampsia

Low-Salt Diet Fish Oil Supplementation Antioxidants CALCIUM SUPPLEMENTATION ASPIRIN There is currently no proven way to prevent

preeclampsia

Mild preeclapsia:Mild preeclapsia:-Maternal evaluation (history & ex.)-Lab:CBC & ElectrolyteRFT: BUN, creatinine ,uric acidLFT & coagulation profile: PT, PTT, D-diamersUrine analysis24hhr urine for protein & creatinine clearance.

Fetal evaluation of CTG, USG, doppler flow. Bed rest in left lateral decubitus position. No use of diuretics & AntiHT

Stabilize & deliverStabilize & deliver, the only cure . Vaginal induction is preferred. Admit & complete maternal evaluation. -Keep NPO -Start IV, cross & type -Foley catheter Monitoring urine output, input & vitals.

Fetal evaluation: electronic fetal monitoring, doppler flow.

Anticonvulsant therapy:-to seizure thresholdto seizure threshold-baseline Mg bld level-Mg sulfateMg sulfate 4g IV boluse over 20min,. Folowed by

maintenance of 2-4g/hr

Oliguric pt needs low infusion rate.Oliguric pt needs low infusion rate.

Management of severe preeclampsia:

Signs of Mg sulfate toxicity:-DTR-RR<10/min-Urine output< 25 cc/hr-Decrease muscle tone-CNS or cardiac depression

Antagonist: calcium gluconatecalcium gluconate 10% 10ml, 1g IV over 2min.

Antihypertensive therapy:-Indicated if BP >140-160/90-110-Labetalol 20-50mg IV q 10mins.-Methyldopa or nifedipine.

ACE-inhibitors avoided.ACE-inhibitors avoided.

Resuscitation, ABCABC Oxygen Arrest convulsions, valium or phenytoin. Ventilatory support, prevent aspiration, auscultate

lungs after every seizure. Haemodynamic stabilization, control BP. Send investigation. Deliver by 6-8hrs. Postpartum care, intensive.

Mgsulfate,Mgsulfate, continue to 24hr after last fit.

Lytic coktail regime:Lytic coktail regime:Chlorpromazine, phenergan & pethidine. AntiHT & diuretics.

Status eclampticus:Status eclampticus: thiopentone Na0.5gm, dissolved in 20% dextrose givin slowly.