hypertension in pregnancy
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HYPERTENSION IN
PREGNANCY
Nahar TaufiqBagian Kardiologi dan Kedokteran Vaskular FKUGM
SMF Jantung/ Pusat Jantung Terpadu RSUP DR SardjitoJogjakarta
Hypertension in Pregnancy: Major cause of maternal and perinatal
morbidity and mortality Complicates up to 10% of pregnancies Second leading cause of maternal mortality
in the developed world (after VTE) ~1/3 of all maternal deaths are from HTN’sive
disorders
Introduction
Physiologic adaptations in normal pregnancy
Blood changes: o ↑ Plasma volume by ≈ 40%.o Platelets count can ↓ below 200 X 109/L due to
normal maternal blood-volume expansion.o ↑ Coagulation factors (Fibrinogen, Factor VII).
Cardiovascular changes:o Marked generalized vasodilation (↓ peripheral
resistance) a/w arterial resistance to constrictor actions of
Angiotensin II.o ↑ CO & Stroke volume.o MAP ↓ by 10 mm Hg.
Renal changes:o Vasodilation ↑ Renal blood flow ↑ GFR
(by 50%).o ↑ in Creatinine clearance with a
concomitant ↓ in S-Creatinine & urea.o ↑ Uric acid clearance & Ca+ excretion.o ↑ Glucosuria + aminoaciduria.
Respiratory changes. Endocrine changes:
o e.g. parathyroid, adrenal, weight, GI changes.
Physiologic adaptations in normal pregnancy
In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy:
Chronic hypertension Gestational hypertension Preeclampsia Preeclampsia superimposed on
chronic hypertension
Severe complicationsHypertension in Pregnancy
MATERNAL
CVA DIC End-organ failure Placental
abruption
FETAL
IUGR, Intra Uterine Growth Restriction
Prematurity Intra-uterine
death
Drugs
A)Parentral drugs: 1) Hydralazine:
It is a peripheral VD. The best Antihypertensive drug used
during Pre-eclampsia and Eclampsia. Dose: 5-10mg IV or IM as initial dose. Repeated every 20-30 minutes until
blood pressure is controlled.
2) Labetalol : α and non selective β- adrenergic blocker
resulting in VD. Dose: 10-20mg IV . The dose can be doubled every 10 minutes
if proper response is not achieved. 3) Diaz oxide :
Used in severe dangerous resistant hypertension as a last resort.
Dose: 50-150mg IV bolus dose. Repeated every 1-2 minutes until BP
decreases.
Drugs
A )Oral drugs:1) α-methyl DOPA :
It is the most commonly used. It is α-adrenergic agonist causing
depletion of catecholamine stores. Dose: 500mg 3-4 times/day orally.
2) Monohydralazine : It is a weak Antihypertensive when
given alone. It used in combination with β-
blockers to increase its efficacy and decrease its side effects.
Drugs
3) β- adrenergic blockers: Atenolol (tenormin) 50-100mg 4 times
daily. Labetalol (Trandate) 10-20mg 3 times
daily. 4) Prazocin :
It is postsynaptic α-adrenergic receptor blocker resulting in VD and reflex tachycardia.
It is a weak Antihypertensive drug so used in combination with other drugs.
5) Calcium Channel Blocker: Nifedipine .
Drugs
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