HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION

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HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION. Sarreshtedar.A.MD.AFSA. Hypertension complications in pregnant women (10%) Maternal mortality & morbidity. Abruptio placenta Pulmonary edema Respiratory failure Cerebral hemorrhage Hepatic failure Acute renal failure. - PowerPoint PPT Presentation

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  • HYPERTENSION DURING PREGNANCYGestational HYPERTENSIONSarreshtedar.A.MD.AFSA

  • Hypertension complications in pregnant women(10%) Maternal mortality & morbidity. Abruptio placenta Pulmonary edema Respiratory failureCerebral hemorrhage Hepatic failure Acute renal failure.DIC

  • Hypertension complication In pregnancy (BABY) Fetal prematurely Intrauterine growth retardation Stillbirth Neonatal death

  • PREGNANCY:HYPERTENSION DISORDERS

    Chronic hypertensionGestational hypertensionPreecampsia-Eclampsia

  • Chronic HypertensionDEFINED:Precedes pregnancyBefore 20th gestational weekFails to normal 12 week after delivery.

  • Chronic hypertension 1%-5% of pregnancies 15% with increased complications Most complications occur in those more than 30y/o

  • Chronic Hypertension Complications in PREGNANCY:(15%)Fetal growth retardationPremature deliveryAbruptio-placentaAcute renal failureHypertension crisis

  • Most of these complications occur:In patients older than 30 y/oLonger duration of hypertensionSuperimposed preeclampsia.

  • 25% of pregnancies (most) associated with chronic hypertension occurs in the setting of superimposed preeclampsia

  • CHRONIC HYPERTENSION & PREGNANCY:LOW-RISK patients:SBP=140-160 mmHgDBP=90-110 mmHgNormal physical examinationNormal EKGNo proteinuria.

  • CHRONIC HYPERTENSION & PREGNANCY:HIGH- RISK patients:SBP=more than 160 mmHgDBP=more than 110 mmHgSigns of preeclampsia.Signs of end organ InvolvementRenal insufficiencyDiabetes mellitusCollagen vascular disease.

  • CHRONIC HYPERTENSION:Incidence of prenatal mortality is high.Fetal growth-Retardation is high.

  • Definition:Rise in pressure of 30/15 mmHg. OrGreater than 140/90 mmHg.

    GESTETIONAL HYPERTENSION :

  • GESTATIONAL HYPERTENSION:

    Induced by pregnancyBeginning after 20 weeksResolving by the sixth postpartum week.

  • GESTATIONAL HYPERTENSION:Transient hypertension.Preeclampsia.

  • GESTATIONAL HYPERTENSION(TRANSIENT)

    Without proteinuria.In the late third trimester.Return to normal by 10th post partum day.

  • GESTATIONAL HYPERTENSION:(PREECLAMPSIA)With proteinuriaEdemaSBP greater than 160 mmHgDBP greater than 110 mmHg

  • Gestational hypertension isSelf-limited and less commonly in next pregnancies.BUT Chronic hypertension progresses and complicates in subsequent pregnancies.

  • Difference Between Preeclampsia And Chronic Hypertension :

  • PREECLAMPSIA-ECLAMPSIA:Definition: BP more than 140/90 mmHgAfter 20 weeks

    EdemaProteinuriaconvulsion

  • Hypertension appears in 12% of first pregnancies after 20 weeks

  • 50% of these 12% will progress to preeclampsia.

  • PREECLAMPSIA-ECLAMPSIA:Pregnancy specific syndromeProteinuria more than 300 mg/24hRegresses within 24h 48hAfter delivery

  • PREECLAMPSIA-ECLAMPSIAPRESENTATION:Blurred visionPulmonary edemaAbdominal painAbnormal laboratory tests :liver enzymes low platelet

  • Mechanism unknownButHypothesis are: Profound vasoconstriction High cardiac output.

  • Decreased Prostaglandin SynthesisVascular prostacyclin uterine PGE 2 platelet aggregation angiotension sensitivityFibrin deposition in glomerulivasoconstriction uteroplacental blood flow uterine reninPROTEINURIAGFRSodium retentionEDEMAHYPERTENSION

  • POST PARTUM ECLAMPSIAUsually occurs within 10 days after delivery with:HypertensionProteinuriaConvulsion

  • MANAGEMENTPrimary goal:Prevent maternal cerebral complicationsSecondary goal :Reduction of :SBP below 126mmHgDBS between 90-100mmHg

  • NOTICE:Gestation hypertension is self- limited Delivery is the only definitive treatment for preeclampsia

  • MANAGEMENTINDICATION FOR Drugs:

    SBP more than 150 mmHgDBS more than 100 mmHgTarget organ damageLV hypertrophyRenal insufficiency

  • DRUG SELECTION:For acute treatment of sever hypertensionFor long term treatment of hypertension

  • Drugs for Acute treatment of Sever Hypertension:

  • METHOD OF TREATMENT IN SEVER HYPERTENSION:

    1:Hydralazin: (Initial Drug)

    5 mg bolus iv over 2 minutesAfter 20 minutes repeatAnd repeated as necessary

  • 2: Labetalol: (second drug)

    If hydralazin not effective orMaternal side effects:Tachycardia Headachenausea

  • Labetalol using :

    20 mg iv After 10 minutes 40 mg ivAfter 3 doses 80 mg in interval of 10-20 minutesAfter 1-2 mg/min in continuous infusion

  • Drugs for long-term treatment of hypertension:

  • NOTICE:PREFERRED THERAPY:METHYL-DOPAACE inhibitors and angiotensin II receptor blockers are:Contraindication because induce neonatal renal failure.

  • Clinical features :

    Chronic hypertension Gestational hypertension Preeclampsia - Eclampsia

  • RISKHIGH: 160/110

    LOW: SBS=140-160 DBS=90-110 NORMAL EKG NORMAL ECHO/ NO PROTEINURIA

  • Gestational hypertension DEFINED:Induced by pregnancyBeginning after 20 weeksResolving by the sixth postpartum week

  • Gestational hypertension Divided by:

    Hypertension without proteinuria (transient )Hypertension with proteinuria

  • CHRACTRISTICS OF PREECLAMPSIA-ECLAMPSIA

    BP more than 160/90 mmHgHeadache Blurred visionPulmonary edemaAbdominal pain Low plateletsAbnormal liver testsUsually regresses within 24-48 hr after delivery.

  • Treatment:

    Primary goal is to prevent maternal complications.Recommended goal of therapy is reduction of mean SBP below 126 mmHg & DBP between 90-105 mmHg