HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION
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DESCRIPTIONHYPERTENSION 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
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
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 :
Induced by pregnancyBeginning after 20 weeksResolving by the sixth postpartum week.
GESTATIONAL HYPERTENSION:Transient hypertension.Preeclampsia.
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
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
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.
Primary goal is to prevent maternal complications.Recommended goal of therapy is reduction of mean SBP below 126 mmHg & DBP between 90-105 mmHg