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

Definitions related hypertensive disorders in 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

Differentiating Hypertensive

in pregnant

Assesment of proteinuria

Reducing the risk hypertensive disorders in pregnancy

Moderate to high Risk Preeclamsia

Pre-eclampsia

Pre-eclampsia

Pre-eclampsia

Pre-eclampsia

Chronic hypertension

X

Chronic hypertension

Chronic hypertension

Chronic hypertension

Gestasional Hypertension

Gestasional Hypertension

Gestasional Hypertension

Gestasional Hypertension

Gestasional Hypertension

Gestasional Hypertension

Severe Hypertension,severe pre-eclamsia and eclamsia

Severe Hypertension,severe pre-eclamsia and eclamsia

Severe Hypertension,severe pre-eclamsia and eclamsia

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

Selamat kepada adik adik angk 180

Dr. Djumikan / PD III, Prof DR Koento Wibisono Rektor UNSProf dr Soetjipto Dekan FK UNS, Dr Sujarsono PD I,

Dr Muhardjo PD II