Management of hypertensive disorders in pregnancy
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An evidence based approach to the management of hypertensive disorders in pregnancy. Based on the NICE guidelines (August 2010) NICE Guideline 107

An evidence based approach to the management of hypertensive disorders in pregnancy. Based on the NICE guidelines (August 2010) NICE Guideline 107

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Management of hypertensive disorders in pregnancy Presentation Transcript

  • 1. MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY - An evidence based approach Dr. Mohammed Sadiq Azam M.D. (Int Med) Senior Resident, Department of Medicine, Osmania General Hospital Physician, Princess Esra Hospital
  • 2. What are we dealing with?
  • 3. Is it Gestational HTN.. Or Chronic HTN?
  • 4. Routine investigations
  • 5. Proteinuria – How to assess??
  • 6. Prevention strategy – Do s
  • 7. and Don’t s… NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN THIS REGARD
  • 8. CHRONIC HYPERTENSION
  • 9. PRE PREGNANCY ADVICE
  • 10. Once upon a time called PIH, now known as... GESTATIONAL HYPERTENSION
  • 11. Decide on Timing of birth
  • 12. Mild Hypertension Moderate Hypertension Severe Hypertension
  • 13. PRE ECCLAMPSIA
  • 14. Pre ecclampsia – Who are at risk?
  • 15. Signs of Severe Pre-ecclampsia
  • 16. Decide on Timing of birth
  • 17. Severe Hypertension not requiring referral to a level 2 setup Mild Hypertension Moderate Hypertension
  • 18. ECCLAMPSIA
  • 19. Antihypertensives – WHAT NOT TO USE
  • 20. Antihypertensives used - Pharmacology
  • 21. Antihypertensives used – Beta Blockers
  • 22. Antihypertensives used - Pharmacology
  • 23. Antihypertensives used – Methyldopa
  • 24. Antihypertensives used - Pharmacology
  • 25. Antihypertensives used - Nifedipine
  • 26. Antihypertensives used - Pharmacology
  • 27. Antihypertensives used - Hydralazine
  • 28. Antihypertensives used - Thiazides
  • 29. Methyldopa vs Labetolol – The King vs the Challenger?
  • 30. “Can I feed the baby while on my antihypertensive meds?”
  • 31. Lifestyle advice
  • 32. What next?
  • 33. Conclusions • Hypertensive disorders complicating pregnancy are one of the major causes of maternal and foetal mortality and morbidity. • Early diagnosis and management can help in circumventing many of the complications of the same. • Both labetolol and methydopa have been recommended as firstline drugs in various studies. Final use depends on a careful assessment of risk benefit ratio and clinician judgement. • Nifidipine sustained release should be used as a second line drug and SUBLINGUAL NIFIDIPINE should NEVER be used.
  • 34. Conclusions • Watch for and screen for pre-ecclampsia in high risk individuals at regular intervals. • Test of choice for proteinuria is an automated reagent strip reading device or urinary spot protein:creatinine ratio. • Aspirin is the ONLY PROVEN method of primary prevention of hypertensive disorders in high risk individuals. • Patient counselling and education regarding nature of illness and informed consent prior to initiating treatment is mandatory. • With early detection and appropriate management, the journey with hypertension can be made a smooth one for both mother and child.
  • 35. Download the presentation online at: www.drmdsadiq.in Any questions?? THANK YOU