Hypertension – sustained systolic BP > 140mmHg or diastolic BP> 90mmHg
Chronic Hypertension – hypertension which predates pregnancy or is diagnosed before 20wks gestation
PIH – hypertension diagnosed after 20 weeks gestation in a patient without a history of chronic hypertension and is defined as a systolic BP greater than 140mmHg or diastolic BP greater than 90mmHg OR alternatively, as a consistent ↑in systolic or diastolic BP by 30mmHg and 15mmHg, respectively above the Pt,s normal base line.
Pre-eclampsia – PIH in association with renal involvement causing proteinuria (>300mg/24h or 2+ on dipstick
HELLP syndrome is a serious complication of severe pregnancy-induced hypertension (high blood pressure problems of pregnancy). It occurs in about 2 percent to 12 percent of women with high blood pressure of pregnancy. It usually develops before delivery, but may occur postpartum (after delivery) as well. HELLP syndrome consists of the following problems:
h emolysis - red blood cells break down.
e levated l iver enzymes - damage to liver cells cause changes in liver function lab tests.
l ow p latelets - cells found in the blood that are needed to help the blood to clot in order to control bleeding.
A positive rollover test result is defined as an increase in diastolic BP of 20mmHg or more when measured 5 minutes after a gravida is “rolled” from the lateral to the supine position b/w 28-32 weeks gestation.
93% of primigravid women with a positive rollover test result later had gestational hypertension and 91% of women who had a negative test result did not have hypertension during that pregnancy.
However the value of this test as a clinical screening tool is debatable because in some studies the false positive rate is high.
Nifedipine(10 mg) orally or sublingually ( tocolytic action)
Avoid ACE inhibitors – associated with oligohydramnios, still birth, neonatal renal failure
Nitroglycerine (50-100 ug iv or sublingually in a 400 ug metered spray)
Nitroprusside( cyanide toxicity more likely if infusion rate exceed 4 ug/kg/min over several hours to days)
Diuretics - NO PLACE [unless heart failure] SINCE PREECLAMPSIA IS ASSOCIATED WITH HYPOVOLAEMIA
Invasive arterial, central venous and pulmonary artery catheter is indicated in pts with severe hypertension, pulmonary edema, persistent oliguria and difficulty in fluid management therapy in ante partum and postpartum period.
Use controversial – risk of profound maternal hypotension and uteroplacental hypoperfusion but a recent study noted that the risk of hypotension was almost six times less in severely preeclamptic woman than in healthy pregnant woman receiving spinal anesthesia for elective CS.
Theoretical advantage of epidural weighed against known benefits of spinal ie. greater reliability, less procedural time, less epidural vascular trauma