brief ppt during housejob at Lyari General Hospital Karachi

1. By: Dr.ARSHAD ALI
H.O of CARDIOLOGY Ward
SMBBMC & LGH.

2.  “Pregnancy-Induced Hypertension (PIH) is the
development of new hypertension in
a pregnant woman after 20 weeks gestation without
the presence of protein in the urine or other signs of
preeclampsia”.
 Hypertension is defined as having a blood pressure
greater than 140/90 mm Hg.
 Most common medical complication of pregnancy.

3.  Chronic hypertension
 Gestational hypertension
 Preeclampsia
 Eclampsia
 Preeclampsia superimposed on chronic hypertension

6. “Chronic hypertension is HTN diagnosed prior to 20th
gestational week or presence of HTN preconception or
denovo HTN in late gestation that fails to resolve
postpartum”
 CAUSES:
 Primary = “Essential Hypertension”
 Secondary = Result of other medical conditions i.e
renal diseases etc

7.  COMPLICATIONS:
 Severe HTN (HTN crises, risk of stroke)
 IUGR
 Abruptio placenta, (premature seperation of placenta
from uterus)

8.  HIGH RISK FACTORS INDICATING POOR OUT
 COME:
 Diastolic BP 85 or greater in repeated observations 6
hrs apart after 14 wks of Gestation.
 H/O severe HTN in previous preganncies.
 H/O abruption
 H/O stillbirth or unexplained neonatal death.
 H/O IUGR
 Age > 35 yrs or chronic HTN of >15 yrs duration.
 Marked obesity
 Secondary HTN

9.  PRENATAL CARE FOR CHRONIC HYPERTENSIVES:
 ECG should be obtained in women with long-standing
HTN.
 Baseline laboratory tests:
• Urinalysis, urine culture, serum creatinine, glucose &
electrolytes.
• Tests will rule out renal diz & identify co-morbidities such
as DM.
• Women with proteinuria on a urine dipstick should have a
quantitative test for urine protein.
“Antenatal visits every 2 weekly until 32 wks & then
every weekly”.

10.  TREATMENT FOR CHRONIC HYPERTENSION:
 Avoid Rx in women with uncomplicated mild esential HTN
as BP may decrease as pregrancy progresses.
 Resinstitute or initial therapy for persistent diastolic
pressures >95 mmHg, systolic pressures >150 mmHg, signs
of HTNive end-organ-damage.
 Methyloda , labetalol & nifedine MC oral agents.
 Avoids: ACEI & ARBs, atenolol, thiazide diuretics.
 Women in active labor with uncontrolled severe chr onic
HTN require Rx with I/V labetalol or hydralazine.

11.  Prevalance 6 to 15% in nulliparas and 2 to 4% in
multiparas.
 Gestational HTN is defined as:
“HTN detected for the first time after 20 wks pregnancy.
The definition is changed to ‘transient’ when pressure
normalizes postpartum”.
 Absence of proteinuria
 Returning to normal within 12 wks aftr delivery.

13.  Criteria to identify high risk women with
gestational HTN:
1. BP > 150/100 mmHg
2. Gestation < 30 wks
3. Evidence of end-organ damage
4. Oligohydraminos
5. Fetal growth restriction
6. Nullipara, Age >35 yrs, BMI > 35 kg/m2.

14. Depends on severity of HTN & gestational age:
 Observational Management:
 Restricted activity
 Close maternal & fetal monitoring
• BP monitoring
• Signs & symptoms of preeclampsia
• Fetal growth & well being (U/S).
Routine weekly or biweekly blood work=Platelets ,
LFTs, creatinine.

15.  Medical Management:
 Acute Therapy = IV Labetalol, IV Hydralazine.
 Expected Therapy = Oral Labetalol, Methyldopa,
Nifedipine.
 Eclampsia prevention = MgSO4
 Contraindicated Anti-hypertensive Drugs:
 ACE inhibitors
 Angiotensin receptor antagonists

16. “A condition in pregnancy characterized by high blood
presure,sometimes with fluid retention & proteinuria”.
 Treatment:
Medications used to Rx Pre-eclampsia:
 MgSO4
 Labetalol
 Hydralazine
 Bethamethasone
 Dexamethasone

17. Eclampsia is defined as :
“the occurrence of one or more convulsions or coma in
association with syndrome of pre-eclampsia”.
 Treatment Goals:
 Control seizures
 Control HTN
 Stabilize & deliver

18.  Diagnosed in the presence of any of the following in a
woman with chronic HTN:
1. De novo proteinuria after 20 week gestation.
2. A sudden inc in the severity of HTN.
3. Appearance of features of preeclampsia –eclampsia.
4. A sudden inc in proteinuria in women who have pre-
existing early in gestation.

19.  Without severe features:
 Stable maternal & fetal status
 Delivery : >37 wks
 With severe features:
 MgSO4 is recommended.
 Delivery: < 34 wks & stable maternal/fetal status.
 Expectant management at tertiary center.

20. “Pre-conception counseling & adjustment of Rx in women
with chronic HTN”.
 Women with chronic HTN may require achange in type of
antiHTNive agent used pre-pregnancy.
 The drugs of choice in pregnancy are still METHYLDOPA
& LABETALOL.
 Atenalol has been shown to lead to fetal growth restriction.
 The use of ARBs, ACEI & Thiazide Diuretics are associated
with fetal anomaly & are therefore contraindicated.

21.  Pregnant women with uncomplicated chronic HTN
should have their BP kept lower than 150/100 mmHg.
 In the presence of target organ damage secondary to
chronic HTN, the aim is to maintain the BP below.