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17.Pregnant Induced Hypertension


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17.Pregnant Induced Hypertension

  1. 1. Hypertensive Disorders of Pregnancy Qu Quanxin Tianjin First Centre Hospital
  2. 2. Definition It is a condition that the pregnant women appear at least 2 of the 3 signs, including hypertension , proteinuria and edema after 20th week of pregnancy.
  3. 3. Classification <ul><li>Preeclampsia/eclampsia </li></ul><ul><li>Chronic hypertension </li></ul><ul><li>Chronic hypertension with superimposed preeclampsia </li></ul><ul><li>Gestational hypertension </li></ul>
  4. 4. Preeclampsia <ul><li>Definition A syndrome unique to pregnancy characterized by the new onset of hypertension and proteinuria in the latter half of gestation. </li></ul><ul><li>Criteria the development of hypertesion( ≥140/90mmHg); and proteinuria(≥0.3g/24h) </li></ul>
  5. 5. Eclampsia <ul><li>Definition Seizures in a woman that cannot be attributed to other causes </li></ul>
  6. 6. Chronic hypertension <ul><li>Exist hypertension prior to pregnancy, the development of hypertension prior to 20 weeks’ gestation, or in cases where hypertension is first noted during pregnancy, persistence of elevated blood pressures greater than 12 weeks’ postpartum </li></ul>
  7. 7. Chronic hypertension with superimposed preeclampsia <ul><li>New-onset proteinuria developed on the basis of chronic hypertension (≥0.3g/24h) after the 20th week of gestation </li></ul>
  8. 8. Gestational hypertension <ul><li>Hypertension without proteinuria first appears after 20 weeks’ gestation or within 48 to 72 hours after delivery and resolves by 12 weeks’ postpartum. </li></ul>
  9. 9. Etiology <ul><li>Genetic factor </li></ul><ul><li>Immunologic factor </li></ul><ul><li>Endocrinologic factor </li></ul><ul><li>Nutritional factor </li></ul><ul><li>Infectious factor </li></ul>
  10. 10. Pathology Uteroplacental ischemia ‘ toxins’ Hypertension and vascular spasmus Ischmia and impairment of varies organs (liver function, renal function, heart function, cerebral lesion, etc) Result in signs and symptoms (headache, faint, nause, epigastric pain, convulsion, coma, etc)
  11. 11. Fluid retention During the normal pregnency period, the average weight gain is about 12kg. In the first trimester, a loss of weight maybe happen for morrning sickness. In the second and third trimester, the average weight gain is about 0.5kg/wk. If the weight gain is greater than 1kg/wk, closely measurement for blood pressure and urine specimen investigation should be done
  12. 12. Hypertension The blood pressure fluctates within the range of 110-120/60-70mmHg in a rest condition. The standards of hypertension used in general medicine are not appropriate in obstetrics. The dividing point between physiology and pathology is accepted as 140/90mmHg or increase of 30/15mmHg over the baseline reading. During pregnancy period, the increased blood pressure should be below 30/15mmHg
  13. 13. Edema During normal pregnancy period, the extracellular fluid increases about 2500ml. The excessive fluid retention eventually results in edema and is often firstly found over the lower subcutaneous surface of the tibia by gentle sustained pressure, and gradually the feet and ankles are obviously swoolen.
  14. 14. Proteinuria The proteinura means that the protein components mainly including albuminuria and globulins are found in urine sample. But there are many causes can give rise to proteinuria , which contamination from vaginal discharge, urinary tract infection and chronic renal disease.
  15. 15. <ul><li>Signs and Syndrome </li></ul><ul><li>Mild hypertension </li></ul><ul><li>Slightly increase on pressure </li></ul><ul><li>Edema </li></ul><ul><li>Proteinuria. </li></ul>
  16. 16. + Edema only limits on feet and calf and can not disappear after rest. ++ Edema develops to thigh. +++ Edema raise to vulva and abdomen. ++++ Edema distributes to all of the body and sometimes company with ascites
  17. 17. <ul><li>Moderate hypertension </li></ul><ul><li>BP ≥ 150/100mmHg,but <160/110mmHg </li></ul><ul><li>Proteinuria ≥ 0.5g/24hn or + </li></ul><ul><li>Edema </li></ul><ul><li>Headach,nausea and vomiting,faint,etc </li></ul>
  18. 18. <ul><li>Serious hypertension </li></ul><ul><li>BP ≥ 160/110mmHg for at least 12h </li></ul><ul><li>Protein in the urine is over 5g/24h or +++~++++ </li></ul><ul><li>Creatinine level increases </li></ul><ul><li>Function of liver impaired obviously </li></ul><ul><li>Function of the placenta impaired </li></ul><ul><li>Fetus IUGR, asphyxia and even death </li></ul>
  19. 19. Pre-eclampsia On the above basic, the patient appears headache, giddy and faint, nausea, epigastric pain and even vomiting, this is called pre-eclampsia. If the patient does not accept treatment appropriately and in time, she will develop to eclampsia.
  20. 20. Eclampsia The patient abruptly comes forth convulsion with or without coma. During convulsion, the patient stops breathing temporarily and face becomes cyanose. This will last for about 1min. After convulsion, patient often drops into coma.
  21. 21. <ul><li>Diagnosis </li></ul><ul><li>History </li></ul><ul><li>Signs and symptoms </li></ul><ul><li>Investigations </li></ul>
  22. 22. <ul><li>Investigations </li></ul><ul><li>Blood RT and coagulators, combination of CO 2 and function of renal and liver </li></ul><ul><li>Urine RT </li></ul><ul><li>Bottom of the eyes </li></ul><ul><li>ECG, B-ultrasound </li></ul><ul><li>CT, MRI </li></ul><ul><li>Placenta function </li></ul>
  23. 23. <ul><li>Differentiation </li></ul><ul><li>Chronic hypertension </li></ul><ul><li>Chronic nephritis </li></ul>
  24. 24. Influence to pregnant women and fetus Pregnant women: heart failure,liver and kidney function failure, DIC, plcenta abruption, HELLP,postpartum haemorrhage Fetus : preterm labor, oligohydramnios, IUGR, fetal distress, death, stillbirth, neonatal death,etc
  25. 25. Therapy Relife convulsion Sedation Antihypertension Diuretics Delivery To terminate pregnancy is the key to resolve the problem. The method to end pregnancy includes induced labour by oxytocin or caesaren section.
  26. 26. Management for pre-eclampsia and eclampsia * Keep the patients in a quiet circumstance and reduce external stimuli as possible * Relief convulsion * Reduce blood pressure * Relief pain during delivery either by vaginal or operation
  27. 27. Question If the patients appeared BP 150/100mmHg, proteinuria (++), edema(++) at 34 gestational age, then the diagnosis should be: A. Mild degree of PIH B. Moderate degree of PIH C. Serious degree of PIH D. Pre-eclampsia E. Eclampsia
  28. 28. Question The influence on pregnant women with PIH is A.Form plcenta praevia B.Result in megaloblastic anemia C.Result in abruptio plcenta D.Result in gestational diabetics E. Result in iron-deficiency anemia
  29. 29. Question The influence on fetus in pregnant women with PIH is A.Fetal malformation B.Fetal heart disease C.Fetal heamorrhage D.Fetal anemia E.IUGR
  30. 30. * Definition of Hypertensive Disorders of Pregnancy * Types of Hypertensive Disorders of Pregnancy and the diagnostic standard * Degree of edema in Hypertensive Disorders of Pregnancy