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

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Management of hypertensive disorders in pregnancy

  1. 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. 2. What are we dealing with?
  3. 3. Is it Gestational HTN.. Or Chronic HTN?
  4. 4. Routine investigations
  5. 5. Proteinuria – How to assess??
  6. 6. Prevention strategy – Do s
  7. 7. and Don’t s… NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN THIS REGARD
  8. 8. CHRONIC HYPERTENSION
  9. 9. PRE PREGNANCY ADVICE
  10. 10. Once upon a time called PIH, now known as... GESTATIONAL HYPERTENSION
  11. 11. Decide on Timing of birth
  12. 12. Mild Hypertension Moderate Hypertension Severe Hypertension
  13. 13. PRE ECCLAMPSIA
  14. 14. Pre ecclampsia – Who are at risk?
  15. 15. Signs of Severe Pre-ecclampsia
  16. 16. Decide on Timing of birth
  17. 17. Severe Hypertension not requiring referral to a level 2 setup Mild Hypertension Moderate Hypertension
  18. 18. ECCLAMPSIA
  19. 19. Antihypertensives – WHAT NOT TO USE
  20. 20. Antihypertensives used - Pharmacology
  21. 21. Antihypertensives used – Beta Blockers
  22. 22. Antihypertensives used - Pharmacology
  23. 23. Antihypertensives used – Methyldopa
  24. 24. Antihypertensives used - Pharmacology
  25. 25. Antihypertensives used - Nifedipine
  26. 26. Antihypertensives used - Pharmacology
  27. 27. Antihypertensives used - Hydralazine
  28. 28. Antihypertensives used - Thiazides
  29. 29. Methyldopa vs Labetolol – The King vs the Challenger?
  30. 30. “Can I feed the baby while on my antihypertensive meds?”
  31. 31. Lifestyle advice
  32. 32. What next?
  33. 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. 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. 35. Download the presentation online at: www.drmdsadiq.in Any questions?? THANK YOU

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