This document discusses various types of hypertension that can occur during pregnancy, including gestational hypertension, chronic hypertension, preeclampsia, eclampsia, and HELLP syndrome. It defines each condition, describes their signs and symptoms, risk factors, pathophysiology, and treatment approaches. Gestational hypertension involves new hypertension after 20 weeks of pregnancy without other signs of preeclampsia. Preeclampsia is hypertension with proteinuria developing in the second half of pregnancy. Eclampsia is preeclampsia with seizures. HELLP syndrome involves liver dysfunction, hemolysis, and low platelets in severe preeclampsia cases. Treatment involves blood pressure control, magnesium sulfate for seizure prevention, and often
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
1. Hypertension in
Pregnancy
Dapinderjit Gill
Ross University MS3
S
2. Hypertension S Gestational HTN
S Transient HTN of
Disorders in pregnancy
Pregnancy S Preeclampsia
S Mild
S Severe
Classification of the
American College of S Eclampsia
Obstetricians and
Gynecologists S Chronic HTN preceding
pregnancy
S Chronic HTN with
superimposed pregnancy-
induced hypertension
S Superimposed
preeclampsia
S Superimposed eclampsia
4. Gestational HTN
S sustained systolic blood pressure at or
above 140mmHg, or a diastolic blood
pressure of 90mmHg or greater
S increase in BP must be present on at least
two separate occasions, 6 hours or more
apart
S HTN in late pregnancy (>20 weeks
gestation) in the absence of other findings
suggestive of preeclampsia
S if BP returns to baseline by 12 weeks
postpartum = dx. of Transient hypertension
of pregnancy
5. Gestational HTN
S 5-10% of pregnancies that proceed beyond 1st trimester
develop gestational HTN
S increased incidence of up to 30% in multiple gestation
S 15-25% of women initially diagnosed with gestational
HTN develop preeclampsia
S Earlier onset of gestational HTN are more likely to
progress to preeclampsia
6. Pathophysiology
Changes seen in patients
S Cardiovascular effects
S Elevated BP
S Increased cardiac output
S Hematologic effects
S Third spacing of fluid due to increased
blood pressure and decreased plasma
oncotic pressure
S Renal effects
S Atheroscleroticlike changes in renal
vessels (glomerular endotheliosis)
decreased glomerular filtration rate and
proteinuria
S Uric acid filtration is decreased
7. Pathophysiology
Changes seen in patients
S Neurologic effects
S Hyperreflexia/hypersensitivity (does not correlate with severity of
disease)
S In severe cases, grand mal seizures
S Pulmonary effects
S Pulmonary edema may occur due
to decreased colloid oncotic pressure
S Fetal effects (severe gestational HTN)
S Vasospasm Decreased intermittent placental perfusion IUGR,
oligohydramnios, low birth weight
8. Pathophysiology
Mechanisms
S Uterine vascular changes
S Trophoblastic-mediated vascular changes decreased
musculature in spiral arterioles development of low
resistance, low pressure, high-flow system
S Inadequate maternal vascular response
S Endothelial damage is also noted within the vessels
S Hemostatic changes
S Increased PLT activation with increased endothelial fibronectin
and decreased antithrombin III and alpha-2-antiplasmin
further endothelial damage is thought to promote further
vasospasm
9. Pathophysiology
Mechanisms
S Changes in prostanoids
S During pregnancy, both PGI2 (vasodilation and decreased
PLT aggregation) and TXA2 (vasoconstriction and PLT
aggregation) are increased with balance favored to PGI2
S In preeclampsia, TXA2 is favored
S Changes in endothelium-derived factors
S Decrease in Nitric oxide promoting
vasoconstriction
10. Gestational HTN
S Mild: outpatient with weekly visits, bed rest
S Antihypertensive therapy:
S Indicated if diastolic pressure is repeatedly above 110mmHg
S Hydralazine (Apresoline) 5mg increments IV until acceptable
BP is obtained (diastolic pressure to 90-100mmHg range)
S Other medications that can be used in pregnancy (oral):
S methyldopa 250mg BID/TID max 3g/day
S Labetalol 100mg max 2400mg/day
S Nifedipine 30-60mg max 120mg/day
S Magnesium sulfate in severe gestational HTN for seizure
prophylaxis
12. Chronic HTN
S HTN present before 20th week of gestation or
beyond 6 weeks postpartum (>12 weeks
postpartum from uptodate.com)
S 15% of gestational HTN cases go on to
develop chronic HTN
S 25% risk of developing superimposed
preeclampsia or eclampsia
S Close monitoring of maternal BP and follow
appropriate fetal growth and well-being
S Pt. should be encouraged to increase the
amount of time she rests
14. Preeclampsia
S Development of HTN with proteinuria
induced by pregnancy generally in
the second half of gestation
S More frequent at the extremes of
reproductive years
S More common in women who have
not carried a previous pregnancy
beyond 20 weeks
old women or young lady?
15. Preeclampsia
S Mild:
S BP: systolic > 140mmHg and/or diastolic > 90mmHg
S Proteinuria: >300mg on 24h collection of +1 on single
sample
S Severe:
S BP: systolic > 160-180mmHg and/or diastolic > 110mmHg
S Proteinuria: >5g on 24h collection or +2 on single sample
S Multisystem alterations: cerebral or visual
disturbances, oliguria, pulmonary
edema, cyanosis, epigastric or right upper quadrant
pain, thrombocytopenia
17. Preeclampsia
S Mild preeclampsia
S If immature fetus bed rest mainly in
lateral decubitus position
S HTN therapy if needed
S Severe preeclampsia
S Magnesium sulfate 4g loading dose with 1-3g/hr infusion rate
S Antihypertensive therapy
S Induction or cesarean delivery
S fetal pulmonary maturity depending on gestational age should be
considered (>=34weeks)
19. Eclampsia
S addition of convulsions in a woman with preeclampsia
S occurs in 0.5-4% of deliveries
S most cases occur within 24h of delivery with about 3% of
cases diagnosed between 2-10 days postpartum
S 25% have eclamptic seizures before labour, 50% during
labour, and 25% after delivery
20. Eclampsia
S Anticonvulsant therapy
S Diazepam or similar drugs
S Magnesium sulfate to prevent further seizures
S Maintain adequate airway, oxygenation, restraining gently
as needed and inserting a padded tongue blade
22. HELLP Syndrome
S HTN patients with hemolysis
(H), elevated liver enzymes
(EL), low platelet count (LP)
S 4-12% of pt. with severe
preeclampsia and eclampsia
develop HELLP syndrome
S first sx. often missed:
nausea, emesis, and non-specific
viral-like syndrome
23. HELLP Syndrome
Treatment:
S cardiovascular stabilization, correction of coagulation
abnormalities, and delivery
S PLT transfusion before or after delivery if PLT count is
<20,000/mm3 (advised at <50,000/mm3 before cesarean)
S <32 weeks gestation; steroid therapy may help stabilize
maternal PLT count
24.
25. References
Beckmann, Charles R.B., Ling, Frank W., Smith, Roger
P., Barzansky, Barbara M., Herbert, William N.P., Laube, Douglas
W. “Obstetrics and Gynecology”. 5th edition Lippincott Williams &
Wilkins. pp. 188-196
Magloire, Lissa etc. “Gestational Hypertension”. May
2011.<uptodate.com>
August, Phyllis et. al. “Management of hypertension in pregnancy
and postpartum women”. May 2011 <uptodate.com>
Editor's Notes
-in the clinical setting, this is sometimes hard to do due to various problems on obtaining reliable assessment of blood pressure. -position; high when pt. is standing, low when pt. is laying down in lateral position and intermediate when pt. Is sitting -inappropriate cuff size can over and under estimate BP -no previous info on baseline BP