The document discusses gestational hypertension, which is defined as high blood pressure that develops after 20 weeks of pregnancy. It can complicate 6-15% of pregnancies and increase risks for both mother and baby. The symptoms, causes, and types of gestational hypertension are explained. Treatment involves lifestyle changes, medication, and delivery depending on severity and gestational age. The effects on maternal and fetal health are also outlined.

2. Mahnoor Shehzadi.
Hamna Naveed.
Rija Fatima.
Kiran Asghar.
Esha Zahid.
Amna Shakeel.

4.  Discharge of ova an ovules from the ovary.
Gestation
Definition:
 Gestation is the period of time between
conception and birth.
 During this time the baby grows inside the
mother womb or uterus.

5.  Gestational age or period is the common term used
during pregnancy.
 A pregnancy may end in a live birth, abortion or
miscarriage.
 Child birth typically occurs around 40 weeks from
the start of the last menstrual period.
 This is just over 9 months or 280 days .every
month averages 31 days. when measured from
fertilization it is about 38 weeks.
 An embryo is the developing offspring during the
first eight weeks following fertilization after which
the term fetus is used until birth.

6. Symptoms of early pregnancy are given
 Missed periods.
 Tender breasts.
 Nausea.
 Vomiting.
 Hunger.
 Frequent urination.
 Pregnancy may be confirmed by pregnancy test.

7.  Pregnancy is divided in to three trimesters
each lasting approximately 3 months.
 The first trimester include conception which
is when the sperm fertilizes the egg.
 During the first trimester the possibility of
miscarriage is at its highest.
 Around the middle of the second trimester,
movement of the fetus may be felt.
 At 28 weeks more than 90% of the babies
can survive outside of the uterus.

10.  Progesterone.
 Estrogen.
Complications
 High blood pressure (hypertension).
 Gestational diabetes.
 Iron deficiency anemia.
 Severe nausea and vomiting.

11. • Also known as high blood pressure
and arterial hypertension.
• Two measurements : systolic (when
heart contracts) and diastolic(when
heart expands) which are maximum
and minimum pressures respectively.
In adults ; systolic: 100-130 mmHg ,
Diastolic : 60-80mmHg
• Blood pressure is measured in
Brachial Artery in upper arm.

12. • Primary Hypertension:
• Hypertension with no clear or identifiable
cause.
• Risk factors: old age, obesity, salt heavy diet,
sedentary lifestyle.
-90-95% cases are of primary
hypertension.
• Secondary Hypertension:
• Hypertension with identifiable cause.
• Risk factors: pregnancy, renal disorders,
hormonal imbalance or other medical
conditions.
-5-10% cases are of secondary
hypertension.

13. • Urgency: Blood pressure rises to
180/110mmHg. No damage to body organs.
BP can be brought down slowly within a few
hours.
• Emergency: Blood pressure rises
extremely and causes damage to other
body organs such as lungs, heart, kidneys
etc. It maybe life-threatening may include
severe chest pain.

14. • Anti-hypertensive medications:
vasodilators(for easy blood flow),
diuretics(increased production of urine),
calcium channel blockers(increase
blood supply).
• Lifestyle modifications: diet regulation(less
intake of salt), daily exercise(running,
swimming, walking), stress reduction.

16. HYPERTENSION IN PREGNANCY
 Hypertension is defined as: systolic
pressure of at least 140 mm of Hg and
diastolic pressure of at least 90 mm of Hg.
 It is one of the most common complication
during pregnancy.
 Increased maternal and perinatal morbidity
and mortality.
 It is a sign of an underlying pathology that
may be pre-existing or appears for the first
time during pregnancy that’s why it is also
called as TOXEMIA OF PREGNANCY.

17.  6% to 8% of all the pregnancies.
 Complicates 10-20% of pregnancies.
 Cause of 10% of preterm birth.

18. CLASSIFICATION
 Chronic Hypertension
 Preeclampsia-eclampsia
 Preeclampsia superimposed upon chronic
hypertension or Renal disease
 Gestational Hypertension (only during
pregnancy)
 Transient Hypertension (only after pregnancy)

20. Gestational Hypertension
 It is the hypertension detected for the first
time after 20 weeks pregnancy.
 Resolves by 12 weeks postpartum.
 Majority of cases are more than or equal to
37 weeks of pregnancy.
 Absence of any evidences for the underlying
cause of hypertension.
 Generally not associated with hemo-
concentration or thrombocytopenia, raised
serum uric acid level or hepatic dysfunction .

21.  50% of women diagnosed with gestational
hypertension between 24 and 35 weeks
develop preeclampsia.
 Prevalence 6-15% in nulliparas and 2-4% in
multiparas.
 Mild hypertension without proteinuria or
other signs of preeclampsia.
 But it can progress onto preeclampsia (when
hypertension is more than 30 weeks
gestation) , about 15-25% risk.

22. TYPES OF GESTATIONAL HTN
EARLY
Before 30 wks, frequently severe, advances to
preeclampsia and has a guarded perinatal
prognosis.
LATE
After 30 wks, frequently in obese women and
multiple pregnancies, due to poor maternal
adaptation to physiology changes in pregnancy.

23. CRITERIA TO IDENTIFY HIGH RISKS
WOMEN WITH GESTATIONAL HTN
 BP> 140/90 mm Hg
 GA< 30 woks
 Twins
 Abnormal CD
 Fetal growth restriction
 Oligohydramnios
 Multiparas or women whose sisters and
mothers had PIH
 Nullipara, age>35 yrs, BMI> 35 kg/m2

24. AFFECT OH GHTN ON BABY
 Hypertension has negative affects on both
mother and baby. Hypertension can prevent
the placenta from getting enough blood. If
the placenta doesn’t get enough blood, your
baby gets less oxygen and food. This can
result in low birth weight. Most women still
can deliver a healthy baby if hypertension is
detected and treated earlier.

25. HOW TO KNOW IF WOMAN HAS
GHTN
 At each prenatal checkup, your healthcare
provider will check your blood pressure and
urine levels. Your doctor may also check your
kidney and blood clotting functions, order
blood tests, perform an ultrasound scan to
check your baby’s growth, and use a Doppler
Scan to measure the efficiency of blood flow
to the placenta.

26. DELIVERY COMPLICATIONS
 Vaginal delivery VS Cesarean section.
 Depends on severity of hypertension.
 It might be between 37-38 weeks of
gestation if complications occur.
 If preterm birth occur then antenatal
corticosteroids are administered depending
on gestation.
 But if the hypertension is controlled it takes
its original time < 37 weeks meaning 40
weeks.

27. Cardiovascular effects:
 Elevated BP.
 Increased cardiac output.
Renal effect:
 Atherosclerotic like changes in renal
vessels(glomerular endotheliosis).
 Uric acid filtrations is decreased.

28. Neurologic effect:
 Hyper-reflexia /hypersensitity(does not
corelate severity of disease.
 In severe cases, grand mal seizures.
Hematologic effects:
 Third spacing of fluid due to increased
blood pressure and decreased plasma
oncotic pressure.

29. Pulmonary effects:
 Pulmonary edema may occur due to
decreased collide oncotic pressure.
Fetal effects:
 Vasospasm.

30. Hemostatic changes:
 Increased PLT activation with increased
endothelial fibro-nectin and decreased
anti-thrombin III and alpha-2-antiplasmin -
--- further endothelial damage is thought
to promote further vasospasm.
Changes in EDF:
 Decrease in nitric Oxide.

31. Uterine vascular changes:
 Trophoblastic- mediated vascular changes
 Decreased musculature in spiral arterioles.
 Development of low resistance, low
pressure, high flow system.
 Inadequate maternal vascular response.
 Endothelial damage is also noted with in the
vessels.

32. Changes in prostanoids:
 Both PGI2 (Vasodilation and decreased PLT
aggregation)and TXA2(vasoconstriction and
PLT aggregation) are increased with balance
favored to PGI2.
 In preeclampsia, TXA2 is favored.

33. Symptoms of Gestation
Hypertension
Headache does not goes away.
Edema (Swelling).
Sudden weight gain.
Vision changes, such as blurred or double vision.
Nausea or Vomiting.
Pain in the upper right side of our belly, or pain
around your stomach.
Making small amounts of urine.

34. Causes of Gestation
hypertension
Pre-existing hypertension(high blood pressure).
Kidney disease.
Diabetes.
Hypertension with previous pregnancy.
Mother’s age younger than 20 or older than 40.
Multiple fetuses(twins,triplets).
 African-Amrican race.

36.  Anti hypertensive drugs
 Anti drug method

37.  If you have mild hypertension and your baby
is not fully developed, your doctor will
probably recommend the following:
1. Rest, lying on your left side to take the
weight of the baby off you major blood
vessels.
2. Increase prenatal checkups.
3. Consume less salt.
4. Drink 8 glasses water a day.

38. 5. Increase the amount of protein.
6. Decrease the number of junk and fried
foods.
7. Exercise regularly.
8. Elevate your feet several time during the
day.
9. Avoid drinking Alcohol.
10. Avoid beverages containing caffeine.
11. Your doctor may suggest you to take the
prescribed medicine and additional
supplements.

39. If you have severe hypertension, your doctor
may try to treat you with blood pressure
medication until you are far enough along to
deliver safely.

40. First Line Agents
 Methyldopa 0.5-3 mg/day
 Labetalol 200-1200 mg/day
Second Line Agents
 Nefedipine 10-30mg
p.o.

41.  Verapamil 80 mg tds p.o.
 Clonidine 0.1-0.6 mg/day
 Hydralazine 50-300 mg/day
 Hydrochlorothiazide 12.5-25 mg/day
 Atenolol
 Diazoxide 30-50 mg in every
5 to 15 min
 Prazosin 0.5-5 mg tds
 Oxprenolol 20-160 mg tds

42.  Nitroprusside
 Contraindicated
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