This document discusses hypertension in pregnancy. It classifies hypertension into pregnancy-induced hypertension and chronic hypertension. It defines the different types of pregnancy-induced hypertension, which include gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and eclampsia. It also lists commonly used anti-hypertensive drugs in pregnancy, including methyldopa, labetalol, and nifedipine. Finally, it discusses the effects of oral contraceptives on blood pressure and appropriate contraceptive options for women with hypertension.

1. Hypertension In
Pregnancy
DR RATNA WATI RAHMAN
FAMILY MEDICINE SPECIALIST

8. CLASSIFICATION
• PREGNANCY INDUCED HYPERTENSION(PIH)
• CHRONIC HYPERTENSION

9. DEFINITION AND OR
1.Chronic hypertension Known HPT or hypertension diagnosed before
20 weeks gestation or HPT persist at least 12
weeks post delivery with BP 140/90 on at
least 2 occasions 4 Hours apart
SBP>30mmHg and DBP>15mmHg
compared to prepregnancy level
2.PIH:
Gestational hypertension
Pre eclampsia
Preeclampsia superimposed
on chronic hypertension
Eclampsia
New onset of BP 140/90 on at least 2
occasions 4 Hours apart after 20 weeks
gestation in a previously normotensive patient
SBP>30mmHg and DBP>15mmHg
compared to prepregnancy level
New onset of BP 140/90 on at least 2
occasions 4 Hours apart after 20 weeks
gestation in a previously normotensive patient
OR
BP160/110mmHg within minutes
1.Protenuria 1+
2.urinary protein greater
than 0.3g/L in 24 hours
New onset of high BP with any of the
following:
1.Platelet <100 000
2.Sr Creat>90umol/L
3.liver enzymes 2x
4.APO
5.Persistent visual sx
HELLP syndrome
Known HPT with
BP 160/110mmHg
with any of the following:
1.Platelet <100 000
2.Sr Creat>90umol/L
3.liver enzymes 2x
4.APO
5.Persistent visual sx
HELLP syndrome
New onset generalized tonic clonic seizure or
coma in a woman with pre eclampsia or
gestational HPT

29. Anti-hypertensive Drugs Commonly Used in
Pregnancy
Drug Remark
Methydopa
(first line)
Oral 250 mg tds, doubling every 48 hours (up to 1 gm tds)
until BP well controlled. Oldest anti-hypertensive agent used in
pregnancy, with best safety profile.
Labetolol
(alternative
first line)
Oral 100 mg bd, doubling every 48 hours (up to 400mg bd) until
BP well controlled.
Nifedipine
(second line)
Oral 10 mg tds, up to 20 mg tds, usually as second line
antihypertensive,when BP poorly controlled despite maximum
doses of methyldopa ― labetalol.

62. Hypertension And Oral Contraceptives
 Combined oral contraceptives (COC) can induce significant
increases in BP with chronic use, which is nearly always
reversible after 4 weeks of discontinuation.
 Hypertension has been reported even with low-dose-
oestrogen monophasic pills.
 A woman who develops hypertension while using COC should
be advised to stop taking them and should be offered
alternative forms of contraception.
 Low dose combined hormonal contraceptives should only be
used if no other method is suitable, even for women with
controlled hypertension.

63.  Drospirenone (a progestin), has anti-mineralocorticoid diuretic
effects, and can lower BP when combined with oestrogen in
COCs.
 It is a recommended alternative for patients with hypertension
or who developed hypertension but wish to continue oral
contraception.
 All progestogen-only methods are appropriate except in
women whose BP is higher than 160/100 mmHg.
 In these patients, the injectable depot medroxyprogesterone
acetate (DMPA) is contraindicated, along with all oestrogen-
containing contraceptives.