2. Overview
Most common medical problem
encountered during pregnancy
Complicate 10% of all pregnancies.
One of the leading causes of maternal
and perinatal mortality worldwide
3. In Malaysia…
From 1997 to 2016, there were
377 cases of death related to
HDP with an average incidence
of 13% per year (excluding
fortuitous deaths). There was no
sign of declining trend over the
stipulated period of time with
the highest mortality incidence
reported in 2011 and lowest in
2000
4.
5.
6.
7. Defintion of
hypertension in
pregnancy
Hypertension is defined as BP ≥ 140 and/or 90
mmHg after a period of rest on 2 occasions at
least 4-6 hours apart.
if hypertension is severe (sBP ≥ 160 and/or
dBP ≥ 110 mmHg), then repeat within 15 min;
↑ SBP ≥ 30 mmHg and/or ↑ DBP ≥ 15 mmHg
above pre-pregnancy or first trimester BP is
no longer recognized as HPT in pregnancy
• But close observation is warranted
8. Blood Pressure Measurement
Using standardised technique, including women’s position (sitting, feet flat on floor), cuff size (‘large’ if the mid
upper arm circumference is ≥ 33 cm)
Korotkoff V should be used as the cut-off point for DBP
BP should be measured in both arms at least initially, and, thereafter, in the same arm for consistency, choosing
the arm with the higher BP
In any setting, should be measured using a device validated for use in pregnancy
The gold standard tool to measure blood pressure in preeclampsia is still the mercury sphygmomanometer
9.
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12. Gestational
Hypertension
Definition
• BP ≥ 140/90 mmHg on two occasions at least 4
hours apart after 20 weeks of gestation, in a
woman with a previously normal blood
pressure
• No proteinuria & sign of end organ dysfunction
• Blood pressure levels return to normal by 12
weeks postpartum
Grading
• Mild : 140-149/90-99
• Moderate : 150-159/100-109
• Severe : SBP ≥ 160 and/or DBP ≥ 110
13. Gestational
Hypertension
Outcomes are usually good
Up to 25% of women with gestational hypertension will eventually
develop PE, and this progression is more likely when the hypertension is
diagnosed before 34 weeks of gestation
Severe-range blood pressures should be managed with the same
approach as for women with severe preeclampsia
Undistinguishable from PE in terms of long-term cardiovascular risks,
including chronic hypertension
14.
15. Criteria for diagnosis pre
eclampsia
Proteinuria is not required for a
diagnosis of preeclampsia but is
present in ≈75% of cases.
16.
17.
18. Eclampsia
Refers to the occurrence of a grand mal seizure in a patient
with preeclampsia in the absence of other neurologic
conditions that could account for the seizure
23. Genetically Inherited
Defective HLA – G
expression, contribute
to inadequate
trophoblastic invasion
Mother with AA
Genotype + fetus with
HLA –C2 Phenotype
25. Related to Immune Mediated
Cytotrophoblast Invasion
Primigravida
Primipaternity
Condom use
Twin
Molar pregnancy
26.
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32.
33. Prevention of eclampsia and other
complications of preeclampsia
Women should be educated about the signs and symptoms of preeclampsia, so
they will notify their provider as soon as clinical manifestation occur for early
diagnosis and referral for further management to prevent progression to
eclampsia.
Follow up high risk women with more frequent clinic visit.
34. Management Overview
Balancing act between maternal & fetal health
- Best care for the mother may result in FGR & best care
for the fetus may place the mother at risk
35. Management
1. Control of Hypertension by using anti-hypertensive
drug
2. Prevention of eclampsia by using anticonvulsive
3. Early delivery irrespective of gestation in the event
of complication
36. References
• Training Manual in Hypertensive Disorder in Pregnancy, 2018
• ISSHP 2021
• ACOG 2020
• Lecture Series by Prof Dr Muralidhar V Pai
