This document provides an overview of the management of hypertensive disorders in pregnancy. It discusses the differences between gestational hypertension and chronic hypertension, how to assess proteinuria, prevention strategies, recommendations for various stages of mild to severe hypertension during pregnancy and postpartum, which antihypertensive medications to use and avoid, risk factors for preeclampsia, and conclusions about early diagnosis and treatment improving outcomes for both mother and baby. The conclusions recommend labetolol and methyldopa as first-line drugs, watching high risk women closely for preeclampsia, using urine protein to creatinine ratio for proteinuria screening, and aspirin as the only proven primary prevention method.

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. What are we dealing with?

3. Is it Gestational HTN.. Or Chronic HTN?

4. Routine investigations

5. Proteinuria – How to assess??

6. Prevention strategy – Do s

7. and Don’t s…
NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN
THIS REGARD

8. CHRONIC HYPERTENSION

9. PRE PREGNANCY ADVICE

13. Once upon a time called PIH, now known as...
GESTATIONAL HYPERTENSION

14. Decide on Timing of birth

15. Mild Hypertension
Moderate Hypertension
Severe Hypertension

19. PRE ECCLAMPSIA

20. Pre ecclampsia – Who are at risk?

21. Signs of Severe Pre-ecclampsia

22. Decide on Timing of birth

23. Severe Hypertension
not requiring referral
to a level 2 setup
Mild Hypertension
Moderate Hypertension

28. ECCLAMPSIA

33. Antihypertensives – WHAT NOT TO USE

34. Antihypertensives used - Pharmacology

35. Antihypertensives used – Beta Blockers

36. Antihypertensives used - Pharmacology

37. Antihypertensives used – Methyldopa

38. Antihypertensives used - Pharmacology

39. Antihypertensives used - Nifedipine

40. Antihypertensives used - Pharmacology

41. Antihypertensives used - Hydralazine

42. Antihypertensives used - Thiazides

43. Methyldopa vs Labetolol
– The King vs the Challenger?

47. “Can I feed the baby while on my
antihypertensive meds?”

48. Lifestyle advice

49. What next?

50. 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.

51. 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.

52. Download the presentation online at:
www.drmdsadiq.in
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