This document provides an overview of hypertensive disorders during pregnancy, with a focus on preeclampsia. It defines key terms, classifies hypertensive disorders, discusses risk factors and pathogenesis of preeclampsia, diagnostic evaluation, management, and recent advancements. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation in previously normotensive women and affects 5-15% of pregnancies. Management involves stabilizing blood pressure, preventing complications, and timely delivery.

1. Presented by,
Mamta Sahu
AIN/2014/317
*

2. *
*Hypertensive disorders due to pregnancy
*Classification
*Important terms and Definitions
*Preeclampsia
*Incidence
*Classification
*Stages of pre eclampsia
*Risk factors for preeclampsia
*Etiopathogenesis
*Signs and Clinical features
*Diagnostic evaluation
*Management of preeclampsia
*Complications of preeclampsia
*Prevention
*Recent advancements
*Summary and conclusion

3. *

4. *
According to National High Blood Pressure
Education Programme (2000):
*Gestational hypertension (PIH)
*Pre eclampsia
*Eclampsia
*Preeclamsia superimposed on chronic
hypertension
*Chronic hypertension

5. *
*Hypertension: Hypertension has been defined as a blood
pressure of 140/90 mm of Hg or greater or an increase of 30 mm
of Hg systolic or 15 mm of Hg diastolic over the baseline value
on atleast two occasions.
*Gestational hypertension: GH is defined as hypertension that
develops for the first time in pregnancy after 20 weeks of
gestation. It is not accompanied by proteinuria and blood
pressure and returns to normal within 12 weeks postpartum.

6. *Proteinuria: urinary excretion of ≥ 0.3 gm/l protein in 24 hours
specimen or 0.1 gm./l.
*Eclampsia: women with preeclampsia complicated with
convulsions and/or coma.
*Preeclampsia superimposed on chronic hypertension: when a
pregnant women with chronic hypertension develops
proteinuria after 20 weeks of gestation.
*Chronic hypertension: known hypertension before pregnancy
or hypertension diagnosed first time before 20 weeks of
pregnancy.

7. *
Preeclampsia is a multi system disorder of unknown
etiology characterised by
*development of hypertension to the extent of 140/90
mm of Hg or more
*with proteinuria
*after the 20th week
*In previously normotensive and non proteinuric women

8. *
*Hypertensive disorders= 8-10%
*Preeclampsia=5-15%
*Primigravidae=10%
*Multigravidae=5%

9. *
PREECLAMPSIA
MILD
PREECLAMPSIA
HELLP
SYNDROME
SUPERIMPOSED
PREECLAMPSIA
SEVERE
PREECLAMPSIA

10. *

11. *

12. *

13. *

14. *
*URINE ANALYSIS
*OPHTHALMOSCOPIC EXAMINATION
*BLOOD VALUES
*ANTENATAL FETAL MONITORING

15. *
*To stabilize hypertension and to prevent its
progression to severe preeclampsia.
*To prevent the complications.
*To prevent eclampsia
*Delivery of the healthy baby in optional
time.
*Restoration of the health of the mother in
puerperium.

16. *
DRUG MODE OF ACTION DOSE
Methyl dopa Central and
peripheral
antiadrenergic
action
250-500 mg
TID or QID
Labetalol Adrenoceptor
antogonist (A and
B blocker)
100 mg
TID or QID
Nifedipine Calcium channel
blocker
10-20 mg
BID
Hydralazine Vascular smooth
muscle relaxant
10-25 mg
BID

17. *
DRUG ONSET OF
ACTION
DOSE
SCHEDULE
MAXIMUM
DOSE
MAINTENACE
DOSE
LABBETALOL
*
5 min 10-20mg/10
min
IV
300mg IV 40 mg
HYDRALAZIN
E
10 min 5mg/30min
IV
30mg IV 10mg/hr
NIFEDIPINE 10min 10-
20mg/30min
PO
240mg/24hr 4-6hr
interval
NITROGLYCE
RINE
0.5-5min 5mg/min
IV
SODIUM
NITROPRUSSI
DE
0.5-5min 0.25-
5սg/kg/min
IV
Short term therapy only
when the other drugs have
failed.

18. *
*Daily clinical evaluation of any symptoms
*Blood pressure
*State of edema and daily weight record
*Fluid intake and urinary output
*Urine examination
*Blood
*Ophthalmoscopic examination
*Fetal well being

19. *
*Immediate complications
* MATERNAL:
During pregnancy: a) eclampsia
b) accidental haemorrhage
c) oliguria and anuria
d) dimness of vision/blindness
e) preterm labour
f) HELLP syndrome
g) cerebral haemorrhage
h) ARDS
During labour: a) eclampsia
b) postpartum haemorrhage
Puerperium: a) eclampsia
b) shock
c) sepsis

20. Fetal complications: a) intrauterine death
b) intrauterine growth retardation
c) asphyxia
d) prematurity
Remote complications: a) residual hypertension
b) recurrent preeclampsia
c) chronic renal diseases

21. Hexagon of
prevention
Of
Preeclampsia
Regular
antenatal
check up
Antioxide
nts
Calcium
supplementati
on
Balanced
diet
Heparin
Antithrom
botic
agents

22. *
Cited by KE Duhig, 3 february 2015
*In 2013, Chappell and colleagues published a prospective
multi-center study of women presenting with suspected
preeclampsia to antenatal clinics or day assessment units.
Maternal PGIF concentrations below the 5th centile were
shown to have a high sensitivity (0.96, 95% CI 0.89-0.99) and a
negative predictive value (0.98, 95% CI 0.93-0.995) for
predicting the development of preeclampsia that requires
delivery within 14 days.
*In this study, of the 287 women before 35 weeks gestation,
seven had a still birth. This latter study used PGIF only and
better results were attributed to a specific assay, which was
provided by a different company and which also can be done
rapidly at point of care.

23. Cited by Jasveer Singh and Manjeet Kaur in 2014.
Published in an International journal of anesthesiology, pain
management, intensive care and resuscitation.
Recent studies show favourable maternal and fetal
outcomes with the use of patient controlled epidural
analgesia technique with the combination of lower
concentrations of local anesthetics with opioids.
Regional anesthesia should be preferred for these
parturients for cesarean section if contraindicated
If general anesthesia is indicated the techniques should be
modified to prevent any stress response.

24. *

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