2. CONTENTS
OVERVIEW OF HTNSIVE DISORDERS IN PREG
CLASSIFICATION OF HTNSIVE DISODERS IN PREGNANCY
PRE-ECLAMPSIA:
Definition
Incidence
Aetiology and pathophysiology
Clinical features
Investigations
Managements
Complications
ECLAMPSIA :
Definition
Types
Pathophysiology
Clinical features
Investigtions
Differentials
Management
Complications
3. HPERTENSIVE DISORDERS IN
PREGNANCY
It’s the most common medical
problem seen in pregnancy.it
constitute major threats to maternal
life during pregnancy,labour and
immediate postpartum Period.In
developing countries,due to
inadequate facilities for
investigation,its not easy to
differentiate btw PIH,ESS.HTN &CRDz
4. CLASSIFICATION OF HTNsive
DISORDERS IN PREG
(1)PIH:
(a)PIH without proteinuria
(b)PIH with proteinuria ie PRE-
ECLAMPSIA
(2)CHTN of any etiology
(a)Essential htn
(b)CRDz
(3)CHTN with superimposed PE
5. PIH
Defined as development of
hypertension in the second half
of pregnancy measured at least
in 2 occasions about 4hrs apart,in
a woman who has previously
been normotensive and in which
BP returns to normal within 6
weeks of delivery
6. DEFINATION CONT......
PIH with proteinuria Is
a benign condition and usually occur in
the 3rd trimester,during labour or
peuperium
CHTN:Present b4 20th week of pregnancy
or that present b4 pregnancy
CHTN WITH SUPERIMPOSED PE: Define as
proteinuria developing for the 1st time
during pregnancy in a woman with known
CHTN
7. PIH with proteinuria or pre-
eclampsia
PRE-ECLAMPSIA is a multi-systemic disorder
characterized by HYPERTENTION and
PROTEINURIA that develops after 20 weeks
gestation in a previously normotensive
woman and in whom BP goes to normal
immediately within 6 weeks of delivery
HYPERTENSION in pregnancy is define as a
BP > or=140/90mmHg or rise in blood
pressure (BP) of > +30/+15 during the course
of pregnancy.
8. PIH with proteinuria or pre-
eclampsia
PROTEINURIA is defined as the presence of
>or = 300mg of protein in a 24-hr urine
collection or a protein measurement of
2+(1g albumin/l in random urine specimen.
Note Oedema is present in > 80% of normal
pregnant women and should not be a
diagnostic criteria .Condition resolves by 6
weeks postpartum
10. INCIDENCE OF PRE-
ECLAMPSIA
There is an increase risk in the following cases
Primigravidae<20 or >35 years
FHx of PE
First pregnancy with a new partner
Multiple pregnancy
Maternal obesity
Fetal/placental hydrops
Pre-existing DM,HTN or Renal dz
11. ETIOLOGY AND
PATHOGENESIS
Basic etiology is ABNORMAL
PLACENTATION:failure of
trophoblast invasion
Failure of second wave of
endovascular trophoblast
migration resulting in reduction
of blood supply to the
fetoplacental unit
12. ETIOLOGY AND
PATHOGENESIS
2 main things we should
remember:ENDOTHELIAL
DYSFUNCTION:due to oxidative
stress and inflammatory
mediators,VASOSPASM due to
imbalance btw
vasodilators(Prstcyl,NO) and
vasoconstriction(TXA2,ANG
II,ENDOTHELIN
13. POSSIBLE MECHANISM OF
ACTION OF PIH
Abnormal cystotrophoblast
invasion->decrease in uterine
placental blood flow->placental
ischaemia->placental release of
cytokine factors(TNF,IL6,placental
syncytiotrophoblast microvillous
membranes)->endothelial
dysfunction->decrease renal
pressure natriuresis->HTN
14. CLINICAL FEATURES
Increase BP
Proteinuria
Headache
Double vision
Blurred vision
Epigastic pain
Flashing lights
Nausea and vomiting
Rapidly increasing oedema
15. INVESTIGATION
Hb and Haematocrit values increases
due to haemoconc. Caued by
decreased plasma volume
Pl count decreases due to incr
intravascular destruction
Clotting profile:clotting
time,PT,partial thromboplastin time &
Fibrinogen level.
16. INVESTIGATION
Serum uric acid tends to be raised but
falls in normal pregnancy.
Serum urea and critenine increases
Liver enzymes elevated ie Alanin &
Aspartate transaminases.
Urinalysis-daily for proteinuria
17. Management
Aims of management:
To prevent maternal complications
To prevent fetal mobidity & mortality.
Patient with mild hypertension without
proteinuria are given out-patient treatment,
councelled & follow up.
18. Management
Aims of management:
Those with proteinuria & severe HTN require
hospital admission for further Investigation &
MX.
But in general the maturity of the fetus
determines the line of action. For
instance,pregnancy of 37-42 weeks with
proteinuria, severe htn requires immediate
BP control and delivery of the baby.
19. Management.........
For cases in which the baby is
immature,conservative
management is adopted to
achieve reasonable maturity to
minimize prenatal death.
However, if BP bcomes
uncontrolled,conservative
management must be
abandoned regardless of the
gestational age of fetus.
20. Conservative management
Bed rest
Monitor urine output & Bp
Review results of maternal and fetal invs
Further management plan
Antihypertensive drugs
LIST OF DRUGS USED
-methyldopa
-hydralazine
-Beta blockers
21. Conservative management
-mix beta & alpha blockers eg.Labetelol
-CCBs eg Nifedipine
In severe HTN,pre treatment with IV
colloids such as haemacel or human
solution not>500mls.useful for improving
renal & uteroplacental blood flow.also help
to reduce BP
22. Fetal assessment
Wellbeing of the fetus can be can
assessed by
-fetal heart rate monitoring
-daily fetal kick charts
-fetal growth
-liquor volume & umbilical artery
dopplers
24. PREVENTION OF PE
Low doses of aspirin(75mg)start
early in 2nd trimester
Calcium supplement is
beneficial in women@high risk
of PE and in those with low
dietary calcium intake
25. ECLAMPSIA
It is defined as PIH
experiencing convulsive attacks
or fits
INCIDENCE
It varies frm one part of the
world to another.
It is low in western countries as
compared to developing
27. Pathology
The pathological features seen in
Eclampsia are mainly due to vascular
spastic effect on some organs.
On the kidneys,bcos of marked spasm of
the glomerular arterioles with narrow
lumina which subsequently enlarge & the
capillary end arterial cells are swollen
with wide spread tubular necrosis.
On the liver,it shows subscapular
haemorrhage & haemorrhagic infarcts.
28. pathology
On the brain,vascular changes
occur in which edema is often
marked.Tiny or large
haemorrhage are often
present.
The lungs show evidence of
congestion,infection or
aspiration pneumonia.
31. DIFFERENTIAL DX
Idiopathic epilepsy
Meningitis
Encephalitis
HIV encephalopathy
Cerebral malaria
Diabetic or hypoglycaemic
coma
32. MX
Control convulsion by giving
magnesium sulphate
Control hypertension using
antihypertensive drugs eg
Hydralazine
Fluid & electrolyte balance
Delivery of the baby.
33. COMPLICATIONS
Cardiac failure
Renal failure.
Hyperpyrexia with or without evidence of
infection.
Cerebrovascular accident
HELLP(Haemolysis, Elevation of Liver
enzyme, Low Platelets) syndrome
Mendelson’s syndrome
34. Complications.......
NOTE THAT;
Delivery is the only cure
Antihypertensive only lower the BP but does not prevent
progress of the dz
Don’t stop giving a bolus dose of magnesium sulphate
