Pregnancy induced hypertension
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This document provides an overview of pregnancy induced hypertension (PIH), including its definition, risk factors, pathophysiology, clinical features, investigations, complications, and treatment. Some key points: - PIH complicates 5-10% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. - It is defined as new onset hypertension (blood pressure over 140/90 mmHg) and proteinuria developing after 20 weeks of gestation. - The pathophysiology involves vasoconstriction due to an imbalance in vasodilators and vasoconstrictors, which can lead to complications like IUGR, preterm birth, and eclampsia.
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Pregnancy induced hypertension
- 1. Pregnancy induced hypertension Dr v. l. deshmukh Asso prof GMCH A’bad
- 4. INTRODUCTION • Global problem • Complicates 5-10% of pregnancy • Responsible for 15-20% maternal mortality • 20-25% PNM • Haemodynamic changes are complex • Risk factors still not well understood
- 5. defination • Multysystem disorder • BP IS RAISED • Systolic >140 mm of hg • Diastolic >90 mm of hg • Asso with proteinuria • May or may not be asso with edema feet • Asso with abnormal wt gain
- 6. physiology • Progesteron in pregnancy leads to smooth muscle relaxation • Results in vasodilatation • Peripheral resistance falls • Leads to fall in BP • THUS BP FALLS IN PREGNANCY • Instead if it rises it is abnormal-PIH
- 7. BP • Systolic >140 • Diastolic>90 • 15 mm rise in diastolic • 30 mm rise in systolic • Over the previous readings • AFTER 20 WK OF GESTATION • Important to have BP readings in early pregnancy
- 8. proteinuria • Significant proteinuria is defined as 300 mg/l or more in 24hr urine sample • Traces= • 1+= • 2=+ • 3+=>3gm/l • 4+=>5 gm/l
- 9. Wt gain • Normal wt gain during pregnancy is 11kg • If wt gain is more –could be a sign of PIH • .>1LB/WK • >500GM/WK • Wt gain is due to water retention • Water retention is due to NA+ RETENTION • Results in edema all over the body ,specially feet(dependant part)
- 10. classification • PIH • Gestational HT(not asso with proteinuria) • Chronic HT(before 20 wk ) • Eclampsia • PIH-mild/ severe
- 11. Mild PIH • BP-140/90 to 160/110 mm of hg • Proteinuria<2+ • Asso with abnormal wt gain • May or may not be asso with edema feet • NOT ASSO WITH WARNING SYMPTOMS
- 12. Severe PIH • BP>160/110 mm of hg • Proteinuria>2+ • Abnormal wt gain • Edema +/- • Asso with warning symptoms • Asso with abnormal haematological inv • oliguria.,DIC,IUFD,jaundice
- 13. Risk factors • Genetic predisposition • Primigravida • Positive family history • Vascular ds • Renal ds • Poor SES • Unbooked • Teenage pregnancy
- 14. pathophysiology •Vasoconstriction •Why? •Vessels more sensitive to vasoconstrictors •Refractory to vasodilators •Vosoconstrictors increase •Vasodilators decrease
- 15. • Normal preg • BALANCE BETWEEN VCAND VD • Net result is VASODILATATION • PIH • IMBALANCE IN VC AND VD • Net result is VASOCONSTRICTI ON
- 16. Results of vasoconstriction • Reduced blood supply to uterus=IUGR • Reduced blood supply to kidney=oliguria • Reduced blood supply to liver=jaundice • Reduced blood supply to brain=headache • Reduced blood supply to eyes=blindness • Reduced blood supply to heart=chest pain • Reduced blood supply to liver=epigastric pain
- 17. Results of vasoconstriction • Decreased intravascular compartment • Less amount of blood •Less amount of plasma volume •Extravasation of excess fluid=edema all over body •Haemoconcentration •Rise in disatolic BP
- 18. Vasocon--- • Genetic/immunologic cause • Altered prostaglandin ratio • Elevated thromboxane/prostacyclin ratio- (TXB2/PGI2) • ARTERIAL VASOCONSTRICTION • Rise in vascular tone and vasospasm • Increase angiotensin2 synthesis-rise in BP
- 19. 2.ENDOTHELIAL INJURY • Endothelium-innermost layer of BV • Vasocons-slowing of blood • Decreased nitricoxide • Endothelial injury
- 20. Endo injury--- • Endoth injury leads to platlet aggregation • Platelets get exhausted •Thrombocytopenia • New platelets thrown in the circulation • New pl are more adhesive in nature • Lead to more pl aggregation • More thrombocytopenia
- 21. Endo injury--- • Pl aggregation further reduce the lumen of BV • Further depletion in blood supply • Pl agg results in formation of microthrombi in minute BV •INTRAVASCULAR COAGULATION= = = DIC
- 22. DIC • DEPOSITION OF FIBRIN • Kidney=proteinuria, edema, oliguria • CNS=headache,visual disturbances,convulsions • Liver=epigastric pain,hepatic dysfunction • Blood=DIC, haemolysis.
- 23. Clinical features • H/o amenn • Edema over ankles, abdomen, vulva, face • Headache • Epigastric pain • Oliguria • Blurring of vsion • H/o jaundice
- 24. C/F • Nausea,vomittings • Loss of FM • BLDG GUMS • Haematuria • F/o abruptio pl • Bldg P/V
- 25. O/E • Wt gain is more • Bp raised • Edema feet,abd wall edema,vulval edema • Bloated • DTR-brisk
- 26. investigations • HB%, platelet count,BT/CT • Urine-albumin • PCV • KFT • LFT • Coagulation profile • funduscopy
- 27. COMPLI--- • Aim-prevent • Detect at the earliest • Treat it timely • Before it endangers life • ALL COMPLICATIONS CAN BE AVOIDED/MINIMISED BY TIMELY INTERFERENCE
- 28. Inv--- • USG-fetal wt,,AFI, FHS, abruptio pl • BPP • Doppler • NST • Se electrolytes • se uric acid • CT scan
- 29. HELLP • Elevated liver enzymes • Low pl count • Normal count=>1.5 lac • 1=1-1.5 lac • 2=50,000-1 lac • 3=<50,000
- 30. complications • Maternal • Fetal • IUGR • IUFD • PRETERM • FD
- 31. COMP--- • MATERNAL • Eclampsia • Abruptio pl • DIC • Oliguria • HELLP • blindness
- 32. • Preterm labor • PPH • Deep venous thrombosis • Pulmonary embolism • ICH • Saggital sinus thrombosis
- 33. T/t • Principles of mgt • Control of BP-90-100 DIASTOLIC • Prevention of complications • If BP controlled- till term • If BP not controlled-ignore the fetal maturity & terminate the pregnancy
- 34. Control of BP • Bedrest • Antihypertensives • Cap depin-10 mg TDS/QID • Tab methyldopa-250-500mg TDS/QID • Tab labetelol-50 mg BD • HYPERTENSIVE CRISIS- inj labetelol 5- 10 mg slowly
- 35. Fetal monitoring USG DFMC • BPP • NST • Doppler
- 36. COMPLICATIONS • INV WILL POINT TOWARDS COMPLICATION • Pl count- low • LFT-deranged • KFT-deranged • BT/CT- prolonged
- 37. Timely interference • Maternal factors • Headache, nausea,vomitting,epi pain • DTR brisk • Oliguria • Bldg gums/haematuria • HELLP • ALBUMINURIA 4+
- 38. TIMELY INTERFERENCE • Fetal • Loss of FM • Oligohydramnions • NST –nonreactive • Doppler-absent/reversed BF • SEVERE IUGR
- 39. MATERNAL MORTALITY • Better understanding,blood tranfusions, componant therapy,steroids • Causes of death • Eclampsia • PPH • Abruptio pl • embolism