32,35,37,30

GESTATIONAL
HYPERTENSION
Definition

 A condition in which B.P is greater than

140/90mmHg, measured on two times,4
hours apart. It appears after the 20th week of
gestation and resolves prior to 6 weeks
postpartum
Symptoms

 It is characterized by high blood pressure at

times accompanied by other systemic
symptoms such headaches, blurred vision,
epigastric pain, peripheral or pulmonary
edema ,pleural and pericardial effusion in
severe cases.
Classification

Classified according to degree of rise in blood

pressure.
 Mild greater than or equal to 140/90 mmhg
 Moderate greater than or equal to 150/100
mmhg
 Severe greater than or equal to 160/110
mmhg
Gestational Hypertension vs Pre
eclampsia and Eclempsia
 Preeclempsia: HTN with proteinuria or
aforementioned symptoms ( due to high
hydrostatic pressure)
 Both conditions are hence differed on the
basis of a urinalysis test.
 Eclampsia: preeclampsia + tonic clonic
seizures( due to cerebral edema)
Pathophysiology

 Second wave of trophoblast fails to develop.

It disintegrates the musculoelastic walls of
the spiral arteries consequently dilating
them. Failure to do so results in very narrow
spiral arteries which lead to an increase in
TPR which results in high blood pressure.
 Diminshd blood flow to the fetus can also
lead to IUGR
History

 Family History
 Previous pregnancy with G.HTN
 Renal disease,autoimmine disease,DM
 Inter-pregnancy interval
Risk Factors

1. Pre-existing hypertension
2. Renal disease
3. Diabetes
4. BMI greater than 35 kg/m2
5. Hypertension with a previous pregnancy
6. Mothers age older than 40
7. Pregnancy interval of more than 10 years.
8. In case of twins and triplets
Complications

Fetal:
 IUGR
 Pre-term delivery
 Still birth
Maternal
 Severe hypertension can lead to pre
eclampsia and eclampsia which results in
seizures and death.
Lab tests and diagnoses
 Monitor BP
 RFTs: Creatinine ( more than 1.1?),uric acid
 LFTs (ALT double?) and CPC: Platelet count (less than
1 lac?)
 Urinalysis to rule out pre-eclampsia
 Coagulation profile
 Fetal movement and heart rate is also monitored to see
whether or not its other stress.
 Dopplers flow test is performed to measure the flow of
blood through a vessels so as to ascertain the risk of
developing hypertension.
Monitoring

 Fetal monitoring: check for IUGR…Growth

scan on 4 weekly bases
 Maternal monitoring: urine dipstick test;
counselling (ask to report early in second
conception); call 6 weeks p.p if still greater
than 140/90 label chronic and refer to medical
specialist; start loprin on 12 weeks till delivery
on 2nd conception
Management & Treatment

 Management: labetalol, Ca channel blockers;

methyl dopa( aldomat)
 Treatment : Delivery!
Management and treatment according
to WHO guidlines
Degree of MILD MODERATE SEVERE
hypertesnion
ADMIT TO NO NO YES
HOSPITAL
TREAT NO With oral labetalol With oral labetalol
as first line as first line
MEASURE BP Not more than Atleast twice a Atleast 4 times a
once a week week day
TEST FOR At each visit At each visit Daily
PROTEINURIA
BLOOD TESTS Only those for LFTs, RFTs and full LFTs ,RFts, Full
rouitne antenatal bood count blood count.
care