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Hypertensive Disorder in Pregnancy Obgyn
Hypertensive Disorder in Pregnancy Obgyn
disorder in
Pregnancy
INTERN. RACHATA PIRIYAMANUN
ADVISOR. SUPATTA
Maternal mortality
(baseline)
2
nd
trimester decreasing
3rd trimester increasing to
baseline
“Lowest BP at 24-28 weeks”
Definition of hypertension
○ Pulmonary edema
Chronic HT Superimposed
< 20 weeks GA preeclampsia
HT Proteinuria Seizure
(300mg/d or
UPCI>0.3)
Gestational HT ✔ ✖ ✖
Preeclampsia ✔ ✔ ✖
Eclampsia ✔ ✔ ✔
Preeclampsia with severe feature?
● Preeclampsia with one of following
○ SBP> 160 mmHg or DBP> 110 mmHg 2 time in 4 hour
○ Pulmonary edema
Ring sign
Laboratory
● UA, UPCI for Proteinuria
● CBC for Thrombocytopenia
● BUN, Cr for Renal insufficiency
● LFT for Impaired liver function
● Uric for hyperuricemia
● Electrolyte
● Coagulation
● HELLP syndrome
○ Hemolysis Elevated Liver enzyme Low Platelets
What is HELLP syndrome ?
● A “severe form” of severe preeclampsia
● 0.5-0.9% of pregnancies
● 10-20% of severe preeclampsia
● HELLP syndrome
○ Hemolysis
○ Elevated Liver enzyme
○ Low Platelets
Complications of HELLP
Maternal complications Maternal complications
Occurrence Occurrence
(%) (%)
Eclampsia 4-9 Eclampsia 4-9
Abruptio placentae 9-20 Abruptio placentae 9-20
DIC 5-56 DIC 5-56
Acute renal failure 7-36 Acute renal failure 7-36
Pulmonary edema 3-10 Pulmonary edema 3-10
7-14 7-14
Wound hematoma/infection (C/S) Wound hematoma/infection (C/S)
Subcapsular hematoma 0.9-2 Subcapsular hematoma 0.9-2