PREGNANCY INDUCED

HYPERTENSION
By Jasmine Mary John
TYPES OF HYPERTENSIVE DISORDERS IN
PREGNANCY
 GESTATIONAL HYPERTENSION
 PRE ECLAMPSIA
 ECLAMPSIA
 CHRONIC HYPERTENSION
 PREECLAMPSIA SUPERIMPOSED ON CHRONIC HYPERTENSION
GESTATIONAL HYPERTENSION

 A sustained rise of BP to 140/90 mm Hg or more on at least two occasions, 4 or more

hours apart beyond the 20th week of pregnancy or within the first 48 hours of delivery
in a previously normotensive woman

The following criteria should be fulfilled:

 There is absence of any evidence for underlying cause of hypertension
 Generally unassociated with edema or proteinuria, or raised uric acid levels,
haemoconcentration, hepatic dysfunction, thrombocytopenia.
 The BP returns to normal by 12 weeks postpartum
PRE-ECLAMPSIA SYNDROME
 Pregnancy specific syndrome that can affect virtually any organ,
characterized by development of HTN to the extent of 140/90 mmHg or more
with Proteinuria after the 20th week in a previously normotensive and
nonproteinuric woman.
 HYPERTENSION + PROTEINURIA
 Proteinuria reflects system wide endothelial leak
 24 hour urine excretion > 300mg
 Urine protein creatinine ratio ≥ 0.3
 Persistent 30mg/dl (1+dipstick) in random urine sample
ECLAMPSIA

 ‘Like a flash of lightening’ – Greek word

 Preeclampsia when complicated with grand mal seizures(generalized tonic
clonic convulsions) and/or coma is ‘eclampsia’
 Seizures are generalized and may occur before, during or after labor
PREECLAMPSIA PREDISPOSED ON
CHRONIC HYPERTENSION
 Chronic underlying hypertension is diagnosed in woman with BP ≥ 140/90 mmhg
before pregnancy or before 20 weeks gestation; or both
 If new onset or worsening baseline hypertension is accompanied by new onset
proteinuria or other findings; then ‘superimposed pre-eclampsia’ is diagnosed
 Usually develops earlier in pregancy as compared to pure pre-eclampsia
 Usually associated with fetal growth restriction
RISK FACTORS – PREECLAMPSIA

 Nulliparous
 Obesity
 Multifetal gestation
 Maternal age 35 years or older
 History of pre-eclampsia
 Gestational DM
 SLE
ETIOPATHOGENESIS
ETHIOPATHOGENESIS

 Pre eclampsia syndrome is characterized by abnormalities that result in

vascular endothelial damage with resultant vasospam, transudation of
plasma, ischemic and thrombotic sequelae
 Presence of chorionic villi is essential but need not be intrauterine
 A fetus is not a requisite for pre-eclampsia to develop
ETIOLOGY
MANAGEMENT ALGORITHM FOR SEVERE
PREECLAMPSIA < 34 WEEKS
CONSIDERATION FOR DELIVERY
MANAGEMENT OF ECLAMPSIA
WHICH PATIENTS SHOULD BE GIVEN
MAGNESIUM SULPHATE?
MAGNESIUM SULPHATE TOXICITY

 Eclamptic convulsions are almost always prevented or arrested by plasma

magnesium levels maintained at 4 to 7 mEq/L
 Patellar reflexes disappear when these levels reach 10 mEq/L – warning of
impending magnesium toxicity
 > 10 mEq/L – breathing weakened
 At 12mEq/L or higher, respiratory paralysis and respiratory arrest follow
 Treatment: Calcium gluconate, 10ml (10% solution) IV slowly.
SERIOUS COMPLICATIONS OF SEVERE
HYPERTENSION
 Placental abruption
 HELLP Syndrome
 Pulmonary edema
 Renal failure
 Eclampsia
 Perinatal/maternal death
 Hypertensive encephalopathy
 Ruptured liver hematoma
MANAGEMENT OF SEVERE HYPERTENSION

 Antihypertensive agents :
 Hydralazine IV (5mg initially upto 30mg)
 Labetalol – alpha 1 and nonselective beta blocker (20mg IV bolus, upto 220mg
total)
 Nifedipine – calcium channel blocker (10mg initially and repeat if necessary
after 30 mins)
 Diuretics – can compromise placental perfusion and hence not recommended
FLUID THERAPY
THANK YOU 😊