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Hypertension in Pregnancy


• Complicate 10-20% of pregnancies

• Elevation of BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, on two occasions at least 6 hours apart.

• Categories for Hypertensive Disorders;
– Preeclampsia

– Chronic Hypertension

– Preeclampsia superimposed on Chronic Hypertension

– Gestational Hypertension

• “Pregnancy Induced Hypertension”
• New onset of hypertension and proteinuria after 20 weeks gestation.
– Systolic blood pressure ≥140 mmHg OR diastolic blood pressure ≥90 mmHg
– Proteinuria of 0.3 g or greater in a 24-hour urine specimen
– **Preeclampsia before 20 weeks, think MOLAR PREGNANCY!

• Classified as;
– Mild Preeclampsia
– Severe Preeclampsia

• Eclampsia
– Occurrence of generalized convulsion and/or coma in the setting of preeclampsia, with no other neurological condition.

• Severe Preeclampsia must have one of the following;
– Symptoms of central nervous system dysfunction
• Blurred vision, scotomata, altered mental status, severe headache
– Symptoms of liver capsule distention
• Right upper quadrant or epigastric pain
– Nausea, vomiting
– Hepatocellular injury
• Serum transaminase concentration at least twice normal
– Severe blood pressure elevation
• Systolic blood pressure ≥160 mm Hg or diastolic ≥110 mm Hg on two occasions at least six hours apart
– Thrombocytopenia
• Less than 100,000 platelets per cubic milimeter
– Proteinuria
• 5 or more grams in 24 hours
– Oliguria
• <500 mL in 24 hours – Severe fetal growth restriction – Pulmonary edema or cyanosis – Cerebrovascular accident 

Chronic Hypertension • “Preexisting Hypertension” • Systolic pressure ≥ 140 mmHg, diastolic pressure ≥90 mmHg, or both. • Present before 20th week of pregnancy or persists longer then 12 weeks postpartum. • 
Chronic Hypertension caused by; – Primary (Essential Hypertension). – Secondary from medical disorders. 

Preeclampsia superimposed upon Chronic Hypertension • Preexisting Hypertension with the following additional signs/symptoms; – New onset proteinuria – Hypertension and proteinuria beginning prior to 20 weeks of gestation. – A sudden increase in blood pressure. – Thrombocytopenia. – Elevated aminotransferases. 

Gestational Hypertension • Mild hypertension without proteinuria or other signs of preeclampsia. • Develops in late pregnancy. • Resolves by 12 weeks postpartum. • Can progress onto preeclampsia. • Usually when gestational hypertension develops before 30 weeks gestation.

Risk Factors for Hypertension in Pregnancy 

• Nulliparity • Preeclampsia in a previous pregnancy • Age >40 years or <18 years
• Family history of pregnancy-induced hypertension
• Chronic hypertension
• Chronic renal disease
• Antiphospholipid antibody syndrome or inherited thrombophilia
• Vascular or connective tissue disease
• Diabetes mellitus (pregestational and gestational)
• Multifetal gestation
• High body mass index
• Male partner whose previous partner had preeclampsia
• Hydrops fetalis
• Unexplained fetal growth restriction

Evaluation of Hypertension in Pregnancy
• History;
• ID and Complaint
• HPI (S/S of Preeclampsia)
• Past Medical Hx, Past Family Hx
• Past Obstetrical Hx, Past Gyne Hx
• Social Hx
• Medications, Allergies
• Prenatal serology, blood work
• Assess for Hypertension in Pregnancy risk factors
• Physical;
• Vitals
– Vision (blurry, scotomata), Headache
• Cardiovascular
• Respiratory
• Abdominal
– Epigastric pain, RUQ pain
• Neuromuscular and Extremities
– Reflex, Clonus, Edema
• Fetus
– Leopold’s, FM, NST

• Laboratory Investigations;
• CBC (Hg, Plts)
• Renal Function (Cr, UA, Albumin)
• Liver Function (AST, ALT, ALP, LD)
• Coagulation (PT, PTT, INR, Fibrinogen)
• Urine Protein (Dipstick, 24 hour)

Management of Hypertension in Pregnancy
• Depends on severity of hypertension and gestational age!!!!

• Observational Management
• Restricted activity
• Close Maternal and Fetal Monitoring
– BP
– S/S of preeclampsia
– Fetal growth and well being (NST, U/S)
• Routine weekly blood work

• Medical Management
• Acute Therapy = IV Labetalol, IV Hydralazine, SR Nifedipine
• Expectant Therapy = Oral Labetalol, Methyldopa, Nifedipine
• Eclampsia prevention = MgSO4

• Contraindicated antihypertensive drugs;
• ACE inhibitors
• Angiotensin receptor antagonists

• Proceed with Delivery
• Vaginal Delivery VS Cesarean Section
• Depends on severity of hypertension!
• May need to administer antenatal corticosteroids depending on gestation!

• Only cure is DELIVERY!!!

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