hypertensivedisorders of pregnancy. pregnancy induced hypertension hypertension/ or proteinuria...

HYPERTENSIVEDISORDERS OF HYPERTENSIVEDISORDERS OF PREGNANCYPREGNANCY

Pregnancy Induced Hypertension

Hypertension/ or Proteinuria developing after 20 weeks of pregnancy, during labour or puerperium in a previously normotensive non- proteinuric woman (ISSHP)

PRE-ECLAMPSIA

Hypertension and Proteinuria Occurring after the 20th week of gestation in a previous normotensive, non proteinuric woman

ECLAMPSIA ECLAMPSIA Above signs + fits.

SUPERIMPOSED PRE – ECLAMPSIASUPERIMPOSED PRE – ECLAMPSIARise of 30 mm hg systolic Or 15 mm hg

diastolic above previous levels with proteinuria

• One measurement of DBP of 110 mm Hg or more

OR• Two consecutive measurements of DBP > 90 mm Hg 4 h or more apart.

HYPERTENSION

PROTEINURIA • Protein excretion of 300 mg or more in

24 hours urine OR

• Two random clean catch or catheter urine specimen with 2+ (1 gm albumin/L) or more

PATHOGENESISPATHOGENESIS

1.1. Rejection phenomenonRejection phenomenon2.2. Uteroplacental ischaemiaUteroplacental ischaemia3.3. Imbalance between prostacyclin andImbalance between prostacyclin and ThromboxaneThromboxane4.4. Decreased GFR with salt and water Decreased GFR with salt and water

retention.retention.5.5. Decreased intra vascular volumeDecreased intra vascular volume6.6. Increased central nervous system Increased central nervous system

irritabilityirritability7.7. D.I.CD.I.C8.8. Dietry factorsDietry factors9.9. Uterine muscle stretchUterine muscle stretch10.10. Genetic factorsGenetic factors

Exact cause is unknown some theories areExact cause is unknown some theories are:

NORMAL PREGNANCYNORMAL PREGNANCY

VasodilatationVasodilatationUteroplacental blood flowUteroplacental blood flowPlatelet aggregationPlatelet aggregation

ThromboxaneThromboxane

ThromboxaneThromboxaneProstacylinProstacylin

VasodilatationVasodilatationUteroplacental blood flowUteroplacental blood flowPlatelet aggregationPlatelet aggregation

PRE -ECLAMPSIAProstacyclin

PRE DISPOSING FACTORS• Age 20 yrs in primi > 30 yrs in

all.• Race• Climate• Diet• Social status• Multiparty• Multiple gestation• Molar pregnancy• Pre existing hypertension• Previous h/o preclampsia, eclampsia• Family history of PIH• Diabetes mellitus • Non immune hydrops• Anti phospholipid antibody syndrome• Collagen disease

FOETALFOETAL1.1. Intra uterine growth retardationIntra uterine growth retardation2.2. Intra uterine deathIntra uterine death3.3. PrematurityPrematurity4.4. Intrapartum foetal distress or still Intrapartum foetal distress or still

birthbirthMATERNALMATERNAL 1.1. EclampsiaEclampsia2.2. Abruptio placentaeAbruptio placentae3.3. D.I.C D.I.C 4.4. Retinal complications Retinal complications 5.5. Renal failureRenal failure6.6. Liver failureLiver failure7.7. Hypertensive encephalopathyHypertensive encephalopathy

COMPLICATIONS

MILD DBP OF < 160/110 No Proteinuria MODERATE

BP OF > 160/110 + Proteinuria SEVERE

1. BP OF > 160/110 mm Hg2. Proteinuria - 5 G IN 24 hoursor 3 – 4

+ on Dipstick3. Oliguria < 500 mls in 24 hours

4. Cerebral & visual disturbances5. Epigastric pain

6. Thrombocytopenia7. Pulmonary oedema 8. Jaundice

TYPES OF P.I.H

LABORATORY FINDINGS

* Haemoglobin and heamatocrit high Platelet count low Serum creatinine high Serum uric acid high AST high Fibrin split products high Alkaline phosphatase high Lactate dehydrogenase high

HELLP SYNDROME

H - Haemolytic anaemia El - Elevated liver enzymes LP - Low platelets

Management• Mild hypertension

– Admit– PIH profile– Record BP four hourly– If BP is controlled and PIH profile is normal

discharge the patient and ask for regular antenatal visits according to gestational age

• Moderate Hypertension– Admit the patient– Record BP four hourly– PIH profile– Anti hypertensive

• Aldomet 250mg up to 04 g daily• Anticonvalacine • Low dose aspirine

• Severe Hypertension– Admit the patient– PIH profile– Record BP four hourly– Antihypertensive– Anticonvalacine– Bishop scoring– Delivery of patient

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