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
Thank You
