Nahar Taufiq Bagian Kardiologi dan Kedokteran Vaskular FKUGM SMF Jantung/ Pusat Jantung Terpadu RSUP DR Sardjito Jogjakarta Hypertension in Pregnancy: Major cause of maternal and perinatal morbidity and mortality Complicates up to 10% of pregnancies Second leading cause of maternal mortality in the developed world (after VTE) ~1/3 of all maternal deaths are from HTNsive disorders Introduction Physiologic adaptations in normal pregnancy Blood changes: o Plasma volume by 40%. o Platelets count can below 200 X 10 9 /L due to normal maternal blood-volume expansion. o Coagulation factors (Fibrinogen, Factor VII). Cardiovascular changes: o Marked generalized vasodilation ( peripheral resistance) a/w arterial resistance to constrictor actions of Angiotensin II. o CO & Stroke volume. o MAP by 10 mm Hg. Renal changes: o Vasodilation Renal blood flow GFR (by 50%). o in Creatinine clearance with a concomitant in S- Creatinine & urea. o Uric acid clearance & Ca + excretion. o Glucosuria + aminoaciduria. Respiratory changes. Endocrine changes: o e.g. parathyroid, adrenal, weight, GI changes. Physiologic adaptations in normal pregnancy Definitions related hypertensive disorders in pregnancy In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: Chronic hypertension Gestational hypertension Preeclampsia Preeclampsia superimposed on chronic hypertension Severe complications Hypertension in Pregnancy MATERNAL CVA DIC End-organ failure Placental abruption FETAL IUGR, Intra Uterine Growth Restriction Prematurity Intra-uterine death Differentiating Hypertensive in pregnant Assesment of proteinuria Reducing the risk hypertensive disorders in pregnancy Moderate to high Risk Preeclamsia Pre-eclampsia Pre-eclampsia Chronic hypertension X Gestasional Hypertension Severe Hypertension, severe pre-eclamsia and eclamsia Drugs A)Parentral drugs: 1) Hydralazine: It is a peripheral VD. The best Antihypertensive drug used during Pre- eclampsia and Eclampsia. Dose: 5-10mg IV or IM as initial dose. Repeated every minutes until blood pressure is controlled. 2) Labetalol : and non selective - adrenergic blocker resulting in VD. Dose: 10-20mg IV. The dose can be doubled every 10 minutes if proper response is not achieved. 3) Diaz oxide : Used in severe dangerous resistant hypertension as a last resort. Dose: mg IV bolus dose. Repeated every 1-2 minutes until BP decreases. Drugs A )Oral drugs: 1) -methyl DOPA : It is the most commonly used. It is -adrenergic agonist causing depletion of catecholamine stores. Dose: 500mg 3-4 times/day orally. 2) Monohydralazine : It is a weak Antihypertensive when given alone. It used in combination with - blockers to increase its efficacy and decrease its side effects. Drugs 3) - adrenergic blockers: Atenolol (tenormin) mg 4 times daily. Labetalol (Trandate) 10-20mg 3 times daily. 4) Prazocin : It is postsynaptic -adrenergic receptor blocker resulting in VD and reflex tachycardia. It is a weak Antihypertensive drug so used in combination with other drugs. 5) Calcium Channel Blocker: Nifedipine. Drugs Selamat kepada adik adik angk 180 Dr. Djumikan / PD III, Prof DR Koento Wibisono Rektor UNS Prof dr Soetjipto Dekan FK UNS, Dr Sujarsono PD I, Dr Muhardjo PD II