CME _ Hypertension in pregnancy hpsf .pptx

management of hypertension in pregnancy : antenatal, postnatal

1. HYPERTENSION IN PREGNANCY By : Afiqa, Iqlima, Kamalia

2. CLASSIFICATION Chronic Hypertension (Primary or Secondary) Pregnancy Induced Hypertension (PIH) Preeclampsia (PE) Preeclampsia superimposed on chronic hypertension Eclampsia

3. DEFINITION Hypertension BP ≽ 140/90 mmHg taken after a period of rest in 2 separate occasion or 6 hours apart. 2) Pregnancy Induced Hypertension (PIH) Diagnosed after 20 weeks of gestation in previously normotensive patient and will resolve after 6 weeks postpartum without any features of preeclampsia 1) Chronic Hypertension Diagnosed before 20 weeks of gestation or beyond 6 weeks postpartum 4) Preeclampsia Diagnosed after 20 weeks of gestation with significant proteinuria 3) Preeclampsia Superimposed on Chronic Hypertension Diagnosed before 20 weeks of gestation with significant proteinuria 5) E clampsia With present of convulsion not cause by neurological disorder.

4. Significant Proteinuria Is defined as ≽ 300mg protein in a 24 hour urine collection or Spot urine protein / creatinine ratio ≽ 30mg/mmol or Urine dipstick at least 2+

5. Diagnosis of severe preeclampsia BP ≽ 160/110 mmHg + other features of PE ie: Maternal organ dysfunction a)Renal impairment : Creatinine > 90 umol/L b)Liver involvement : RUQ/epigastric pain ± elevetad transaminases at least 2x upper limit of normal c)Neurology complication :eclampsia, blinnd, stroke, headache, hyperreflexia, clonus d)Hematology complication : platelet <150000/dl, DIVC, hemolysis Uteroplacental insufficiency : Fetal growth restriction

6. IE symptoms The symptoms of IE should always be looked for in patients with hypertensive disorders in pregnancy Frontal Headache Blurring of Vision Epigastric pain / RUQ pain Vomiting

7. Complications MATERNAL HEMATOLOGY HELLP syndrome (Hemolysis (LDH) , elevated liver enzyme (ALT and AST) , low platelet) CNS Eclampsia (Cerebral vasospasm leading to ischemia, disruption of BBB and cerebral edema) Cerebral hemorrhage b) EYE Retinal detachment ➝ blurring of vision (sometimes loss of vision) Retinal haemorrhage c) HEART High output failure (Maternal vascular resistance ↑ ⟶ preload ↑ ⟶ left heart failure Acute pulmonary edema (Blood from heart flow back to the lung ⟶ congestion ⟶ ↑ resistance ⟶ pulmonary edema

8. Complications MATERNAL e ) LUNG Aspiration pneumonia (during fit) [loss of protective reflex during fitting］ *Gravid uterus (↑ risk of aspiration pneumonia) ⟶ cause compression ⟶ reduce mortality ⟶ gastric emptying f) LIVER Subcapsular hemorrhage ⟶ epigastric pain Infarction and rupture Congestion g) RENAL Renail failure (Alteration in renal perfusion ⟶ renal failure) Nephrotic syndrome (Glomerular damage ⟶ all protein leaking ⟶ hypoalbuminaemia ⟶ ↓oncotic pressure ⟶ fluid loss to the 3rd space ⟶ generalised edema h) ABRUPTIO PLACENTA d/t necrosis of distal end of spiral arteries

9. Complications FETAL a) IUGR d/t uteroplacental insufficiency ⟶ placental bed ischemia ⟶ ↓blood supply (oxygenation and nutrition) ⇾ asymmetrical IUGR (brain sparin effect d/t redistribution of blood flow) ⇾ head circumference maintain but other body part smaller) b) OLIGOHYDRAMNIOS (↓ blood flow ➝ ↓GFR ➝ ↓ urine output) c) FETAL DISTRESS d) FETAL DEATH / IUD e) PREMATURITY

10. Physical Examination GENERAL BP (both lying and standing) Edema - Facial puffiness, Periorbital edema, pedal edema up to which level? CVS and RESPIRATORY EXAMINATION Bibasal crepitation ⟶ pulmonary edema ABDOMEN Epigastric tenderness CNS Brisk reflex, ankle clonus FUNDOSCOPY Papilloedema, retinal hemorrhage