Hypertensive disorders of Pregnancy.pptx

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1. Hypertensive disorders of Pregnancy Moderator Dr. Pruthivi Raj By Dr Pushpa K

2. Index Introduction Classification Etiology and risk factors Pathophysiology Complication Prevention Management

3. Introduction Most common medical complications Incidence 7-10% all pregnancies 70% Preeclampsia – Eclampsia 30% Chronic HTN 0.05 Eclamsia Major cause of maternal and perinatal mortality and morbidity.

4. Classification Gestational Hypertension (transient Hypertension) Preeclampsia – Eclampsia syndrome Chronic Hypertension Preeclampsia superimposed on chronic Hypertension

5. Gestational Hypertension BP 140/90 mmHg or more for the first time in pregnancy after 20 weeks of gestation on 2 occasions 4 hours apart. No proteinuria Return on BP to normal within 12 weeks after delivery.

6. Preeclampsia – Eclampsia syndrome

7. Chronic Hypertension A known hypertensive human becoming pregnant with BP 140/90 mmHg or more before pregnancy or diagnosed before 20 weeks of pregnancy. Hypertension first diagnosed after 20 weeks but persisting 12 weeks after delivery.

8. Preeclampsia superimposed on chronic Hypertension Development of features of preeclampsia in chronic hypertension. New onset of proteinuria after 20 weeks of gestation in a woman who had hypertension but no proteinuria before 20 weeks of gestation. Sudden increase in proteinuria. Sudden increase in BP in a woman where BP was well controlled. Thrombocytopenia Deranged LFT/RFT

9. Indicators of Severity of gestational hypertensive disorders

10. Risk factors

11. Etiology Etiology – Unknown Some of theories Abnormal trophoblast invasion Vascular endothelial damage Immunologic theory Dietary deficiency Increased Pressor response Angiogenic and antiangiogenic proteins Genesis of Pre-eclampsia as a Two-stage disorder

12. Pathophysiology

13. HELLP Syndrome Criteria for Diagnosis for HELLP Syndrome Hemolysis, Bilirubin more than or equal to 1.2 mg/dL, absent plasma haptoglobulin , schistiocytes in the blood smear(LDH > 600 IU/L). Elevated liver enzymes ( AST or ALT > 70 IU/L) Low platelet count, Platelets < 100 * 10 3 / mm 3

14. HELLP Syndrome Classification

15. Complications During pregnancy During labour During Puerperium Eclampsia Eclampsia Eclampsia Abruptio placenta Postpartum haemorrhage Postpartum shock Oliguria Increased operative delivery Infection Eye complications Death Death Preterm labour Cerebral haemorrhage Coagulation failure and DIC HELLP syndrome ARDS Maternal complications

16. Foetal complications Intrauterine growth restriction Intrauterine asphyxia Intrauterine foetal death Prematurity Oligohydramnious

17. Prevention Use of antiplatelet agent Use of calcium

18. Anti-Hypertensive drugs

19. Investigation Maternal Complete blood count Coagulation profile Renal function test Liver function test Urine Examination Ophthalmoscopic examination Fetal monitoring Daily fetal movement count Non-stress test Ultrsound

20. Management of gestational hypertension

21. Timing of birth Do not offer planned early birth before 37 weeks to women with gestational hypertension whose blood pressure is lower than 160/ 110 mmHg, unless there are other medical indications. For women with gestational hypertension whose blood pressure is lower than 160/110 mmHg after 37 weeks, timing of birth, and maternal and fetal indications for birth should be agreed between the woman and the senior obstetrician. If planned early birth is necessary, offer a course of antenatal corticosteroids and magnesium sulfate if indicated.

22. Management of Pre-eclampsia

23. Management of Chronic Hypertension Preconceptional care Treatment during pregnancy Timing of birth

24. Management of Eclampsia Basic Principles fall under three major categories: Control of convulsion Control of hypertension Delivery of the fetus

25. MGSO 4 Regiments

26. Monitoring Patellar reflex RR > 16/min. U/O > 100ml/4hrs Serum Mg++ level.

27. Long-term Consequences Cardiovascular Neurovascular Metabolic Renal Central nervous system Chronic hypertension Stroke Type 2 diabetes Glomerular dysfunction White-matter lesions Ischemic heart disease Retinal Detachment Metabolic syndrome Retinopathy Atherosclerosis Diabetic Retinopathy Obesity Cardiomyopathy Thromboembolism

28. References Williams textbook of Obstetics ACOG and NICE guidelines JB Sharma

29. Thank you