HYPERTENSION  IN  PREGNANCY
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HYPERTENSION IN PREGNANCY LEADING CAUSE OF MATERNAL DEATH AND PERINATAL MORTALITY / MORBIDITY BP MONITORING IS MAJOR ACTIVITY OF ANTENATAL CARE AFFECTS UP TO 10 % OF ALL PREGNANCIES. 75 70. wks. 40. 0. TERMINOLOGY. korotkofF V normal pregnancy. dbs.

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HYPERTENSION IN PREGNANCY LEADING CAUSE OF MATERNAL DEATH AND

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Hypertension in pregnancy leading cause of maternal death and

HYPERTENSION IN PREGNANCY

LEADING CAUSE OF MATERNAL DEATH AND

PERINATAL MORTALITY / MORBIDITY

BP MONITORING IS MAJOR ACTIVITY OF

ANTENATAL CARE

AFFECTS UP TO 10 % OF ALL PREGNANCIES


Hypertension in pregnancy leading cause of maternal death and

75

70

wks

40

0

TERMINOLOGY

korotkofF V

normal

pregnancy

dbs

ABNORMAL VALUES ?

> 140 / 90 ( NELSON)

DBP > 90 two readings

systolic rise > 30 or diastolic > 15

PROTEINURIA

> 0 . 3 GM IN 24 HOURS


Hypertension in pregnancy leading cause of maternal death and

CLASSIFICATION

PREGNANCY INDUCED HYPERTENSION

DEVELOPING AFTER 20 / 40

PREVIOUSLY NORMOTENSIVE

PROTEINURIC PIH ( PRE - ECLAMPSIA)

> 0 . 3 G / 24 HR

CHRONIC HYPERTENSION

DIAGNOSED BEFORE OR DURING

PREGNANCY

- essential

- renal disease

- phaeo / conn’s

- coartation

CHRONIC HYPERTENSION WITH SUPERIMPOSED

PRE – ECLAMPSIA

ECLAMPSIACONVULSION DURING PREGNANCY

OR WITHIN 7 DAYS OF DELIV.,

NOT CAUSED BY EPILEPSY


Hypertension in pregnancy leading cause of maternal death and

PET

AETIOLOGY

GLYCEROPHOSPHOLIPIDS

ARACHIDONIC ACID

CYCLO

OXYGENASE ASPIRIN

PROSTAGLANDINS

THROMBOXANES PROSTACYCINS

?IMMNUNOLOGIC MECHANISMS


Hypertension in pregnancy leading cause of maternal death and

PET RISK FACTORS

PRIMIGRAVIDA OR NEW PARTNER

AGE

RACE

LOW SOCIAL CLASS

FAMILIAL TREND ? SINGLE GENE

UNDERLYING HYPERTENSIVE DISORDER 20 %

DIABETES 50 %

TWINS ( MONO) 30 %

HYDATIDIFORM MOLE

PREVIOUS PET 30 %


Hypertension in pregnancy leading cause of maternal death and

SEVERE ( FULMINATING ) PET

DBP > 110 WITH PROTEINURIA

SYMPTOMSHEADACHE

VISUAL SPOTS

EPIGASTRIC PAIN

VOMITING

HYPER - REFLEXIA


Hypertension in pregnancy leading cause of maternal death and

head ache


Hypertension in pregnancy leading cause of maternal death and

PET MANAGEMENT

MILD-MONITOR, DELIVER NEAR TERM

MODERATE-FETUS MATURE, DELIVER

-FETUS IMMATURE, MONITOR

MOTHERLFT

URIC ACID, BUN

CREATININE CLEARANCE

COAGULATION

SYMPTOMS

BABYBIOPHYSICAL

GROWTH

DOPPLER

NST


Hypertension in pregnancy leading cause of maternal death and

ANTIHYPERTENSIVES

LONG TERM

METHYL DOPA

LABETOLOL

ATENOLOL

NIFEDIPINE

HYDRALLAZINE

ACUTE

HYDRALLAZINE

SODIUM NITRO – PRUSSIDE

LABETOLOL


Hypertension in pregnancy leading cause of maternal death and

ANTICONVULSANTS

PROPHYLAXIS

MAGNESIUM SULPHATE

PHENYTOIN

DIAZEPAM

TREATMENT

DIAZEPAM


Hypertension in pregnancy leading cause of maternal death and

ECLAMPSIA

RxControl airway

Stop convulsion

reduce BP

Deliver ( GA C. Section)

watch postnatally

† FROM BRAIN HEMORRHAGE AND 60 %

HAVE LIVER DYSFUNCTION


Hypertension in pregnancy leading cause of maternal death and

PREDICTION OF PET

RISK FACTORS

ROLL OVER TEST OF GANT

ANGIOTENSION II PRESSOR TEST

URIC ACID

COAGULATION FACTORS

SERUM RHUBARB

DOPPLER ULTRASOUND


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