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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

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

ABNORMAL VALUES ?

> 140 / 90 ( NELSON)

DBP > 90 two readings

systolic rise > 30 or diastolic > 15

PROTEINURIA

> 0 . 3 GM IN 24 HOURS


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


PET

AETIOLOGY

GLYCEROPHOSPHOLIPIDS

ARACHIDONIC ACID

CYCLO

OXYGENASE ASPIRIN

PROSTAGLANDINS

THROMBOXANES PROSTACYCINS

? IMMNUNOLOGIC MECHANISMS


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 %


SEVERE ( FULMINATING ) PET

DBP > 110 WITH PROTEINURIA

SYMPTOMSHEADACHE

VISUAL SPOTS

EPIGASTRIC PAIN

VOMITING

HYPER - REFLEXIA



PET MANAGEMENT

MILD - MONITOR, DELIVER NEAR TERM

MODERATE - FETUS MATURE, DELIVER

- FETUS IMMATURE, MONITOR

MOTHER LFT

URIC ACID, BUN

CREATININE CLEARANCE

COAGULATION

SYMPTOMS

BABY BIOPHYSICAL

GROWTH

DOPPLER

NST


ANTIHYPERTENSIVES

LONG TERM

METHYL DOPA

LABETOLOL

ATENOLOL

NIFEDIPINE

HYDRALLAZINE

ACUTE

HYDRALLAZINE

SODIUM NITRO – PRUSSIDE

LABETOLOL


ANTICONVULSANTS

PROPHYLAXIS

MAGNESIUM SULPHATE

PHENYTOIN

DIAZEPAM

TREATMENT

DIAZEPAM


ECLAMPSIA

Rx Control airway

Stop convulsion

reduce BP

Deliver ( GA C. Section)

watch postnatally

† FROM BRAIN HEMORRHAGE AND 60 %

HAVE LIVER DYSFUNCTION


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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