Hypertension in pregnancy. Hypertensive disorders complicate 3.7% of all pregnancies and is a leading cause of maternal and perinatal mortality and morbidity. Identification of patients at high risk and timely detection with proper management can prevent life threatening complications.
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Hypertension in pregnancy
Hypertensive disorders complicate 3.7% of all pregnancies and is a leading cause of maternal and perinatal mortality and morbidity.
Identification of patients at high risk and timely detection with proper management can prevent life threatening complications.
Diagnosis-working group report(2000)
Bp >/= 140/90 mm of hG for first time during pregnancy
Bp returns to normal within 12 weeks postpartum
So final diagnosis-only post partum
-minimum criteria bp>/=140/90 mm of hg after 20 weeks gestation.
Increased certainity of pre-eclampsia
3)eclampsia-seizures that cannot be attributed to other causes in a woman with pre eclampsia
4)Superimposed preeclampsia(on chronic hypertension)
New onset proteinuria >/=300 mg/24 hrs but no proteinuria before 20 weeks.
Sudden increase in proteinuria/BP/platelet count<100,000/cumm if hypertension & proteinuria before 20 weeks
5)Chronchypertension-BP>/=140/90 mm of hg before pregnancy or before 20 weeks gestation (excluding hydatidiform mole/acute polyhydramnios)
Hypertension first diagnosed after 20 weeks gestation and persistent after 12 weeks post partum.
h/o symptoms of pre-eclampsia(usually after 20th week)
To diagnose HT in pregnancy BP should be >/= 140/90 mm of hg at 2 separate readings at least 4 hrs apart.
MAP=systolic BP+2* diastolic BP
MAP>/=105 mm of hg or ^ in MAP by 20 mmof hg from previous is also diagnostic of HT in pregnancy
Diastolic BP tends to rise first followed by the systolic
P/A-the fundal height will be less than period of gestation-oligohydramnios,iugr
Abdominal wall edema may be present-FHS may be difficult to localise
Signs of IUD/abruption/preterm labour
Fundoscopic examination-retinal edema,arteriolar constriction,alteration of normal vein to arteriole diameter from 3:2 to 3:1,nicking of veins by the arterioles
Patient may present with eclampsia in the antenatal period(50%)
Eclamptic fit-premomitory stage,tonic stage,clonic stage,stage of coma. Fits usually multiple episodes at varying intervals/status epilepticus