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.
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