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Hypertensive Disorders of Pregnancy

Learn to differentiate, manage gestational hypertension, preeclampsia, and chronic hypertension, including postpartum follow-up. Review prevention, risk factors, epidemiology, and disparities.

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Hypertensive Disorders of Pregnancy

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  1. Hypertensive Disorders of Pregnancy Laura Chambers-Kersh Resident School 10/5/16

  2. OBJECTIVES • Review and differentiate the diagnosis and management of gestational hypertension (GHTN), preeclampsia (with and without severe features), and chronic hypertension in pregnancy • Explain potential duration of disease presentation, including postpartum follow-up • Review preeclampsia prevention and risk factors • Touch briefly on epidemiology and racial disparities

  3. Chronic Hypertension • 3% of pregnancies • 25% go on to develop superimposed preeclampsia

  4. Gestational Hypertension • 50% of women diagnosed with gestational HTN between 24 and 35 weeks will develop preeclampsia

  5. Preeclampsia • 4.6% of pregnancies worldwide, 3.4% in the US • Accounts for 15% of all US preterm births • Causes 18% of maternal deaths in the US Abalos E, Cuesta C, Grosso AL, Chou D, Say L SO. Eur J Obstet Gynecol Reprod Biol. 2013 Sep; 170(1):1-7. Epub 2013 Jun 7. Ananth CV, Keyes KM, Wapner RJ SOBMJ. 2013;347:f6564.  Goldenburg RL, Rouse DJ. New England Journal of Medicine 1998; 339:313-20. The Preeclampsia Foundation (PF): http://www.preeclampsia.org/statistics.asp, Population Reference Bureau 2002: www.prb.org/pdf/WorldPopulationDS02_Eng.pdf

  6. Racial Disparities • 2012 cross-sectional study examining racial-ethnic disparities in pregnancy among Medicaid recipients in 14 southern states • 3-year data set (2005-2007) for approximately 1.5 million birth • Rates are shown after adjusting for age, hospital stay and c-section OR, 95% CI Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Matern Child Health J. 2013 Oct;17(8): 1518-25. doi: 10.1007/s10995-012-1162-0.

  7. Eclampsia • Antepartum 53% • intrapartum 19% • postpartum 28%

  8. Chronic Hypertension Outcomes • 26% get superimposed preeclampsia • 0.7-1.7% abruption • 28% preterm delivery • 20% NICU admission • 17% birth weight < 2500 gm • 4% perinatal mortality

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