Y2B3Cs Htn In Preg

Front 1

most commonly encountered problem in pregnancy

Back 1

Hypertension

Front 2

Chronic Hypertension

Back 2

HTN diagnosed prior to pregnancy
BP >140/90 prior to preg or before 20 weeks

Front 3

Chronic Hypertension Dx requires at least one of the following...

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1. Known HTN prior to preg
2. HTN prior 20 weeks gestation
3. presisting HTN > 12 weeks postpartum

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A preg-specific syndrome of reduced organ perfusion related to vasospasm and activation of the coagulation cascade

Back 4

Pre-eclampsia

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Pre-Eclampsa is characterized by triad of:

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1. HTN after 20weeks in previously normotensive pt
2. Proteinuria
3. weight gain/edema

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Risk factors of pre-eclampsia

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history of HTN
greater than 35
extreme maternal age (<18 or >35)
obesity prior to preg
hx of diabetes, lupus, renal disease
carrying more than 1 fetus
black
primigravida

Front 7

Pre-Eclampsia sx

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- rapid weight gain
• Elevated BP >140/90**
• Proteinuria**
• Headache of new onset.*
• While mild lower extremity edema is common in normal pregnancy, rapidly increasing or nondependent edema may be a signal of developing preeclampsia. *
• Epigastric pain is due to hepatic swelling and stretching of the liver capsule.*

Front 8

Pre-Eclampsia most occurs during what trimester?

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3rd

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Mild PreEclampsia

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• BP > 140 Systolic, 90 Diastolic
• Proteinuria: 300mg protein or greater in a 24-hour specimen

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Severe PreEclampsia

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• BP > 160 Systolic, > 110 Diastolic
• Proteinurea: >5gm in 24 hours, 3+ urine dip
• Oliguria: less than 400ml in 24 hours
• Pulmonary Edema
• Epigastric or RUQ Pain: Usually indicates liver involvement

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Severe PreEclampsia Sx

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• Retinal vasospasm is a severe manifestation of maternal disease; consider delivery*
• Visual disturbances: scintillations and scotomata. These disturbances are presumed to be due to cerebral vasospasm.**
• Hyperreflexia-3+ DTR’s*
• Clonus is a sign of neuromuscular irritability that usually reflects severe preeclampsia.*

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HELP Syndrome

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Hemolysis,
Elevated Liver enzymes,
Low Platelets

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Eclampsia

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A true Obstetrical emergency.*
• Tonic-Clonic seizures in a pregnant female with no previous seizure history.*

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maternal indications for delivery in preeclampsia

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• Gestational age 38 weeks
• Platelet count < 100,000 cells/mm3
• Progressive deterioration in liver and renal function
• Suspected abruptio placentae
• Persistent severe headaches, visual changes, nausea, epigastric pain, or vomiting

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fetal indications for delivery in preeclampsia

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• Severe fetal growth restriction
• Nonreassuring fetal testing results
• Oligohydramnios

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Treatment of HTN in severe Preeclampsia:
For SBP > 160 mm Hg and/or DBP > 105 mm Hg

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• Parenteral hydralazine is most commonly used.*
• Parenteral labetalol * is second-line drug (avoid in women with asthma and CHF.)
• When treating hypertension, be very careful NOT to lower blood pressure too much (less than 140/90

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chronic HTN with superimposed Preeclampsia

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• Chronic HTN with : New-onset proteinuria after the 20th week of gestation.*
• Sudden significant increases in blood pressure (>160 systolic or >110 diastolic at rest), in a previously controlled HTN pt.
•

Front 18

Gestational HTN

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• HTN without proteinuria appearing after 20 weeks GA*
• HTN without proteinuria appearing within 48 to 72 hours after delivery.*
• Resolves by 12 weeks’ postpartum.*