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Hypertensive disorder in pregnancy (Definition (Classification :white…
Hypertensive disorder in pregnancy
Definition
:<3:Hypertension: SBP ≥ 140 mmHg
or
DBP ≥ 90 mmHg for ≥ 2 times in 4 hrs apart
:red_flag:Severe Hypertension: SBP ≥ 160 mmHg
or
DBP ≥ 110 mmHg
Classification
:white_flower:
Gestational
hypertension: :<3:
after GA ≥ 20 wks
Failure of BP to normalize postpartum → change Dx to '
Chronic HT'
Preeclampsia
&
eclampsia
syndrome:
:<3:
AND
:yellow_heart:
Proteinuria
Urine protein > 300 mg/24 hr or
UPCR > 0.3 or
Urine dipstick ≥ 1+ (if quantitative methods not available)
:<3:
AND
one
of the followings of
multisystemic signs
usu indicate ds
severity
in
absence of proteinuria
Thrombocytopenia (Plt < 100,000 / mcL)
New deve of Renal insufficiency (Serum Cr
> 1.1
mg/dL or
> x2 WNL
)
Impaired LFT (inc AST, ALT
> x2 WNL
)
Pulmonary edema
New onset Cerebral or Visual symptoms
Severe
preeclampsia
Dx fr
one
of the followings (severe features)
Severe HT (SBP ≥ 160 mmHg or DBP ≥ 110 mmHg)
Thrombocytopenia (Plt < 100,000/ mcL)
New onset renal insufficiency
Impaired LFT
Pulmonary edema
Cerebral or Visual symptoms
Eclampsia: preeclampsia +
convulsions
Chronic
hypertension: :<3:
before conception
or
before
GA 20 wks
Transient
HT of pregnancy: HT in 1st half of preg
THEN
normalize postpartum
Chronic HT with
superimposed preeclampsia
Diagnosis :tada: by HT in early gestation who deve proteinuria
after GA 20 wks
and HT with proteinuria
before GA 20 wks
who...
7 scenarios
:rainbow:
Sudden
exacerbation
of HT or a
a need to escalate
anti-HT meds dose ทั้งๆที่ก่อนหน้านี้ well controlled HT
Sudden
got other S&S
Plt < 100,000 /mcL
Symptoms of RUQ, epigastric pain and severe headaches
Deve. pulmonary congestion or edema
Deve. renal insufficiency
Sudden, substantial, sustain increasing in protein excretion
Types :tada:
without
severe features
(SBP ≥ 160 mmHg & DBP ≥ 110 mmHg :red_flag: & proteinuria)
with severe features
(alrdy got
presence of organ dysfunction
)
Late postpartum
hypertension: normotensive gestation who
deve HT
(usu. mild) in period of
2 wks to 6 months postpartum
Prevention
Of Preeclampsia
Aspirin
(60 - 81 mg) from
GA 12 wks
till delivery
By stop aspirin
before delivery 5-10 days
Calcium gluconate
2g/day in
2nd half of pregnancy
Note: only benefit in hypocalcemia population so no need for Ca in normal pregnancy