Hypertensive disorder in pregnancy
Definition
❤Hypertension: SBP ≥ 140 mmHg or DBP ≥ 90 mmHg for ≥ 2 times in 4 hrs apart
🚩Severe Hypertension: SBP ≥ 160 mmHg or DBP ≥ 110 mmHg
Classification 💮
Gestational hypertension: ❤ after GA ≥ 20 wks
Preeclampsia & eclampsia syndrome:
Chronic hypertension: ❤ before conception or before GA 20 wks
Chronic HT with superimposed preeclampsia
❤ AND 💛 Proteinuria
❤ AND one of the followings of multisystemic signs usu indicate ds severity in absence of proteinuria
Urine protein > 300 mg/24 hr or
UPCR > 0.3 or
Urine dipstick ≥ 1+ (if quantitative methods not available)
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
Diagnosis 🎉 by HT in early gestation who deve proteinuria after GA 20 wks and HT with proteinuria before GA 20 wks who... 7 scenarios 🌈
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
Transient HT of pregnancy: HT in 1st half of preg THEN normalize postpartum
Types 🎉
without severe features
(SBP ≥ 160 mmHg & DBP ≥ 110 mmHg 🚩 & proteinuria)
with severe features
(alrdy got presence of organ dysfunction)
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
Failure of BP to normalize postpartum → change Dx to 'Chronic HT'
Late postpartum hypertension: normotensive gestation who deve HT (usu. mild) in period of 2 wks to 6 months postpartum