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