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Hypertension in pregnancy (:star:Risk factors :grapes: (Young &…

- - - - Sustained SBP ≥ 140 mmHg or DBP ≥ 90 mmHg
        (Inc in BP must measured ≥ 2 seperate occasions ≥ 6 hours or more apart)
      - BP returns to baseline by 12 wks postpartum ➪ Dx Transient hypertension of preg
      - :yellow_heart:HTN GA after 20 wks + No proteinuria or Absence of other findings suggest preeclampsia
    - - Preg specific HTN with Multisystem involvement
      - :yellow_heart:1. New onset HTN with New onset proteinuria* in GA after 20 wks
        
        Significant proteinuria*
        
        24hr urine protein ≥ 300 mg
        
        UPCR ≥ 0.3
        
        Urine dipstick 1+
      - :yellow_heart:2. New onset HTN without proteinuria with New onset of any of the following
        
        Thrombocytopenia (plt < 100,000/microL)
        
        Renal insufficiency (Serum Cr ≥ 1.1 mg/dL or Doubling Serum Cr conc. in absence of other renal ds)
        
        Impaired LFT (x2 of normal conc of Liver transaminases – AST, ALT)
        
        Pulmonary edema
        
        Cerebral or Visual symptoms
      - Degrees
        
        Mild (nonsevere): SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg AND Proteinuria ≥ 300 mg on 24hr urine collection or dipstick +1 on single sample
        
        Severe:grapes: : same as Mild plus any of the item listed
        
        SBP ≥ 160 mmHg or DBP ≥ 110 mmHg
        
        24 hr collection of Urine protein excretion ≥ 5 g
        
        Thrombocytopenia
        
        Hepatic dysfunction (Elevated liver transaminases or Epigastric pain)
        
        Renal compromise (Oliguria, or Elevated serum Cr ≥ 1.1 in nonrenal ds women)
        
        Pulmonary edema
        
        Neurologic disturbances (Visual changes, Headache, Seizures, Coma)
        
        Placental abruption, Fetal growth restriction, or Oligohydramnios
      - HELLP syndrome - variant of preeclampsia with poor prognosis
        (Hemolysis, Elevated LFT, Low plt) :grapes:
      - Eclampsia: Preeclampsia + Convulsions
        
        Often preceded by premonitory event – Severe headache & hyperreflexia
        
        25% hv eclamptic seizures before labor
        
        50% hv eclamptic seizures during labor
        
        25% hv eclamptic seizures after delivery*
    - - HTN present predate conception or before GA 20 wks
      - HTN that persists beyond 12 wks postpartum
      - Complications: 15% of gestational HT can deve into Chronic HT, 25% risk of deve superimposed preeclampsia or eclampsia
    - - :yellow_heart: New onset proteinuria in a woman with Chronic HT and no proteinuria prior GA 20 wks
      - :yellow_heart: Women with proteinuria before GA 20 wks who more likely in the following seven scenarios :rice_scene:
        
        Sudden exacerb. of HT or Need to escalate anti-HT drug dose esp when prev. well controlled with these meds
        
        Sudden manifestations of S&S -- :arrow_up: abn Liver enzymes
        
        Plt < 100,000/microliters
        
        manifest symptoms (RUQ pain and severe headaches)
        
        deve Pulmonary congestion or edema
        
        deve Renal insufficiency (Serum Cr doubling or increasing ≥ 1.1 mg/dL in women w/o other renal ds)
        
        Sudden, substantial ad sustained increases in protein excretion
- - - - Normal preg: :arrow_down: immune respone ➭ preserve preg
      - Preeclampsia: Immune response dysfunc
      - Immunological factors
    - - preeclampsia is multifactorial, polygenic disorder
        
        60% concordance in monozygotic, female twin pairs
        
        22 - 47% twins
        
        20 - 40% daughter of preeclamptic mothers
        
        11 - 37% sisters of preeclamptic women
  - - - Stage I Poor placentation:
        Incomplete trophoblastic invasion of spiral arterioles ➭ :arrow_down: uteroplacental blood flow
      - Stage II Inflammation:
        Ischemic placenta induces Widespread endothelial cell damage and Maternal systemic inflammatory response (such conditions include CVS, Renal ds, DM, obesity, Immunological disorders or Hereditary influences)