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Hypertension in Pregnancy, นางสาวจุฑารัตน์ สีบูพิมพา 601410066-0 - Coggle…
Hypertension in Pregnancy
Treatment
For mild hypertension, conservative measures followed by antihypertensives if needed
Methyldopa, beta-blockers, or calcium channel blockers tried first
Avoidance of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBS), and aldosterone antagonists
For moderate or severe hypertension, antihypertensive therapy, close monitoring, and, if condition worsens, possibly termination of pregnancy or delivery, depending on gestational age
Preeclampsia with severe feature
Diagnosis
At least one or more of the abnormal conditions occurred.
Systolic BP (SBP) > 160 mmHg / Diastolic BP (DBP)> 110 mmHg
Thrombocytopenia
Plt.<10000 cell/mm3
Impaired liver function
AST/ALT >2 Double Upper normal limit
Severe persistence
Renal insufficiency
Serum creatinine >1.1 or > 2 Double Serum creatinine without another kidney disease
ulmonary edema
Have recurrent headaches or blurred vision
Treatment
Prevent seizures (Stabilization) with MgS04 iv load 4 gm. Then iv drip 1-2 gm / hr
Admit
Short-actinganti-hypertensive drugs) BP >160/110 mmHg
Hydralazine
Labetalol
Nifedipine
Niardipine
Labor
Corticosteroid for fetal lung maturity 24-34 weeks gestation.
Expectant management
Up to 34 weeks
Unstable maternal or fetal conditions should be delivered immediately regardless of gestational age.
34 weeks gestation: Clot after Stabilize mother and <24 weeks gestational age (Previable stage) Give birth after Stabilize mother
Meaning
BP >140/90 mmHg , proteinuria
urine protein creatinine index (UPCI) > 0.3 urine dipstickz1 +
HELLP syndrome
Hemolysis
LDH>600 U/L
Microangiopathic hemolysis (MAHA)
Low platelet (LP)
Platelets <10000 cell/mm3
Elevated liver enzyme (EL)
AST/ALT >2 Double Upper normal limit
Treatment
Preeclampsia non severe features
Gestational Hypertension
hronic hypertension+superimposed preeclampsia
Geststional Age >37 Weeks
Expectant management
<37 Weeks
Corticosteroid for fetal lung maturit
Blood pressure 2 weeks
BP > 140/90 mmHg, have to come to check before the appointment
No need for antihypertensive drugs
Except for Chronic HT requiring antihypertensive drugs available
Gestationnal HT
Proteinuria checked once a week.
Once a week
CBC c platelet and Liver Function Test
non severe features
category
Preeclampsia / Eclampsia
Preeclampsia
Ht with proteinuria
Eclampsia
Ht with seizures
Chronic hypertension
High blood pressure found before or before 20 weeks gestation, or persist in hypertension after 12 weeks after delivery.
Gestational hypertension
blood pressure was detected during the 20 weeks gestation without protein in the urine.
Blood pressure usually returns to normal within 12 weeks of delivery
Chronic hypertension
Superimposed preeclampsia
Hypertension that was found before or before 20 weeks of gestation and also found proteinuria
Hypertension that was found before or before 20 weeks of pregnancy.
นางสาวจุฑารัตน์ สีบูพิมพา 601410066-0