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PIH (Pregnancy-Induced Hypertension) - Coggle Diagram
PIH (Pregnancy-Induced Hypertension)
PIH
Definition:
Hypertension (>/=140/90)
after
20 weeks
of pregnancy in the
absence of proteinuria
or other markers of PE.
Affects 6-7% of pregnancies.
Increase risk of developing PE (15-26%)
Risk increases w/ earlier onset of HTN.
Delivery should be aimed at the time of EDD
BP usually returns to pre-pregnancy limits w/in 6 weeks of delivery.
Chronic Hypertension
Complicates 3-5% of pregnancies
Pregnant women who have a high booking BP (130-140/80-90 or >) are likely to have chronic hypertension.
Increased risk of developing PE
Delivery should be planned at around the time of the EDD
Now more common because of an older pregnant population.
If
BP very high, important to exclude a secondary cause
, rather than attributing it to essential hypertension.
Postpartum Hypertension
New HTN may arise in the postpartum period.
It is important to determine whether this is physiological, pre-existing chronic hypertension. or new-onset pre-eclampsia (PE)
Remember, BP peaks on the 3rd - 5th day postpartum.
Symptoms such as
epigastric pain
or
visual disturbance
and
new-onset proteinuria
are suggestive of
postpartum PE
Postnatal Management of Hypertension
Medication:
a) Postnatally,
methyldopa should be changed to a beta-blocker
because of the risk of postnatal depression.
b)
Captopril
(up to 50mg PO tds)
c) Nifedipine (10mg PO bd up to 30mg POqds) may also be used.
Women should be told that breast-feeding is safe with these drugs.
The GP can follow up the BP in the community and titrate the medication to the BP.
Women on medication should be offered a postnatal follow-up appointment 6 weeks postnatally.
The BP usually resolves by 6 weeks.
If still raised after this, it is important to look for secondary causes of hypertension.
Antihypertensive medication:
Hypertension in Pregnancy Treatment Principles
Treatment of BP is urgently required for maternal safety at levels of >/=160/110
Escalation of treatment is required until levels are <160/110
Treatment should aim for BP levels not <120/80
Treatment of BP
protects women from the adverse effects of increased BP
but
does not alter the course of pre-eclampsia
.
Types of bleeding:
APH
(Antepartum Haemorrhage): Bleeding
after 24 weeks
Miscarriage
: Fetal demise
before 24 weeks
EPH
(Early Pregnancy Haemorrhage): Bleeding
before 24 weeks.
When to terminate pregnancy:
W/ drugs: 38 weeks
W/o drugs: 40 weeks
