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Hypertension in Pregnancy - Coggle Diagram
Hypertension in Pregnancy
Definitions
Definitions H/T
a DBP of 90mmHg or more, taken on 2 occasions > 4 hrs apart OR
A single DBP of> 110mmHg
Can occur either in
Women who already have H/T (1º or 2º)
Manifest in 2nd half of pregnancy
Pregnancy HT & Chronic HT
May be difficult to differentiate
Both have high risk of complications
Chr HT –
Diagnosed prepregnancy
high BP early in pregnancy
Definitions - PE
A multisystem disorder characterized by HT + proteinuria
Proteinuria - > 300mg urine pr / 24 hrs
Occurs > 20 wks gestation
Resolves postnatally
Complications of PE – eclampsia, HELLP synd
Definitions -Eclampsia
The occurrence of tonic-clonic convulsions in a woman with PE
Pregnancy
Any gestation
No neurological disease
Classification
Gestational hypertension.
Preeclampsia (mild, severe)
Eclampsia.
Superimposed preeclampsia upon chronic hypertension.
Chronic hypertension with pregnancy
Incidence
PE – 2-8% of all pregnancies
Risk in 1st pregnancy – 4.1%
Risk in later pregnancies – 1.7%
Risk in woman with PE in 1st pregnancies-14.7%
Risk in woman with PE in previous 2 pregnancies – 31.9%
Summary
Gestational hypertension:
Hypertension for first time after 20 w,
without proteinuria. BP returns to normal
before 12 weeks postpartum.
Chronic hypertension with pregnancy:
Hypertension antedates pregnancy and detected before 20 w, & lasts more than
12 weeks postpartum.
Pathology
Primarily a disorder of placental dysfunction
leading to a syndrome of endothelial dysfunction with associated vasospasm
Evidence of placental insufficiency with associated abnormalities
diffuse placental thrombosis, an inflammatory placental decidual vasculopathy, and/or abnormal trophoblastic invasion of the endometrium
This supports abnormal placental development or placental damage from diffuse microthrombosis as being central to the development of this disorder
Maternal personal risk factors for pre-eclampsia
First pregnancy
Multigravida pregnant by a different partner
Age younger than 18 years or older than 35 years
Multiple pregnancy
Family history of preeclampsia in a first-degree relative
Obesity
Preexisting diabetes
History of preeclampsia
Chronic hypertension,Renal disease
Smoking
Diagnosis of Eclampsia
Eclamptic fit stages ( 4 stages):
Premonitory stage (1/2 minute):
Eye rolled up
Twitches of the face and hands.
Tonic stage (1/2 minute):
Generalized tonic spasm with opisthotonus.
Cyanosis.
Tongue may be bitten between the clenched teeth.
Signs
Rapid rise in BP
Papilloedema
Fluid retention (non-dependent edema)
Hyperreflexia
Clonus
Uterus and fetus may feel small for gestational age
Symptoms
Headache
Blurring of vision
Nausea and vomiting
Epigastric pain (distension of the liver capsule)
Oliguria or anuria
Investigations
Urine - 24 hour urine, Proteinuria
Kidney functions - serum creatinine, urea, creatinine clearance and uric acid
Liver functions - bilirubin, Enzymes (SGPT and SGOT)
Blood - CBC, HCt , Hemolysis and Platelet count (Thrombocytopenia)
Coagulation Profile - Bleeding and clotting time
Treatment
PREVENTION
Antepartum
Proper antenatal care
Expectant treatment
Control hypertension
Treatment of eclampsia
Prevention and control of convulsions
Termination of pregnancy
Intrapartum care
Postpartum care