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Hypertensive Disorders in Pregnancy - Coggle Diagram
Hypertensive Disorders in Pregnancy
Chronic Hypertension
Definition
Present before pregnancy OR
Diagnosed <20 weeks OR
Persists >12 weeks postpartum
Management
Labetalol
Nifedipine
Methyldopa
Avoid ACE inhibitors and ARBs
Low-dose aspirin 100–150 mg <16 weeks (high-risk)
Fetal surveillance (growth scans)
Delivery: 38–39 weeks if uncomplicated
Gestational Hypertension
Definition
Onset ≥20 weeks
No maternal organ dysfunction
Resolves ≤12 weeks postpartum
Management
Monitor BP and urine protein
Antihypertensives if needed
Fetal surveillance
Deliver 37–38 weeks if stable
Manage as pre-eclampsia if deteriorates
Pre-eclampsia
Definition
HTN ≥20 weeks
PLUS maternal organ dysfunction
Proteinuria not required
Maternal Organ Dysfunction (any one)
Proteinuria ≥300 mg/24h OR PCR ≥30
Renal impairment (↑ creatinine)
Liver involvement (↑ LFTs)
Neurological symptoms
Hematological abnormalities
Uteroplacental dysfunction (IUGR)
Management (Non-severe)
Admit or close monitoring
Antihypertensives
Maternal labs (FBC, LFTs, U&E)
Fetal surveillance
Deliver 37 weeks
Severe Pre-eclampsia
Diagnostic Criteria (any one)
BP ≥160 systolic OR ≥110 diastolic
Severe headache
Visual disturbance
Epigastric / RUQ pain
Platelets <100
↑ Creatinine
Pulmonary edema
IUGR
Management
Admit (HD/ICU)
BP control: Labetalol, Hydralazine, Nifedipine
Magnesium sulfate prophylaxis
Loading: 4 g IV
Maintenance: 1 g/hour
Fluid restriction
Continuous maternal & fetal monitoring
<34 weeks: corticosteroids if stable
Delivery: ≥34 weeks or earlier if unstable
HELLP Syndrome
Definition
Hemolysis
Elevated liver enzymes
Low platelets
Management
Treat as severe pre-eclampsia
Magnesium sulfate
BP control
Correct coagulopathy
Urgent delivery
Eclampsia
Definition
Pre-eclampsia + seizures
Can occur antenatal, intrapartum, postpartum
Management
Immediate stabilisation
ABC
Left lateral position
Oxygen
Protect airway
Stop seizures
Magnesium sulfate
Loading: 4 g IV
Maintenance: 1 g/hour
Recurrent seizure
Additional magnesium
Benzodiazepine if refractory
Control BP
Treat if ≥160/110
Monitor magnesium toxicity
Delivery after stabilisation
Mode based on obstetric indication
Magnesium Sulfate Monitoring
Respiratory rate ≥12/min
Urine output ≥25 mL/hour
Deep tendon reflexes present
Toxicity
Loss of reflexes
Respiratory depression
Coma
Treatment
Stop magnesium
IV calcium gluconate 10 mL of 10%
Antihypertensive Drugs
Labetalol
Nifedipine
Methyldopa
Hydralazine (IV emergency)
Delivery Timing Summary
Gestational HTN → 37–38 weeks
Pre-eclampsia → 37 weeks
Severe PE → ≥34 weeks or earlier
Eclampsia → after stabilisation
AMC Exam Rule
Classify → Assess severity → Magnesium if severe → Control BP → Deliver