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HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION

HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION. Sarreshtedar.A.MD.AFSA. Hypertension complications in pregnant women (10%) Maternal mortality & morbidity. Abruptio placenta Pulmonary edema Respiratory failure Cerebral hemorrhage Hepatic failure Acute renal failure.

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HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION

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  1. HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION Sarreshtedar.A.MD.AFSA

  2. Hypertension complications in pregnant • women(10%) • Maternal mortality & morbidity. • Abruptio placenta • Pulmonary edema • Respiratory failure • Cerebral hemorrhage • Hepatic failure • Acute renal failure. • DIC

  3. Hypertension complication • In • pregnancy (BABY) • Fetal prematurely • Intrauterine growth retardation • Stillbirth • Neonatal death

  4. PREGNANCY: • HYPERTENSION DISORDERS • Chronic hypertension • Gestational hypertension • Preecampsia-Eclampsia

  5. Chronic Hypertension • DEFINED: • Precedes pregnancy • Before 20th gestational week • Fails to normal 12 week after delivery.

  6. Chronic hypertension • 1%-5% of pregnancies • 15% with increased complications • Most complications occur in thosemore than 30y/o

  7. Chronic Hypertension Complications in PREGNANCY: • (15%) • Fetal growth retardation • Premature delivery • Abruptio-placenta • Acute renal failure • Hypertension crisis

  8. Most of these complications occur: • In patients older than 30 y/o • Longer duration of hypertension • Superimposed preeclampsia.

  9. 25% of pregnancies (most) associated with chronic hypertension occurs in the setting of superimposed preeclampsia

  10. CHRONIC HYPERTENSION & PREGNANCY: • LOW-RISK patients: • SBP=140-160 mmHg • DBP=90-110 mmHg • Normal physical examination • Normal EKG • No proteinuria.

  11. CHRONIC HYPERTENSION & PREGNANCY: • HIGH- RISK patients: • SBP=more than 160 mmHg • DBP=more than 110 mmHg • Signs of preeclampsia. • Signs of end organ Involvement • Renal insufficiency • Diabetes mellitus • Collagen vascular disease.

  12. CHRONIC HYPERTENSION: • Incidence of prenatal mortality is high. • Fetal growth-Retardation is high.

  13. GESTETIONAL HYPERTENSION : Definition: Rise in pressure of 30/15 mmHg. Or Greater than 140/90 mmHg.

  14. GESTATIONAL HYPERTENSION: • Induced by pregnancy • Beginning after 20 weeks • Resolving by the sixth postpartum week.

  15. GESTATIONAL HYPERTENSION: • Transient hypertension. • Preeclampsia.

  16. GESTATIONAL HYPERTENSION • (TRANSIENT) • Without proteinuria. • In the late third trimester. • Return to normal by 10th post partum day.

  17. GESTATIONAL HYPERTENSION: • (PREECLAMPSIA) • With proteinuria • Edema • SBP greater than 160 mmHg • DBP greater than 110 mmHg

  18. Gestational hypertension • is • Self-limited and less commonly in next pregnancies. • BUT • Chronic hypertension • progresses and complicates in subsequent pregnancies.

  19. Difference Between Preeclampsia And Chronic Hypertension :

  20. PREECLAMPSIA-ECLAMPSIA: • Definition: • BP more than 140/90 mmHg • After 20 weeks • Edema • Proteinuria • convulsion

  21. Hypertension appears in 12% of first pregnancies after 20 weeks

  22. 50% of these 12% will progress to preeclampsia.

  23. PREECLAMPSIA-ECLAMPSIA: • Pregnancy specific syndrome • Proteinuria more than 300 mg/24h • Regresses within 24h 48h After delivery

  24. PREECLAMPSIA-ECLAMPSIA • PRESENTATION: • Blurred vision • Pulmonary edema • Abdominal pain • Abnormal laboratory tests :liver enzymes – low platelet ……

  25. Mechanism • unknown • But • Hypothesis are: • Profound vasoconstriction • High cardiac output.

  26. Decreased Prostaglandin Synthesis Vascular prostacyclin uterine PGE 2 uteroplacental blood flow platelet aggregation angiotensionsensitivity uterine renin vasoconstriction Fibrin deposition in glomeruli GFR PROTEINURIA Sodium retention HYPERTENSION EDEMA

  27. POST PARTUM ECLAMPSIA • Usually occurs within 10 days after delivery with: • Hypertension • Proteinuria • Convulsion

  28. MANAGEMENT Primary goal: Prevent maternal cerebral complications Secondary goal : Reduction of : SBP below 126mmHg DBS between 90-100mmHg

  29. NOTICE: • Gestation hypertension is self- limited • Delivery is the only definitive treatment for preeclampsia

  30. MANAGEMENT • INDICATION FOR Drugs: • SBP more than 150 mmHg • DBS more than 100 mmHg • Target organ damage • LV hypertrophy • Renal insufficiency

  31. DRUG SELECTION: • For acute treatment of sever hypertension • For long term treatment of hypertension

  32. Drugs for Acute treatment of Sever Hypertension:

  33. METHOD OF TREATMENT IN SEVER HYPERTENSION: • 1:Hydralazin: (Initial Drug) • 5mg bolus iv over 2 minutes • After 20 minutes repeat • And repeated as necessary

  34. 2: Labetalol: (second drug) • If hydralazin not effective or • Maternal side effects: • Tachycardia • Headache • nausea

  35. Labetalol using : • 20 mg iv • After 10 minutes 40 mg iv • After 3 doses 80 mg in interval of 10-20 minutes • After 1-2 mg/min in continuous infusion

  36. Drugs for long-term treatment of hypertension:

  37. NOTICE: PREFERREDTHERAPY:METHYL-DOPA ACE inhibitors and angiotensin II receptor blockers are: Contraindication because induce neonatal renal failure.

  38. بسم الله دواء وااحمدلله شفاء هو الشافی شفاء

  39. Clinical features : • Chronic hypertension • Gestational hypertension • Preeclampsia - Eclampsia

  40. RISK • HIGH: 160/110 • LOW: • SBS=140-160 • DBS=90-110 • NORMAL EKG • NORMAL ECHO/ • NO PROTEINURIA

  41. Gestational hypertension DEFINED: Induced by pregnancy Beginning after 20 weeks Resolving by the sixth postpartum week

  42. Gestational hypertension Divided by: Hypertension without proteinuria (transient ) Hypertension with proteinuria

  43. CHRACTRISTICS OF PREECLAMPSIA-ECLAMPSIA • BP more than 160/90 mmHg • Headache • Blurred vision • Pulmonary edema • Abdominal pain • Low platelets • Abnormal liver tests • Usually regresses within 24-48 hr after delivery.

  44. Treatment: • Primary goal is to prevent maternal complications. • Recommended goal of therapy is reduction of mean SBP below 126 mmHg & DBP between 90-105 mmHg

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