Hypertension in Pregnancy

 Hypertension in Pregnancy

Differences

• Chronic HPT: <20wks dx or beyond 6wks postpartum
• Gestational HPT/ pregnancy induced hypertension (PIH without proteinuria) / Preeclampsia(PIH with proteinuria) / Eclampsia (PIH with convulsion): > 20wks dx
• Chronic HPT with superimposed preeclampsia : PE in women who have pre existing hypertension. Include: worsen HPT, proteinuria, non-dependant oedema.

Pathophysio of preeclampsia

Found this video on youtube which is quite useful in helping to understand about Preeclampsia. Enjoy!

complications

- 

Need for delivery when

- end organ damage

- inability to control BP

- fetal well being

Postpartum monitoring

- BP monitoring

- Ur protein and output checked

- check signs and Sx of preeclampsia --> postpartum eclampsia

- medication titrated according to BP

- counsel regarding subsequent pregnancies

- for contraceptions and proper spacing

- long term follow up at KK to watch out for chronic HPT. 

Management

1. Mild pregnancy induced hypertension:

• diastolic BP 90-100, no proteinuria
• Mx: 
• rest at home with daily BP and urine check by community midwife
• once or twice weekly Day Care Unit attendance for BP and CTG check
• delivery by term or sooner

2. Moderate PIH     

• diastolic BP 100-110 or less if complicated by proteinuria
• Mx:
• tx in hospital, daily ur albumin, 4hrly BP
• check fluid balance, amount of oedema
• weekly weight
• Daily CTG
• Meds: labetalol 100mg TDS max 300mg 6hrly , T. methyldopa 250mg QID to max 3g/d
• deliver 38wks or sooner

3. Severe PIH

• almost like severe PE Mx
• proteinuria>3g/L
• BP>160 systolic
• BP>110 diastolic with no BP > than 160/110 with no proteinuria
• oliguria (<400ml/24hrs)
• presence of Impending Eclampsia
• Mx:
• Tx in hospital
• Observation and meds like PIH
• check for
• reflex, clonus
• opthal
• LFT, PLT
• quantitative proteinuria daily
• Delivery by 36 wks or sooner
• Aim to reduce to diastolic 90-100mmHg 

Key Points:

1st trimester :  1-12
2nd trimester: 13-26
3rd trimester: 27-EDD(40)

Proteinuria: 1+    0.3g/L,  

                      2+    1.0g/L, 

                      3+    3.0g/L, 

                      4+    >20g/L