Gestational Hypertension

Gestational hypertension >140/90 mm Hg after 20 weeks of pregnancy with normal blood pressure and may develop into preeclampsia Preeclampsia diagnosed in a woman with gestational hypertension who also has increased protein in her urine Eclampsia is a severe form of preeclampsia. Seizures

Gestational Hypertension Risk factors pre-existing hypertension (high blood pressure) kidney disease diabetes hypertension with a previous pregnancy mother's age younger than 20 or older than 40 multiple fetuses (twins, triplets) African-American race

Complications Stillbirth Intrauterine growth restriction Preterm birth Placental abruption

During pregnancy…. http://bestpractice.bmj.com/ Upregulation of Renin- angiotensin- aldosterone system Elevation in Blood Pressure Decrease in systemic vascular resistance High cardiac output http://bestpractice.bmj.com/

Diagnostic Tools Pam sabi daw po ni manel xa na lang yung magsesend sayo, kasi lilipat yata sila ng bahay eh kaya si pa nya nasesend Pam tanggalin mo na lang yung nasa first 3 slyd kung ayaw mo report hehe yun kasi yungn dinagdag ko eh Sorry ulit

Clinical Pearls in Management No specific treatment; CLOSE MONITORING is important to detect any pre-eclampsia and its accompanying complications Prevent convulsions and control hypertension

Management of Gestational Hypertension Initial hospitalization for 3 days OPD follow – 2x weekly

Management of Gestational Hypertension Initial hospitalization for 3 days Bed rest Baseline data: Maternal wt, BP, Hct, SGPT, uric acid, platelet count, fetal BPS, Doppler velocimetry Mnemonics: HELLP (Hemolytic anemia, elevated Liver Enzymes, Low Platelet Count) Monitor feto-meternal status: daily fetal movement counting

Management of Gestational Hypertension OPD follow – 2x weekly Review of Fetal movement count chart, BP, wt and NST Give oral methyldopa, low dose aspirin and high dose calcium if indicated OPD results Normal parameters  wait till term Any deterioration in the parameters Non-reactive NST  Fetal BPS+ AFI and/or Doppler flow analysis (to determine timing and manner of delivery)

Prevention

BMI and Diet Augmented placental production of leptin, adinopectin, TAG, and inflammation BMI>30 increases risk of: Preeclampsia Gestational diabetes Fetal macrosomia

Low Dose Aspirin Based on a functional imbalance between vasodilator and vasoconstrictor eicosanoids. TXL-A2 increased and PGI levels decreased Aspirin- inhibits TX-A2 while PGI can be resynthesized from the endothelium.

Low Dose Aspirin Can be given provided that: Have identified risk based on previous history of hypertension, adverse obstetric outcomes, MAP or roll over tests, abnormal doppler waveforms or angiotensin sensitivity tests No history of aspirin allergy or hypersensitivity Started on 2nd trimester Doses lept at 60-80 mg/day Platelet and coagulation profiles are monitored. Fetal Ductus Arteriosus and urine production/AF volume are monitored.

High Dose Calcium: 2 gram/day (-) PTH Intracellular Ca Smooth muscle relaxation Response to pressor stimuli

High Dose Calcium: 2 gram/day Ca supplement: -higher level of Ca excretion - increased levels of serum Mg -smooth muscle relaxation in BV -Control of HPN

Anti-Oxidant Therapy Not recommended