High blood pressure in pregnancy Dr. Mohammed Karami

High blood pressure in pregnancy 34 years old G4 P3 + 0 … her previous deliveries all were SVD. She is 7 month pregnant unbooked presented to ER with sever headache. Her blood pressure was 170/100. fundal height correspond to 28 week gestation

Differential diagnosis Chronic hypertention Chronic hypertention with superimposed preeclampsia Transient hyper tention GTD multiple gestation – plyhydromnias anti phospho lipid syndrom Chronic illness ((rena failure))

High risk Age ((more than 35 or less than 15)) Parity Obstetric history – abortion, ectopic, GDM, PET, GTD, anti partum hemorrhage

etiology Uteroplacental ischemia is the central cause Production of toxins released to the circulation Imbalance bet vasoconstrictors and vasodilators (PGI2 TO Thromboxane A2 ratio) Def of nitric oxide and increase in endothelin.

pathophysiology Generalized vasospasm (rise in BP) Renal blood flow and GFR decrease , it leads to cons in the afferent then damage to membrane (cause of proteinuria) Decrease in blood flow and increase vas resistance to uteroplacental circ.

Risk factor Age <15, >35 Nulliparous Previous PET Family hx Chronic HTN DM,SLE,APLA,Renal disease Multiple gestations, polyhydramnios GTD

complication Eclampsia Pul. Edema Renal, heart failure, CVA DIC, thrombocytopenia Prematurity,IUGR,placental abruption Perinatal asphyxia

Other important point in history headach analysis Other sumptoms of increase blood pressure Symptoms of the preeclampsia Risk factor of preeclampsia Cmplication of preeclampsia Previus history Family history Past medical history Drugs Other problem in current pregnancy

juandice, pallor, cyanosis, swelling, chovestic sign head General looks, petechia Vitals , abnormal movement Physical examination juandice, pallor, cyanosis, swelling, chovestic sign head Lower zone crepitation, sign of pumonary odema chest Right upper quadrent tenderness, destintion, lepold maneouver abdomen Edema, reflexes, prephral pulse, clonus, Lower limb

investigation: CBC --- low platelet, high HCT, low HG Coagulation profile --- high PT,APTT low fib U & E + creatinine --- high uric acid & CR LFT --- high LE, alb, bil Urine analysis --- protienurea .3 g per day Urine output --- oligurea 500ml per day

investigation: Ultrasound --- IGUR((24W)), amniotic fluid CTG BPP --- early 26-28W if at risk ((36)) Cord doppler --- reduced blood flow

1 2 3 4 management delivery hypertention eclampsia Intrapartum 4 MAJOR STEPS 1 delivery 2 hypertention 3 eclampsia 4 Intrapartum

1 delivery SVD unless C/S is indicated if mild --- wait and observed, at 38 W if sever --- period of stabilization delivered immediately if there is worsen sign or fetal distress

2 hypertention HTN crisis ((160/105)) --- hydralazine or labetalol nefidipine, hypotention IV sodium nitriprosside , fetal cyanide toxicity if chronic, methyldopa is the safest Ca channel blocker & labetalol also safe ACE inhibitors & ARB, fetal toxicity

3 eclampsia ABC & stabilization control the blood pressure every 10 min prevent convulsion , mgso4 ((check level)) once hypoxia , HTN and convulsion stabilized , induce delivery vaginally asses urine output, reflexes and vitals for mg toxicity

4 Intrapartum careful monitoring for mother & baby, seziur prophylaxis (MGSO4) placental abruption , failure to progress Nonreassuring NST necessitating C/S Epidural anesthesia unless there is coagulapathy.