Hypertensive Disorders of Pregnancy

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Hypertension in Pregnancy

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Presentation transcript:

Hypertensive Disorders of Pregnancy Laura Chambers-Kersh Resident School 10/5/16

OBJECTIVES Review and differentiate the diagnosis and management of gestational hypertension (GHTN), preeclampsia (with and without severe features), and chronic hypertension in pregnancy Explain potential duration of disease presentation, including postpartum follow-up Review preeclampsia prevention and risk factors Touch briefly on epidemiology and racial disparities

Chronic Hypertension 3% of pregnancies 25% go on to develop superimposed preeclampsia

Gestational Hypertension 50% of women diagnosed with gestational HTN between 24 and 35 weeks will develop preeclampsia

Preeclampsia 4.6% of pregnancies worldwide, 3.4% in the US Accounts for 15% of all US preterm births Causes 18% of maternal deaths in the US Abalos E, Cuesta C, Grosso AL, Chou D, Say L SO. Eur J Obstet Gynecol Reprod Biol. 2013 Sep; 170(1):1-7. Epub 2013 Jun 7. Ananth CV, Keyes KM, Wapner RJ SOBMJ. 2013;347:f6564. Goldenburg RL, Rouse DJ. New England Journal of Medicine 1998; 339:313-20. The Preeclampsia Foundation (PF): http://www.preeclampsia.org/statistics.asp, Population Reference Bureau 2002: www.prb.org/pdf/WorldPopulationDS02_Eng.pdf

Racial Disparities Adverse outcome African Americans Hispanic Preeclampsia 1.30 (1.28, 1.33) 0.89 (0.87, 0.94) Preterm birth 1.34 (1.32, 1.36) 0.91 (0.90, 0.93) abruption 1.23 (1.19, 1.27) 0.63 (0.61, 0.66) Fetal death 1.89 (1.81, 1.98) 0.86 (0.81, 0.92) 2012 cross-sectional study examining racial-ethnic disparities in pregnancy among Medicaid recipients in 14 southern states 3-year data set (2005-2007) for approximately 1.5 million birth Rates are shown after adjusting for age, hospital stay and c-section OR, 95% CI Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Matern Child Health J. 2013 Oct;17(8): 1518-25. doi: 10.1007/s10995-012-1162-0.

Eclampsia Antepartum 53% intrapartum 19% postpartum 28%

Chronic Hypertension Outcomes 26% get superimposed preeclampsia 0.7-1.7% abruption 28% preterm delivery 20% NICU admission 17% birth weight < 2500 gm 4% perinatal mortality