HYPERTENSIVE DISORDERS OF PREGNANCY

CLINICAL CLASSIFICATION OF HYPERTENSIVE DISORDERS OF PREGNANCY 1. Gestational hypertension (without proteinuria) 2. Gestational proteinuria (without hypertension) 3. Gestational proteinuric hypertension (pre-eclampsia) B.CHRONIC HYPERTENSION AND CHRONIC RENAL DISEASE 1. Chronic hypertension (without proteinuria) 2. Chronic renal disease (proteinuria with or without HTN 3. Chronic HTN/ CRD with superimposed pre-eclampsia C.UNCLASSIFIED HYPERTENSION AND/OR PROTEINURIA 1. Unclassifiedhypertension (with out proteinuria) 2. Unclassifiedproteinuria (with out hypertension) 3. Unclassifiedproteinuric hypertension. GESTATIONAL HYPERTENSION AND /OR PROTEINURIA A. GESTATIONAL HYPERTENSION AND /OR PROTEINURIA

P.I.H HTN/ or PTN developing after 20 weeks of pregnancy, during labour or the puerperium in a previously normotensive non-proteinuric woman (ISSHP)

PRE-ECLAMPSIA Hypertension and Proteinuria Occurring after the 20 th week of gestation in a previous normotensive, non proteinuric womanECLAMPSIA Above signs + fits. SUPERIMPOSED PRE – ECLAMPSIA Rise of 30 mm hg systolic Or 15 mm hg diastolic above previous levels with proteinuria

One measurement of DBP of 110 mm Hg or more OR Two consecutive measurements of DBP > 90 mm Hg 4 h or more apart. HYPERTENSION

PROTEINURIA Protein excretion of 300 mg or more in 24 hours urine OR Two random clean catch or catheter urine specimen with 2+ (1 gm albumin/L) or more

PATHOGENESIS 1. Rejection phenomenon 2.Uteroplacental ischaemia 3.Imbalance between prostacyclin and Thromboxane Thromboxane 4.Decreased GFR with salt and water retention. 5.Decreased intra vascular volume 6.Increased central nervous system irritability 7.D.I.C 8.Dietry factors 9.Uterine muscle stretch 10.Genetic factors Exact cause is unknown some theories are Exact cause is unknown some theories are:

DAMAGE TO ENDOTHELIAL CELLS DEFICIENCY OF (ENDOTHELIAL DERIVED RELAXING FACTOR) PLATELET AGGREGATION VASOSPASM HYPERTENSION

NORMAL PREGNANCY Vasodilatation Uteroplacental blood flow Platelet aggregation Thromboxane Thromboxane Prostacylin Vasodilatation Uteroplacental blood flow Platelet aggregation PRE -ECLAMPSIA Prostacyclin

PRE DISPOSING FACTORS Age20 yrs in primi> 30 yrs in all. Race Climate Diet Social status Multiparty Multiple gestation Molar pregnancy Pre existing hypertension Previous h/o preclampsia, eclampsia Family history of PIH Diabetes mellitus Non immune hydrops Anti phospholipid antibody syndrome Collagen disease

FOETAL 1. Intra uterine growth retardation 2.Intra uterine death 3.Prematurity 4.Intrapartum foetal distress or still birth MATERNAL 1. Eclampsia 2.Abruptio placentae 3.D.I.C 4.Retinal complications 5.Renal failure 6.Liver failure 7.Hypertensive encephalopathy FOETAL 1. Intra uterine growth retardation 2.Intra uterine death 3.Prematurity 4.Intrapartum foetal distress or still birth MATERNAL 1. Eclampsia 2.Abruptio placentae 3.D.I.C 4.Retinal complications 5.Renal failure 6.Liver failure 7.Hypertensive encephalopathy COMPLICATIONS

 MILD D BP OF < 160/110 No Proteinuria  MODERATE BP OF > 160/110 + Proteinuria  SEVERE 1. BP OF > 160/110 mm Hg 2. Proteinuria - 5 G IN 24 hoursor 3 – 4 + on Dipstick 3. Oliguria < 500 mls in 24 hours 4. Cerebral & visual disturbances 5. Epigastric pain 6. Thrombocytopenia 7. Pulmonary oedema 8. Jaundice TYPES OF P.I.H