HYPERTENSIVEDISORDERS OF PREGNANCY

Pregnancy Induced Hypertension Hypertension/ or Proteinuria developing after 20 weeks of pregnancy, during labour or 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:

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

Management Mild hypertension –Admit –PIH profile –Record BP four hourly –If BP is controlled and PIH profile is normal discharge the patient and ask for regular antenatal visits according to gestational age

Moderate Hypertension –Admit the patient –Record BP four hourly –PIH profile –Anti hypertensive Aldomet 250mg up to 04 g daily Anticonvalacine Low dose aspirine

Severe Hypertension –Admit the patient –PIH profile –Record BP four hourly –Antihypertensive –Anticonvalacine –Bishop scoring –Delivery of patient

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