1. Gestational Hypertension

2. 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

3. 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

4. Complications Stillbirth Intrauterine growth restriction Preterm birth
Placental abruption

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

7. 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

8. 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

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

10. 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

11. 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)

13. Prevention

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

15. 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.

16. 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 mg/day
Platelet and coagulation profiles are monitored.
Fetal Ductus Arteriosus and urine production/AF volume are monitored.

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

18. 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

19. Anti-Oxidant Therapy
Not recommended