1. HYPERTENSION DURING PREGNANCY Gestational HYPERTENSION
Sarreshtedar.A.MD.AFSA

2. Hypertension complications in pregnant
women(10%)
Maternal mortality & morbidity.
Abruptio placenta
Pulmonary edema
Respiratory failure
Cerebral hemorrhage
Hepatic failure
Acute renal failure.
DIC

3. Hypertension complicationIn
pregnancy (BABY)
Fetal prematurely
Intrauterine growth retardation
Stillbirth
Neonatal death

4. HYPERTENSION DISORDERS
PREGNANCY:
HYPERTENSION DISORDERS
Chronic hypertension
Gestational hypertension
Preecampsia-Eclampsia

5. Chronic Hypertension DEFINED: Precedes pregnancy
Before 20th gestational week
Fails to normal 12 week after delivery.

6. Chronic hypertension 1%-5% of pregnancies
15% with increased complications
Most complications occur in those more than 30y/o

7. Chronic Hypertension Complications in PREGNANCY:
(15%)
Fetal growth retardation
Premature delivery
Abruptio-placenta
Acute renal failure
Hypertension crisis

8. Most of these complications occur:
In patients older than 30 y/o
Longer duration of hypertension
Superimposed preeclampsia.

9. 25% of pregnancies (most) associated with chronic hypertension occurs in the setting of superimposed preeclampsia

10. CHRONIC HYPERTENSION & PREGNANCY:
LOW-RISK patients:
SBP= mmHg
DBP= mmHg
Normal physical examination
Normal EKG
No proteinuria.

11. CHRONIC HYPERTENSION & PREGNANCY:
HIGH- RISK patients:
SBP=more than 160 mmHg
DBP=more than 110 mmHg
Signs of preeclampsia.
Signs of end organ Involvement
Renal insufficiency
Diabetes mellitus
Collagen vascular disease.

12. CHRONIC HYPERTENSION:
Incidence of prenatal mortality is high.
Fetal growth-Retardation is high.

13. GESTETIONAL HYPERTENSION : Rise in pressure of 30/15 mmHg.
Definition:
Rise in pressure of 30/15 mmHg. Or
Greater than 140/90 mmHg.

14. GESTATIONAL HYPERTENSION:
Induced by pregnancy
Beginning after 20 weeks
Resolving by the sixth postpartum week.

15. GESTATIONAL HYPERTENSION:
Transient hypertension.
Preeclampsia.

16. GESTATIONAL HYPERTENSION
(TRANSIENT)
Without proteinuria.
In the late third trimester.
Return to normal by 10th post partum day.

17. GESTATIONAL HYPERTENSION:
(PREECLAMPSIA)
With proteinuria
Edema
SBP greater than 160 mmHg
DBP greater than 110 mmHg

18. Gestational hypertension is
Self-limited and less commonly in next pregnancies.
BUT
Chronic hypertension
progresses and complicates in subsequent pregnancies.

19. Difference Between Preeclampsia And Chronic Hypertension :
Preeclampsia
Older>30 ))
Young<20 ))
Age
Multipara
Primigravide
Parity
Before 20 weeks of pregnancy
After 20 weeks of pregnancy
Onset
Gradual
Sudden
Weight gain and edema
> 160
< 160
Systolic blood pressure
Arteriovenous nicking, exudates
Spasm,edema
Funduscopic findings
Absent
Present
Proteinuria
Normal
Increased
Plasma uric acid
Elevated
Blood pressure after delivery

20. PREECLAMPSIA-ECLAMPSIA:
Definition:
BP more than 140/90 mmHg
After 20 weeks
Edema
Proteinuria
convulsion

21. Hypertension appears in 12% of first pregnancies after 20 weeks

22. 50% of these 12% will progress to
preeclampsia.

23. PREECLAMPSIA-ECLAMPSIA:
Pregnancy specific syndrome
Proteinuria more than 300 mg/24h
Regresses within 24h
48h
After delivery

24. PREECLAMPSIA-ECLAMPSIA
PRESENTATION:
Blurred vision
Pulmonary edema
Abdominal pain
Abnormal laboratory tests :liver enzymes – low platelet ……

25. Mechanism unknown But Hypothesis are: Profound vasoconstriction
High cardiac output.

26. Decreased Prostaglandin Synthesis
Vascular prostacyclin uterine PGE 2
uteroplacental blood flow
platelet aggregation
angiotension sensitivity
uterine renin
vasoconstriction
Fibrin deposition in glomeruli
GFR
PROTEINURIA
Sodium retention
HYPERTENSION
EDEMA

27. Usually occurs within 10 days after delivery with:
POST PARTUM ECLAMPSIA
Usually occurs within 10 days after delivery with:
Hypertension
Proteinuria
Convulsion

28. Prevent maternal cerebral complications
MANAGEMENT
Primary goal:
Prevent maternal cerebral complications
Secondary goal :
Reduction of :
SBP below 126mmHg
DBS between mmHg

29. NOTICE: Gestation hypertension is self- limited
Delivery is the only definitive treatment for preeclampsia

30. MANAGEMENT INDICATION FOR Drugs:
SBP more than 150 mmHg
DBS more than 100 mmHg
Target organ damage
LV hypertrophy
Renal insufficiency

31. DRUG SELECTION: For acute treatment of sever hypertension
For long term treatment of hypertension

32. Drugs for Acute treatment of Sever Hypertension:
Dose
Drug
Class
5-10 mg IV q min
Hydralazine
Arterial dilator
30-60mg IV q min
diazohide
10-20mg PO q 30 min
Nifedipine
Calcium channel blocker
mg IV q min
Labetalol
Alpha/beta-adrenergic blocker
( up to 300 mg)
(50 mg/250 ml saline):
Sodium nitroprusside
Arterial /venous dilator
kg/min

33. METHOD OF TREATMENT IN SEVER HYPERTENSION:
1:Hydralazin: (Initial Drug)
5 mg bolus iv over 2 minutes
After 20 minutes repeat
And repeated as necessary

34. 2: Labetalol: (second drug)
If hydralazin not effective or
Maternal side effects:
Tachycardia
Headache
nausea

35. Labetalol using : 20 mg iv After 10 minutes 40 mg iv
After 3 doses 80 mg in interval of minutes
After 1-2 mg/min in continuous infusion

36. Drugs for long-term treatment of hypertension:
Maximum Dose
Starting Dose
DRUG
CLASS
4 g/d
250 mg tid
Methyldopa
Central alpha-agonist
1.2 mg/d
mg bid
clonidin 
20 mg/d
1 mg bid
Prazosin
Alpha-adrenergic blocker
120mg/d
10 mg qid
Nifedipine
Calcium chanel blocker
100 mg/bid
100 mg qd
Atenolol
Beta-adrenergic blocker
2400 mg/d
100 mg tid
Labetalol
Alpha/beta-adrenergic blocker
50 mg/d
25 mg qd
Hydrochlorothiazide
Diuretics

37. NOTICE: PREFERRED THERAPY:METHYL-DOPA
ACE inhibitors and angiotensin II receptor blockers are:
Contraindication
because induce neonatal renal failure.

38. بسم الله دواء
وااحمدلله شفاء
هو الشافی شفاء

39. Clinical features : Chronic hypertension Gestational hypertension
Preeclampsia - Eclampsia

40. RISK LOW: DBS=90-110 NORMAL EKG NORMAL ECHO/ NO PROTEINURIA
HIGH: 160/110
LOW:
SBS=
DBS=90-110
NORMAL EKG
NORMAL ECHO/
NO PROTEINURIA

41. Gestational hypertension
DEFINED:
Induced by pregnancy
Beginning after 20 weeks
Resolving by the sixth postpartum week

42. Hypertension without proteinuria (transient )
Gestational hypertension
Divided by:
Hypertension without proteinuria (transient )
Hypertension with proteinuria

43. CHRACTRISTICS OF PREECLAMPSIA-ECLAMPSIA
BP more than 160/90 mmHg
Headache
Blurred vision
Pulmonary edema
Abdominal pain
Low platelets
Abnormal liver tests
Usually regresses within hr after delivery.

44. Treatment: Primary goal is to prevent maternal complications.
Recommended goal of therapy is reduction of mean SBP below 126 mmHg & DBP between mmHg