1. Nahar Taufiq Bagian Kardiologi dan Kedokteran Vaskular FKUGM SMF Jantung/ Pusat Jantung Terpadu RSUP DR Sardjito Jogjakarta

2. Hypertension in Pregnancy:  Major cause of maternal and perinatal morbidity and mortality  Complicates up to 10% of pregnancies  Second leading cause of maternal mortality in the developed world (after VTE)  ~1/3 of all maternal deaths are from HTN’sive disorders Introduction

3. Physiologic adaptations in normal pregnancy  Blood changes: o ↑ Plasma volume by ≈ 40%. o Platelets count can ↓ below 200 X 10 9 /L due to normal maternal blood-volume expansion. o ↑ Coagulation factors (Fibrinogen, Factor VII).  Cardiovascular changes: o Marked generalized vasodilation ( ↓ peripheral resistance)   a/w arterial resistance to constrictor actions of Angiotensin II. o ↑ CO & Stroke volume. o MAP ↓ by 10 mm Hg.

4.  Renal changes: o Vasodilation  ↑ Renal blood flow  ↑ GFR (by 50%). o ↑ in Creatinine clearance with a concomitant ↓ in S- Creatinine & urea. o ↑ Uric acid clearance & Ca + excretion. o ↑ Glucosuria + aminoaciduria.  Respiratory changes.  Endocrine changes: o e.g. parathyroid, adrenal, weight, GI changes. Physiologic adaptations in normal pregnancy

5. Definitions related hypertensive disorders in pregnancy

6.  In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy:  Chronic hypertension  Gestational hypertension  Preeclampsia  Preeclampsia superimposed on chronic hypertension

7. Severe complications Hypertension in Pregnancy MATERNAL  CVA  DIC  End-organ failure  Placental abruption FETAL  IUGR, Intra Uterine Growth Restriction  Prematurity  Intra-uterine death

8. Differentiating Hypertensive in pregnant

9. Assesment of proteinuria

10. Reducing the risk hypertensive disorders in pregnancy

11. Moderate to high Risk Preeclamsia

12. Pre-eclampsia

15. Pre-eclampsia

16. Chronic hypertension X

20. Gestasional Hypertension

26. Severe Hypertension, severe pre-eclamsia and eclamsia

29. Drugs  A)Parentral drugs:  1) Hydralazine:  It is a peripheral VD.  The best Antihypertensive drug used during Pre- eclampsia and Eclampsia.  Dose: 5-10mg IV or IM as initial dose.  Repeated every 20-30 minutes until blood pressure is controlled.

30.  2) Labetalol :  α and non selective β- adrenergic blocker resulting in VD.  Dose: 10-20mg IV.  The dose can be doubled every 10 minutes if proper response is not achieved.  3) Diaz oxide :  Used in severe dangerous resistant hypertension as a last resort.  Dose: 50-150mg IV bolus dose.  Repeated every 1-2 minutes until BP decreases. Drugs

31.  A )Oral drugs: 1) α-methyl DOPA :  It is the most commonly used.  It is α-adrenergic agonist causing depletion of catecholamine stores.  Dose: 500mg 3-4 times/day orally. 2) Monohydralazine :  It is a weak Antihypertensive when given alone.  It used in combination with β- blockers to increase its efficacy and decrease its side effects. Drugs

32.  3) β- adrenergic blockers:  Atenolol (tenormin) 50-100mg 4 times daily.  Labetalol (Trandate) 10-20mg 3 times daily.  4) Prazocin :  It is postsynaptic α-adrenergic receptor blocker resulting in VD and reflex tachycardia.  It is a weak Antihypertensive drug so used in combination with other drugs.  5) Calcium Channel Blocker:  Nifedipine. Drugs

33. Selamat kepada adik adik angk 180 Dr. Djumikan / PD III, Prof DR Koento Wibisono Rektor UNS Prof dr Soetjipto Dekan FK UNS, Dr Sujarsono PD I, Dr Muhardjo PD II