chronic hypertension in pregnancy

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CHRONIC HYPERTENTION IN PREGNANCY

• Narendra sisodia

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DEFINITION

• Presence of hypertension of any cause antedating
  or before 20th wks of pregnancy and persisting
  beyond 12 wks after delivery.

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RISK FACTORS

• Age (gt40 yrs)
• Duration of HT (gt15 yrs)
• BP (gt160/110 mm Hg)
• Any medical disorder (Renovascular)
• Presence of Thrombophilias

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CAUSES

• Essential hypertension
• Chronic renal disease
• Coarctation of aorta
• Endocrine disorders
• Connective tissue disorders

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ESSENTIAL HYPERTENTION

• BP gt140/90 mm Hg or more prior to 20th wk
• Cardiac enlargement
• Presence of any medical disorder
• Persistently raised BP even after 42 days
  postpartum

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FEATURES

• Elderly
• Multipara
• Onset before 20th wk
• Persists even after 3 months
• Family history
• No proteinuria
• HT retinopathy

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EFFECT OF PREGNANCY ON HT

• Mid pregnancy fall in 50
• Progressive rise in 50
• Superimposed by pre-eclampsia in 20
• Malignant HT rarely
• Deterioration in 30

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SUPERIMPOSED PRE-ECLAMPSIA

• New onset proteinuria (gt0.5g/24hr)
• Aggravation of HT
• Thrombocytopenia
• Raised liver enzymes

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EFFECT OF HT ON PREGNANCY

• MATERNAL

• Mild risk remain unaltered
• Severe or superimposed pre-eclampsia risks is
  very much increased
• Risk of placental abruption is high

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• FOETAL

• Growth retardation
• Preterm birth
• Perinatal death
• 10 - lt160/100 mm Hg
• 20 - gt160/100 mm Hg
• 30 - superimposed pre-
• eclampsia

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MANAGEMENT

• AIM

• To stabilise BP lt160/100 mm Hg
• To prevent pre-eclampsia
• To monitor maternal foetal well being
• To terminate pregnancy at optimal time

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• Pre-conceptional evaluation counselling
• - etiology
• - severity
• - possible outcome
• Women with severe uncontrolled HT should be
  discourage to become pregnant unless controlled

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• GENERAL

• MILD CASES
• Adequate rest
• Low salt diet
• Frequent check-ups
• Routine investigation fundus examination
  regularly

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• SEVERE CASES
• Hospitalisation
• Managed as Pre-eclampsia

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• OBSTETRIC

• Mild spontaneous labour is
• awaited
• Severe continue to atleat 34 wks
• otherwise upto 37 wks
• then to terminate it

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RATIONALE OF ANTI-HT DRUGS

• Routine use not favoured, since it may cause
  decrease placental perfusion
• Advised when BP gt160/100mm Hg to prevent organ
  damage

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• Drugs that can be used are
• - Methyl dopa
• - Nifidipine
• - Labetalol
• - Hydralazine

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• Drugs which should not be used are
• - Diuretics
• - ACE- inhibitors
• - Sod. Nitroprusside
• - Non selective beta
• blockers

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THANK YOU
THANK YOU