Hypertension in Pregnancy

1
Hypertension in Pregnancy

• Anna Mae Smith, MPAS, PA-C

2
Bood Pressure

• 15-20 mm Hg above baseline in the diastolic
  reading
• 30mmHg above baseline systolic

3
Preeclampsia

• A syndrome of pregnancy-induced
• hypertension
• proteinuria
• edema
• May have disturbances in other organ systems
• most often occurs in primigravidas

4
Proteinuria

• gt 300 mg of protein in a 24-hour urine specimen
• gt1 protein on dipstick sampling of a random
  urine specimen
• Usually a late sign

5
Variant - HELLP Syndrome

• H - hemolysis
• EL - elevated liver enzymes
• LP- low platelet count

6
Eclampsia

• Preeclampsia is bad but dont let it progress!!!
• ECLAMPSIA
• Seizures preceded by headaches, epigastric pain,
  hyperreflexia, and hemoconcentration
• generalized seizures or coma ensues

7
Chronic hypertension

• hypertension antedates pregnancy, appears before
  week 20 of gestation, or persists indefinitely
  after delivery
• see table 22-2

8
Transient Hypertension

• Occurs late in pregnancy have no other signs of
  preeclampsia or preexisting hypertension
• The blood pressure normalizes postpartum, but
  hypertension often recurs during subsequent
  pregnancies
• These women are likely to have essential
  hypertension later in life

9
Risk Factors

• Primigravid status
• Family history of preeclampsia or eclampsia
• Previous preeclampsia or eclampsia
• New paternity

10
Risk Factors

• Extremes of maternal age (younger than 20 y or
  older than 35 y of age)
• Preexisting hypertensive vascular, autoimmune, or
  renal disease
• Diabetes mellitus
• Multiple Gestation
• Hydatidiform mole

11
Organ Dysfunction

• Renal
• Liver (HELLP)
• Placenta (IUGR, abruption)
• Cardiac/Pulmonary - decreased CO
• CNS - multifocal petechial hemorrhages at the
  gray matter-white matter junction

12
Prevention

• Baby ASA
• Calcium
• Low salt diet?

13
Treatment

• The most effective therapy for preeclampsia is
  delivery of the fetus and placenta

14
Mild preeclampsia

• Bed rest observation
• Reduced activity reduces premature labor, lowers
  blood pressure, and promotes diuresis
• May need to hospitalize initially to check mom
  babe

15
Severe Preeclampsia

• 30wks deliver
• lt 30 may try drugs to gain time
• Hydralazine
• Labetalol
• Mag. Sulfate - prevent seizures
• check reflexes
• reversed with Ca gluconate

16
Eclampsia

• SEIZING!!!
• Mag sulfate
• CXR
• ABG

17
Chronic HTN

• Methyldopa
• Diuretics