1 Hypertensive Disorders in Pregnancy
1 Hypertensive Disorders in Pregnancy
1 Hypertensive Disorders in Pregnancy
Disorders In Pregnancy
Dr Kailash Kharkwal
Hypertensive Disorders
• Most common medical complication in pregnancy
• 5-10% incidence
• Major cause of maternal and perinatal morbidity worldwide
Hypertension
• BP > 140 mm Hg systolic and /or > 90 mm Hg diastolic (Korotkoff 5
[K5])
• Present on at least 2 occasions, at least 6 hours apart, but within a
maximum of a 1 week period
+
• Vasospasm due to imbalance between vasodilators (PGI2, NO) &
vasoconstrictors (TxA2, angiotensin 2, endothelin)
Pathology
• PET is the clinical ice-berg tip manifestation of the disturbances in the
maternal homeostasis, involving many systems and organs
Multisystem Features Of Preeclampsia
Hypertension Proteinuria
Multi-organ disease
Cerebral vessels
Liver
Eclampsia
Fetus HELLP syndrome
Antenatal corticosteroids
• < 34 weeks POG
2) Control of Hypertension:
Parentral drugs:
1. Labetalol :
• First-line therapy (rapid onset of action, good safety profile)
• α and non selective β- adrenergic blocker
• 20 mg IV over 2 minutes followed at 10-minute intervals by
doses of 20 to 80 mg
− Up to a maximum total cumulative dose of 300 mg
− E.g. Give 20 mg, then 40 mg, then 80 mg, then 80 mg, then 80 mg
2) Control of Hypertension:
2. Hydralazine:
• 5 mg IV over 1 to 2 minutes
• If BP goal is not achieved within 20 minutes, give a 5 to 10 mg
bolus depending upon the initial response
− The maximum bolus dose is 20 mg
− If a total dose of 30 mg does not achieve optimal blood pressure
control, another agent should be used.
− The fall in blood pressure begins within 10 to 30 minutes and lasts
from 2 to 4 hours.
3. Diazoxide:
• Used in severe dangerous resistant hypertension as a last resort
• Dose: 50-150mg IV bolus dose
• Repeated every 1-2 minutes until BP decreases
2) Control of Hypertension:
Oral drugs:
1. α-methyl DOPA:
• It is the most commonly used
• It is α-adrenergic agonist causing depletion of catecholamine
stores
• Dose: 250-500mg 4 times/day orally
3. β-adrenergic blockers:
• Labetalol (Trandate) 100-400mg 2 times daily
• Atenolol (tenormin) 50-100mg once daily
Target BP
• 130 to 150 mm Hg systolic and 80 to 100 mm Hg diastolic OR reduce
MAP by no more than 25% over 2 hours
• Cerebral or myocardial ischemia or infarction can be induced by
aggressive antihypertensive therapy if the blood pressure falls below
the range at which tissue perfusion can be maintained by
autoregulation
TTT of Preeclampsia
3) Prevention of convulsions
4) Termination of pregnancy
Magnesium Sulfate (MgSO4):
• IV regimen:
– Initially 4-6 gm (20%) in 100ml solution, given
over 15-20 minutes.
– Then, 1-2 gm/hour by IV drip
• IM regimen:
– 10 gms of 50% solution are given deeply IM (5
gms in each buttock)
– Maintain with 5 gm/4 hours of 50% solution
Preeclampsia: Termination of Pregnancy
• Definitive treatment: DELIVERY!
• Based on the factors:
a) POG
b) Severity of PE
c) Maternal / Fetal condition
Timing of delivery:
• Mild or Severe pre-eclampsia is usually treated conservatively till the
end of the 36th week to ensure reasonable maturation of the fetus
Mild Preeclampsia :
• Deliver at ≥37 weeks of gestation
• Labor induction encouraged
Indications of termination before 36th week include:
• Fetal
• Maternal
Fetal:
a) Intrauterine growth restriction,
b) Oligohydramnios,
c) Reduced fetal movements,
d) Abnormal fetal heart patterns, or
e) Failing biochemical results.
Maternal:
a) Blood pressure is sustained or exceeds 160/110 mmHg
b) Urine proteinuria > 5 gm/24 hours
c) Oliguria
d) Evidence of DIC
e) Imminent or already developed eclampsia
Severe Preeclampsia:
• Deliver regardless of gestational age
Method of delivery
• Vaginal delivery
• Caesarean section
Method of delivery
Vaginal delivery may be commenced in vertex presentation by:
a) Amniotomy + oxytocin if the cervix is favourable
b) Prostaglandin vaginal tablet (PGE2) if the cervix is not favourable.