Definition:
BP of 140/90 mmHg or more taken on 2 occasion at least 4 hour apart; OR An increase in systolic BP of 30 mmHg or/and diastolic BP of 15 mmHg compared to pre-pregnancy level
1) GESTATIONAL HYPERTENSION
Is hypertension after 20th week of gestation in a previously normotensive woman x proteinuria Condition return to norm within 6 weeks after labour 2) PRE- ECLAMPSIA
3) CHRONIC HYPERTENSION
Presence of hypertension of at least 140/90 mmHg before 20th week of pregnancy or beyond 6 weeks postpartum.
Includes essential & secondary hypertension. 4) CHRONIC HYPERTENSION WITH SUPERIMPOSED PRE-ECLAMPSIA
Development of pre-eclampsia in patient with pre-existing hypertension Criteria used should include: worsening of hypertension
proteinuria
Management:
-past history or family history of pre eclampsia or eclampsia -excessive weight gain 2. Physical examination,urinanlysis,BP
3. Confirm Diagnosis:
Outpatient management:
Antenatal clinic visit: every 4 weeks every 2 weeks if x on treatment,norm biophysical profile,good fetal growth if on treatment
Tests: urinalysis (protein) BP SFH and liquor vol. BUSE,FBC,Serum uric acid
Fetal surveillance: US monthly,FKC Inpatient/Admission: BP every 4 hrs SFH and liquor vol. Daily PE chart,urine protein FBC,BUSE,serum uric acid LFT,Coagulation profile(if suspected HELLP) I/O chart Fetal surveillance: FKC,CTG,US v v Antihypertensive agents only used if DBP>100mmHg.(aim: maintain 90-100mmHg) Dexamethasone if early delivery expected (<34weeks)
Intrapartum management:
BP/ pulse rate half hourly To continue oral antihypertensive treatment Strict I/O chart Adequate analgesia(preferable epidural analgesia)
CTG monitoring Shortened 2nd stage- assisted delivery,episiotomy X syntometrime/ergometrine! Use Syntocinon 10 units Postpartum management Beware of Sx of IE and pulmonary oedema BP monitoring 1/2hourly monitoring for at least 2 4hours before sending to postnatal ward 4 hourly monitoring in the ward for 24 48hours before discharge Antihypertensive should be continued and stopped later on postnatal review. (methydopa discontinue can cz postpartum depression)
Asymptomatic BP< 140/90mmHg Reflexes not brisk Urine albumin- nil Mono-antihypertensive therapy v Review patient in 2 weeks and 6 weeks
ANTI-HYPERTENSIVE MEDICATION
ECLAMPSIA
Pregnancy induced hypertension with generalized tonic clonic fits OBSTETRICAL EMERGENCY! Aim of management: Control convulsion
Stabilize patient
Delivery
Management
4 subsections:
2) Anticonvulsive therapy
3) Antihypertensive therapy
4) Delivery
3. Abort fit by- MgSO4 loading dose= 4g IV bolus over 10-15 min
= 5g IM each buttock(10g)
OR
OR
1.Investigations-
BUSE,FBC Serum Ca2+,Mg Renal function test (urea,uric acid,creatinine) Coagulation profile UFEME ECG GXM 2. STOP !!! If present signs of Mg toxicity:
Syntocinon!!!