9. Hypertension in Prgnancy.pptx

Hypertension in Pregnancy-1 Dr Sathisha Nayak Learning objectives: • Physiological changes in pregnancy and Blood pressure • Definition • Classification • Etiology • Pathophysiology • Clinical Features • Complications • Management • Prevention Physiological Changes in BP in pregnancy • Increased...

Hypertension in Pregnancy-1 Dr Sathisha Nayak Learning objectives: • Physiological changes in pregnancy and Blood pressure • Definition • Classification • Etiology • Pathophysiology • Clinical Features • Complications • Management • Prevention Physiological Changes in BP in pregnancy • Increased intravascular volume • Decreased vascular sensitivity • Decreased peripheral resistance • slight fall of BP during mid pregnancy • Increased blood flow to peripheral structures including placenta Classification • Pregnancy Induced Hypertension (Gestational Hypertension) Mild/severe gestational hypertension Mild severe Pre-eclampsia Imminent Eclampsia Eclampsia • Pregnancy Associated Hypertension • Super imposed Hypertension Definitions • Gestational Hypertension  BP 140/90 2 readings 6 hors apart, FIRST TIME after 20 week, recovers <7 days after delivery  Mild(<140/100),Severe (>140/100) • Pre-Eclampsia  Gestational hypertension with protenuria • Imminent Eclampsia  Gestational hypertension/pre-eclampsia with features of imminent eclampsia • Eclampsia  Gestational hypertension/pre-eclampsia with convulsions Etiology/pathophysiology • Placental factor induced changes in maternal systems • Increased vascular sensitivity leading to vasospasm • Multiple endothelial damage • Leaking of albumin leading to interstitial edema • contraction of intravascular volume • Tissue hypoxia • Coagulation derangement • Tissue hemorrhage Clinical features • Swelling of feet, face and other body parts • Excessive weight gain • Headache, vomiting, visual disturbances • Severe pain abdomen(epigastric or right hypochondrial) • Increase in Blood pressure • Brisk DTR/Clonus • Convulsions Complications • Maternal  Eclampsia  Renal failure  Cerebral hemorrhage  Abruption  DIC  Cerebral hemorrhage  Retinal detachment, HELP syndrome • Fetal  IUGR  IUFD Evaluation • Urine analysis  Albumin/Protein, microscopy, casts • Liver function Test • Renal function Test • Coagulation Profile • Fundoscopy • Ultrasound scan • CTG/Biophysical profile Pregnancy associated Hypertension • Renal hypertension • Essential Hypertension • Vascular Hypertension Typically pre existing or < 20 weeks of gestation No recovery after delivery Other associated Clinical features. Sometimes Gestational hypertension is suprerimposed