![Page 1: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/1.jpg)
![Page 2: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/2.jpg)
Seyed Morteza Mahmoodi
![Page 3: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/3.jpg)
Gestational Hypertension
Pre eclampsia and Eclampsia
Chronic Hypertension
Contents
Complications
![Page 4: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/4.jpg)
Gestational Hypertension
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
![Page 5: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/5.jpg)
Gestational Hypertension
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
![Page 6: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/6.jpg)
![Page 7: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/7.jpg)
![Page 8: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/8.jpg)
![Page 9: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/9.jpg)
![Page 10: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/10.jpg)
Hypertension Pregnancy-induced hypertension Gestational hypertension Transient hypertension of pregnancy Chronic hypertension Pre-eclampsia Eclampsia Increment of 30 mm Hg systolic or 15 mm Hg
diastolic blood pressure (Levine, 2000; North and colleagues, 1999)
![Page 11: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/11.jpg)
![Page 12: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/12.jpg)
Abnormality Nonsevere Severe
Diastolic blood pressure <110 mm Hg 110 mm Hg
Systolic blood pressure <160 mm Hg 160 mm Hg
Proteinuria 2+ 3+
Headache Absent Present
Visual disturbances Absent Present
Upper abdominal pain Absent Present
Oliguria Absent Present
Convulsion (eclampsia) Absent Present
Serum creatinine Normal Elevated
Thrombocytopenia Absent Present
Serum transaminase elevation Minimal Marked
Fetal-growth restriction Absent Obvious
Pulmonary edema Absent Present
![Page 13: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/13.jpg)
![Page 14: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/14.jpg)
![Page 15: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/15.jpg)
![Page 16: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/16.jpg)
-Defective trophoblastic invasion-Immunological maladaptive tolerance-Maternal maladaptation to CV changes in normal
pregnancy-Abnormal placentation.-Genetic and nutritional factors
![Page 17: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/17.jpg)
![Page 18: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/18.jpg)
![Page 19: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/19.jpg)
![Page 20: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/20.jpg)
![Page 21: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/21.jpg)
![Page 22: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/22.jpg)
![Page 23: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/23.jpg)
Residual HTRecurrent pre-eclampsiaChronic renal disease
![Page 24: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/24.jpg)
Injuries Pulmonary:-Edema-pneumonia, aspiration-ARDS-Embolism Hyperpyrexia LVF RF
Hepatic necrosis Subcapsular haematoma Cerebral hemorrhage Disturbed vision Haematological, DICPostpartum-Shock-Sepsis-Psychosis
![Page 25: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/25.jpg)
![Page 26: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/26.jpg)
![Page 27: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/27.jpg)
![Page 28: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/28.jpg)
![Page 29: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/29.jpg)
![Page 30: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/30.jpg)
![Page 31: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/31.jpg)
Insidious, slow course. Mild symptoms:Mild symptoms:-Ankle edema-Extend to be generalized Alarming symptoms:Alarming symptoms: Acute onset-Headache-Disturbed sleep-Oliguria-Epigastric pain-Eye symptoms, restlessness.
![Page 32: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/32.jpg)
Raised BP Abnormal weight gain, Oedema. Pulmonary oedema Retinal, Neurological examination, Abdominal examination, Secondary and end organ damage,
![Page 33: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/33.jpg)
![Page 34: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/34.jpg)
EpilepsyEpilepsy HysteriaHysteria EncephalitisEncephalitis MeningitisMeningitis Puerperal cerebral thrombosis.Puerperal cerebral thrombosis. PoisoningPoisoning Cerebral malariaCerebral malaria Intra-crainal tumours.Intra-crainal tumours.
![Page 35: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/35.jpg)
![Page 36: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/36.jpg)
Blood values: CBC, serum sodium, potassium, creatinine, and glucose levels, LFT, coagulation profile creatinine.
Urine Serum uric acid, biochemical marker of pre-biochemical marker of pre-
eclampsiaeclampsia. Serum lipids Radiological ECG, EEG Fetal monitoring
![Page 37: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/37.jpg)
![Page 38: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/38.jpg)
![Page 39: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/39.jpg)
![Page 40: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/40.jpg)
More than 100 clinical, biophysical, and biochemical tests have been reported to predict preeclampsia
Low-Salt Diet Fish Oil Supplementation Antioxidants CALCIUM SUPPLEMENTATION ASPIRIN There is currently no proven way to prevent
preeclampsia
![Page 41: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/41.jpg)
![Page 42: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/42.jpg)
Mild preeclapsia:Mild preeclapsia:-Maternal evaluation (history & ex.)-Lab:CBC & ElectrolyteRFT: BUN, creatinine ,uric acidLFT & coagulation profile: PT, PTT, D-diamersUrine analysis24hhr urine for protein & creatinine clearance.
![Page 43: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/43.jpg)
Fetal evaluation of CTG, USG, doppler flow. Bed rest in left lateral decubitus position. No use of diuretics & AntiHT
![Page 44: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/44.jpg)
Stabilize & deliverStabilize & deliver, the only cure . Vaginal induction is preferred. Admit & complete maternal evaluation. -Keep NPO -Start IV, cross & type -Foley catheter Monitoring urine output, input & vitals.
![Page 45: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/45.jpg)
Fetal evaluation: electronic fetal monitoring, doppler flow.
Anticonvulsant therapy:-to seizure thresholdto seizure threshold-baseline Mg bld level-Mg sulfateMg sulfate 4g IV boluse over 20min,. Folowed by
maintenance of 2-4g/hr
Oliguric pt needs low infusion rate.Oliguric pt needs low infusion rate.
Management of severe preeclampsia:
![Page 46: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/46.jpg)
Signs of Mg sulfate toxicity:-DTR-RR<10/min-Urine output< 25 cc/hr-Decrease muscle tone-CNS or cardiac depression
Antagonist: calcium gluconatecalcium gluconate 10% 10ml, 1g IV over 2min.
![Page 47: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/47.jpg)
Antihypertensive therapy:-Indicated if BP >140-160/90-110-Labetalol 20-50mg IV q 10mins.-Methyldopa or nifedipine.
ACE-inhibitors avoided.ACE-inhibitors avoided.
![Page 48: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/48.jpg)
Resuscitation, ABCABC Oxygen Arrest convulsions, valium or phenytoin. Ventilatory support, prevent aspiration, auscultate
lungs after every seizure. Haemodynamic stabilization, control BP. Send investigation. Deliver by 6-8hrs. Postpartum care, intensive.
![Page 49: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/49.jpg)
Mgsulfate,Mgsulfate, continue to 24hr after last fit.
Lytic coktail regime:Lytic coktail regime:Chlorpromazine, phenergan & pethidine. AntiHT & diuretics.
Status eclampticus:Status eclampticus: thiopentone Na0.5gm, dissolved in 20% dextrose givin slowly.
![Page 50: Pregnancy Induced Hypertension, Preeclampsia, Eclampsia](https://reader035.vdocuments.net/reader035/viewer/2022062220/556afbddd8b42a2a4f8b4c36/html5/thumbnails/50.jpg)