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HYPERTENSIVE DISORDERS OF
PREGNANCY
General Classification
Preeclampsia or Eclampsia (hypertension and
Diagnosis of Hypertension
Blood pressure readings vary depending on
PREECLAMPSIA
A syndrome unique to pregnancy, characterized by
at least 6 hr apart
Proteinuria 5 gram in a 24 h urine collection
or qualitative +3
Oliguria (< 500 ml in 24 hr)
Cerebral or visual disturbances
Pulmonary edema or cyanosis
enzyme)
Thrombocytopenia
Fetal growth restriction
Eclampsia
Is the presence of tonic clonic seizures in a
Chronic Hypertension
The diagnosis of chronic hypertension
Etiology Preeclampsia /
Eclampsia
Preeclampsia is called a disease of theories,
because genetic,immunologic,vascular,
hormonal, nutritional, and behavioral factors
have all been proposed as causes. No single
definitive cause has been identified and the
origins of the disease are considered to be
multifactorial.
Pathophysiology
Generalized vasospasm
GFR and renal blood flow are significantly
lower
Damage of glomerular membranes ,
increasing their permeability to proteins and
leading to proteinuria.
Cerebral vascular resistance is high in
patients with PE and Eclampsia
Pathology
Lack of decidualization of the myometrial
MANAGEMENT OF PREECLAMPSIA
FAVOURABLE
MILD PREECLAMPSIA
AMBULATORY CARE
BED REST : NOT NECESSARILY
REGULAR DIET, NO SALT RESTRICTION
PRENATAL VITAMIN
HOSPITAL CARE
OBSTETRIC MANAGEMENT
SEVERE PREECLAMPSIA
MEDICAL TREATMENT
OBSTETRIC MANAGEMENT :
CONSERVATIVE : -
PREGNANCY 37 WEEKS
ACTIVE
PREGNANCY 37 WEEKS
: -
FETAL INDICATION
MATERNAL INDICATION
MEDICAL TREATMENT :
HOSPITALIZE
TOTAL BED REST
FLUID THERAPY : RINGER LACTATE, DEXTROSE 5%.
Mg SO4 IV
ANTI HYPERTENSION :
HYDRALAZIN
LABETALOL
NIFEDIPINE : 10 20 mg / ORALLY EVERY - 1 H,
MAX : 120 mg / 24 Hours
DIURETIC
: NOT RECOMMENDED
ANTI OXYDANT : N-ACETYL CYSTEIN
CORTICOSTEROID + LUNG MATURITY 34 WEEKS
OBSTETRIC MANAGEMENT
CONSERVATIVE MANAGEMENT:
GOAL
INDICATION
FETAL
: - PREGNANCY 37 WEEKS
- IUGR AND ABNORMAL
BIOPHYSICAL PROFILE
ECLAMPSIA : PE + CONVULSION
BASIC MANAGEMENT :
CONTROL THE AIRWAY, BREATHING, CIRCULATION (ABC)
MEDICAL TREATMENT :
SAME AS SEVERE PREECLAMPSIA
MOTHER
BABY
HELLP SYNDROME
IUGR
LIVER RUPTURED
PREMATURE LABOR
PULMONARY EDEMA
RENAL FAILURE
CEREBRAL PALSY
ABRUPTIO PLACENTAE
PNEUMO THORAX
DIC
IUFD
HELLP SYNDROME
FIRST DISCRIBED BY WEINSTEIN 1982:
ACRONYM OF : H
INCIDENCE :
HEMOLYSIS
EL
LP
CRITERIA DIAGNOSTIC
LABORATORY FINDING:
HEMOLYSIS
ABNORMAL PERIPHERAL SMEAR : SCHISTOCYTES AND
BURR CELLS
TOTAL BILIRUBIN LEVEL > 1,2 mg/Dl
LACTATE DEHYDROGENASE LEVEL > 600 /L
MEDICAL MANAGEMENT
OBSTETRIC MANAGEMENT
WHEN MOTHERS IS STABLE TERMINATE THE
PREGNANCY OR CONSERVATIVE MANAGEMENT.
CONSERVATIVE MANAGEMENT CAN BE DONE
WHEN :
COMPLICATION
THE COMPLICATIONS THAT CAN OCCUR IN
HELLP SYNDROME ARE : NEUROLOGIC