Hypertensive Disorders Of Pregnancy Medical Presentation

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Published on : May 10, 2018 | Views : 1306 | Downloads : 3

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HYPERTENSIVE DISORDERS OF PREGNANCY definition and theories Swathi Suresh Final Year MBBS
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OUTLINE Terminology and Classification Diagnosis (Definition) Etiological Theories Pathogenesis
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TERMINOLOGY Gestational Hypertension: any form of new onset, pregnancy-related hypertension. It emphasises the cause and effect connection between pregnancy and its unique form of hypertension i.e., preeclampsia and eclampsia.
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Classification of hypertensive disorders of pregnancy The Working Group of the National High Blood Pressure Education Programme (NHBPEP-2000) classification: Gestational Hypertension (formerly PIH) Preeclampsia Eclampsia Chronic Hypertension Chronic Hypertension with superimposed preeclampsia
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Hypertensive disorders of pregnancy Hypertension is diagnosed when the resting blood pressure is 140/90 mm of Hg or greater, on at least two occasions, four to six hours apart.
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Diagnosis Gestational Hypertension BP ≥140/90 mm of Hg for the first time during pregnancy after 20 weeks of gestation No proteinuria BP returns to normal < 12 weeks’ postpartum Final diagnosis can only be made postpartum May have other signs or symptoms of preeclampsia like epigastric discomfort or thrombocytopenia
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Diagnosis Preeclampsia Minimum criteria BP ≥140/90 mm Hg after 20 weeks’ gestation Proteinuria ≥ 300 mg/24 hours or ≥ 1+ dipstick Increased certainty of preeclampsia BP ≥160/110 mm of Hg Proteinuria 2.0 g/24 hours or ≥ 2+ dipstick Serum creatinine > 1.2 mg/dl unless known to be previously elevated Platelets < 1,00,000/mm3 Microangiopathic hemolysis (increased LDH) Elevated ALT or AST Persistent headache or other visual/cerebral disturbances Persistent epigastric pain
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Diagnosis Eclampsia Seizures that cannot be attributed to other causes in a woman with preeclampsia.
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Diagnosis Chronic Hypertension BP ≥ 140/90 mm of Hg before pregnancy or diagnosed before 20 weeks’ gestation not attributable to gestational trophoblastic disease or Hypertension first diagnosed after 20 weeks’ gestation and persistent after 12 weeks’ postpartum
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Diagnosis Chronic Hypertension with superimposed preeclampsia New-onset proteinuria ≥ 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks’ gestation. A sudden increase in proteinuria or BP, or platelet count < 1,00,000/mm3 in women with hypertension and proteinuria before 20 weeks’ gestation.
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Theories of etiology Abnormal trophoblastic invasion
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Theories of etiology Immunological factors Formation of blocking antibodies to placental antigenic sites might be impaired – Nulliparity, New paternity and Multiple pregnancy. Th1 / Th2 imbalance: May favour preeclampsia. Immune complexes and anti-endothelial cell antibodies.
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Theories of etiology Vasculopathy and inflammatory changes
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Theories of etiology Nutritional factors Obesity (risk increased to 13.3 percent when BMI > 35 kg/m2) Daily intake of ascorbic acid (in pregnancy) < 85 mg : Incidence of preeclampsia was found to be doubled.
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Theories of etiology Genetic Factors An association between HLA-DR4 and proteinuric hypertension may exist. Women homozygous for angiotensinogen gene variant T235 had abnormal trophoblastic invasion.
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Pathogenesis Vasospasm Endothelial cell activation
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