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Hypertensive disorders of pregnancy
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Chronic HTN
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Systolic pressure ≥140 or diastolic pressure ≥90 prior to conception or 20 weeks gestation
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Gestational HTN
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· New-onset elevated blood pressure at ≥20 weeks gestation
· No proteinuria or end-organ damage
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Preeclampsia
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New-onset elevated blood pressure at ≥20 weeks gestation
AND
Proteinuria OR Signs Of end-organ damage
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Eclampsia
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Preeclampsia
AND
New-onset grand mal seizures
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Chronic HTN w/ PIH
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Chronic hypertension AND features Of PIH
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· Defintion by timeline:
o <20 w or dx pre-pregnancy ⤴️BP → Chronic HTN
· If >20 w w/o other sx → Gestation HTN
· If >20 w + Proteinuria → Preelampsia
· If >20 w + Proteinuria + seizure → Eclampsia
· Management wise:
o If Gestational HTN / Chronic HTN & ❌ organ damage → Manage OP Conservative
· If we reached preclampsia and above → Manage IP aggresively
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Preeclampsia
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Def
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New-onset HTN (SBP ≥140/DBP ≥90) at ≥20 weeks gestation
PLUS
Proteinuria &/or end-organ damage
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Severe
Features
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· Very high HTN: 2160/DBP 2110 (2 times 24 hs apart)
· ⤵️ PLT
· ⤴️ Creatinine
· ⤴️ Transaminases
· Pulmonary edema
· Visual / cerebral / Gl sx
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Dx
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If Urine dipstick +1 confirm dx w/ either 24h urine / protein-to-cr ratio
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Tx
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· Mild: Delivery at ≥37 w
· Severe: Delivery at ≥34 w
· Magnesium sulfate (SZ ppx)
· Antihypertensives
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HELLP syndrome
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S/S
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· Preeclampsia
· Nausea/vomiting
· RUQ abdominal pain
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Dx
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· Microangiopathic hemolytic anemia
· ⤴️ liver enzymes
· ⤵️ PLT count
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Tx
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· Delivery
· Magnesium for seizure prophylaxis
· Antihypertensive drugs
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Eclampsia
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Def
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Severe preeclampsia + seizures
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Clx
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· Hypertension
· Proteinuria
· Severe headaches
· Visual disturbances
· Right upper quadrant or epigastric pain
· 3-4 minutes of tonic-clonic seizure, usually self-limited
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Tx
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· Administer magnesium sulfate
· Administer antihypertensive agent
· Deliver the fetus
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Pregnancy-related risks due to hypertension
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Mom 👩🏻
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· Superimposed preeclampsia
· Postpartum hemorrhage
· GDM
· Abruptio placentae
· Cesarean delivery
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Baby 👶🏼
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· Fetal growth restriction
· Perinatal mortality
· Preterm delivery
· Oligohydramnios
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Antihypertensives in pregnancy 🤰🏻
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1˚
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· BB (labetalol)
· CCB (nifedipine)
· Hydralazine
· Methyldopa
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2˚
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· Clonidine
· Thiazide
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❌
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· ACE inhibitors
· ARB
· Direct renin inhibitors
· Nitroprusside
· Mineralocorticoid receptor antagonists (spironolactone)
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Fast HY Review 