Monday, 2 December 2013

Hypertension in pregnancy - Preeclampsia

2.Preeclampsia :
Pregnancy specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation.
Women in either end of reproductive age are more susceptible.

Minimum criteria:
-BP >/ 140/90 mm of hg after 20 weeks gestation.
-Proteinuria >/300mg/ 24hrs or >/ 1+ dipstick.

Increased certainty of preeclampsia:
-BP >/ 160 /110 mg hg.
-Proteinuria 2.0 g / 24 hrs or >/ 2+ dipstick.
-Serum creatinine > 1.2 mg/dl unless known to be previously elevated.
-Platelets < 100,000 / mm3.
-Microangiopathic hemolysis.
-Increased LDH.
-Elevated AST or ALT.
-Persistent headache or other cerebral or visual disturbance.
-Persistent epigastric pain.

Diastolic hypertension of 95 mm of hg or greater associated with three fold increase in the fetal death rate.
Proteinuria without hypertension is rather benign.
Epigastric or right upper quadrant pain result from hepatocellular necrosis, ischemia, edema that stretches the Glisson capsule.
 Elevated serum hepatic transaminase levels is a sign to terminate the pregnancy.

Indications of severe disease:
-Thrombocytopenia caused by platelet aggregation, activation.
-Microangiopathic hemolysis induced by severe vasospasm.
-Gross hemolysis as hemoglobinemia, hemoglobinuria or hyperbilirubinemia.
-Cardiac dysfunction with pulmonary edema, IUGR.
-Unrelenting severe headache or visual disturbances may precede rapid increase in BP followed by convulsions can occur.


-Hypertension in pregnancy-classification
-Hypertension in pregnancy-gestational hypertension
-Preeclampsia
-Eclampsia, preeclamsia superimposed on chronic hypertension
-Chronic hypertension
-Hypertension in pregnancy-etiology and pathogenesis
-Pathology
-Mild hypertension in pregnancy-prevention and management
-Severe hypertension in pregnancy-management
-Severe preeclampsia in pregnancy-management
-Complications of hypertension
-Antihypertensive therapy- centrally acting drugs
-Antihypertensive therapy-beta blockers, calcium channel blockers
-Antihypertensive therapy-alpha blockers, vasodilator, diuretics, ACE inhibitors
-Acute severe hypertension - treatment
-Eclampsia - signs and symptoms
-Eclampsia - management

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