Hypertension

In Obstetrics
Tarana Nadeem
6th course
Bogomolets national medical university
Gestational hypertension
The definition of hypertension during pregnancy is based on official blood pressure
values, SBP>_140 mmHg and/or DBP>_90 mmHg on 2 occasions 4 hrs apart.
● mild (140-159/90-109 mmHg)
● moderate(140-159/90 -109 mmHg)
● severe (>_160/110 mmHg).

Increase in BP AFTER 20 WEEKS OF GESTATION and bp falla back withinn12 weeks

of delivery is called PIH.

If pregnant female with G.HTN develops proteinuria it then becomesxpre eclampsia.

BP measurement
Manual auscultation remains the goldstandard for BP measurement in pregnancy,becaue
automated devices tend to under record the BP and are unreliable in severe preeclampsia.

ABPM devices recommended for use in pregnancy

All pregnant women should be assessed for proteinuria in early pregnancy to detect pre-
existing renal disease and, in the second half ofpregnancy, to screen for pre-eclampsia.

Reassessment 6 weeks postpartum can help distinguish between pre-existing hypertension

and pregnancy-related hypertension.
Check for proteinuria
● greater than or equal to 300mg urine protein excretion in a 24-hour period
● a protein/creatinine ratio of greater than or equal to 0.3
● Urine dipstick with protein reading of at least 1+

If protein uria absent , look for end organ damage >>> if present- pre eclampsia

If absent - gestational hypertension

EoD INCLUDES

Thrombocytopenia ,renal failure , pulmonary edema, liver dysfunction or new-onset

headaches that do not respond to medications and have no other cause.
 Eclampsia
Onset: The majority of cases occur intrapartum and postpartum.

Most often associated with severe preeclampsia

Eclamptic seizures: generalized tonic-clonic seizures (usually self-limited)

Deterioration with headaches, RUQ pain, hyperreflexia, and visual changes are
warning signs of a potential eclamptic seizure.
 Acute kidney injury, oliguria.

Multi organ damage GI:

in PIH Epigastric or right upper-quadrant discomfort.

Neurologic:

Altered mental status ranging from confusion to coma.

Visual disturbance.

Headache.

Intracranial hemorrhage.

Hyperreflexia (sometimes with clonus).

Seizures.
Treatment preeclampsia
Medical management
Start antihypertensives - iv lobetalol
Iv hydrazaline
Ccb - niedipine
Administer magnesium sulfate for seizure prophylaxis.
Monitor blood pressure, oxygen saturation, and urine output.
Manage complications (e.g., pulmonary edema, headache, renal
insufficiency).

Note ⇒ dont use diuretics !!!!

MgSO4 toxicity
Antidote ⇒ calcium gluconate 1gm
Check for knee jerk reflex IV
Urine output < 30
Respiratory ratecdecreases
Ecg
Obstetric management Unstable: Stabilize the mother and
proceed to delivery.
Indications for immediate delivery
regardless of gestational age present: Stable
Deliver. ● Administer corticosteroids for fetal
Indications for immediate delivery lung maturity.
absent ● Consider a trial of expectant
management.
● ≥ 34 weeks' gestation: Deliver. ● Strictly monitor maternal and fetal
● Between fetal viability and 34 status.
weeks' gestation: Assess maternal
and fetal status.
Treatment eclampsia
Obstetric management
Place patient in the left lateral decubitus position ● Eclampsia is an indication for immediate
to: delivery regardless of gestational age.
● Vsginal Delivery should occur only after the
Prevent placental hypoperfusion due to IVC
compression mother is stable and seizures have stopped.

Reduce the risk of aspiration

Start anticonvulsive therapy.

First line: magnesium sulfate

Start antihypertensives for urgent blood pressure

control in pregnancy.
Medical management
Administer blood products (e.g., platelets, PRBCs, FFP) as needed to manage hemorrhage and
coagulopathy
Initiate antihypertensives for urgent blood pressure control in pregnancy.
Administer magnesium sulfate for seizure prophylaxis.

Obstetric management
Expedited delivery is indicated for all patients regardless of gestational age.
≥ 34 weeks' gestation: Deliver immediately.
24–34 weeks' gestation: Administer corticosteroids for fetal lung maturity, if feasible.
Delivery may be delayed until 24–48 hours after corticosteroid administration if maternal and
fetal status remains stable
Case
35-year old G1P0 woman presents to a small rural ED complaining of 10 hrs of 4/10 regular period-
like pelvic cramping radiating into her lower back as well as gradual onset 8/10 diffuse “throbbing”
headache accompanied by blurring vision. expert peer reviewShe denies vaginal bleeding, urinary
symptoms, GI symptoms, fever or chills. She denies neck pain or stiffness, limb weakness or
numbness or speech difficulty. Her Group B Strep status is unknown. According to her LMP she is
approximately 30 weeks gestation. She has had no prenatal care to date

Her past medical history is unremarkable and she does not take any medication.

Her vital signs in the ED reveal a BP of 175/115, heart rate of 95, respiratory rate of 17 and
temperature of 36.5.

Her GCS is 15, PERL, gait normal, no pronator drift, but her extremity deep tendon reflexes are
hyper-reflexic. Her chest is clear. Her lower abdomen is tender with no periotneal signs and no
organomegaly. Her cervix is 2 cm dilated and soft. There is some greenish discharge per os.

A urine dip shows 3+ protein and 2+ blood. Routine blood work is sent, but no results are available
at this time.
Preterm labor as there are regular contractions of
the uterus resulting in changes in the cervix.

severe pre-eclampsia.
THANK YOU FOR YOUR ATTENTION