Hypertension in pregnancy

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A 45 minutes

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HYPERTENSION IN
PREGNANCY

Introduction
• Kenya and third world leading causes of
maternal mortality;
Hemorrhage
Infections
Toxaemias
• The second most common cause of maternal
mortality in the United States (after
thromboembolic disease)
• It is also associated with high perinatal mortality
and morbidity rates, primarily due to iatrogenic
prematurity.

Spectrum of Hypertensive Disease in
Pregnancy
•Preeclampsia –eclampsia(also called
pregnancy –induced hypertension)
•Chronic Hypertension
•Preeclampsia superimposed upon
underlying hypertension
•Gestational hypertension (also called
transient hypertension)

Maternal Evaluation
• Hypertension should be confirmed by at least two measurements at
least several six hours apart.
• Laboratory evaluation typically includes:– Hematocrit(hemoconcentration supports the diagnosis of preeclampsia)
hemoconcentration, suggests contraction of intravascular volume and
progression to more severe disease, while a falling hematocrit may be a
sign of hemolysis.
– Platelets count
– Qualification of protein excretion
– Serum creatinine concentration
– Serum uric acid concentration
– Lactic acid dehydrogenase concentration(LDH) An elevated LDH
concentration is a better sign of hemolyis and a marker of severe
disease or HELLP syndrome/ microangiopathic hemolysis

• 24 hour urine collection for total protein and creatinine clearance
• Periodic reassessment of serum creatinine and quantitative testing
for urine protein is recommended.

Fetal Evaluation
• A baseline ultrasound examination at 16 to 20 weeks of
gestation is recommended to confirm gestational age so
there will be less uncertainty about a diagnosis of fetal
growth delay if a late pregnancy sonogram shows a
small fetus.
• Close fetal surveillance is warranted when there is an
high potential for uteroplacental vasculopathy, as with
preeclampsia or intrauterine growth restriction.
– serial sonographic assessment of fetal growth is
indicated ( eg, at 28 to 32 weeks, then monthly until
delivery), with twice weekly nonstress testing or
biophysical profile examination restriction.

Screening Tests


The most promising of test is measurement or urinary placental
growth factor (PIGR). This is based on the finding that
preeclmapsia may be caused by an imbalance of angiogenic factors
that occurs...


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