chronic hypertension in pregnancy - PowerPoint PPT Presentation

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chronic hypertension in pregnancy

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Title: chronic hypertension in pregnancy


1
CHRONIC HYPERTENTION IN PREGNANCY
  • Narendra sisodia

2
DEFINITION
  • Presence of hypertension of any cause antedating
    or before 20th wks of pregnancy and persisting
    beyond 12 wks after delivery.

3
RISK FACTORS
  • Age (gt40 yrs)
  • Duration of HT (gt15 yrs)
  • BP (gt160/110 mm Hg)
  • Any medical disorder (Renovascular)
  • Presence of Thrombophilias

4
CAUSES
  • Essential hypertension
  • Chronic renal disease
  • Coarctation of aorta
  • Endocrine disorders
  • Connective tissue disorders

5
ESSENTIAL HYPERTENTION
  • BP gt140/90 mm Hg or more prior to 20th wk
  • Cardiac enlargement
  • Presence of any medical disorder
  • Persistently raised BP even after 42 days
    postpartum

6
FEATURES
  • Elderly
  • Multipara
  • Onset before 20th wk
  • Persists even after 3 months
  • Family history
  • No proteinuria
  • HT retinopathy

7
EFFECT OF PREGNANCY ON HT
  • Mid pregnancy fall in 50
  • Progressive rise in 50
  • Superimposed by pre-eclampsia in 20
  • Malignant HT rarely
  • Deterioration in 30

8
SUPERIMPOSED PRE-ECLAMPSIA
  • New onset proteinuria (gt0.5g/24hr)
  • Aggravation of HT
  • Thrombocytopenia
  • Raised liver enzymes

9
EFFECT OF HT ON PREGNANCY
  • MATERNAL
  • Mild risk remain unaltered
  • Severe or superimposed pre-eclampsia risks is
    very much increased
  • Risk of placental abruption is high

10
  • FOETAL
  • Growth retardation
  • Preterm birth
  • Perinatal death
  • 10 - lt160/100 mm Hg
  • 20 - gt160/100 mm Hg
  • 30 - superimposed pre-
  • eclampsia

11
MANAGEMENT
  • AIM
  • To stabilise BP lt160/100 mm Hg
  • To prevent pre-eclampsia
  • To monitor maternal foetal well being
  • To terminate pregnancy at optimal time

12
  • Pre-conceptional evaluation counselling
  • - etiology
  • - severity
  • - possible outcome
  • Women with severe uncontrolled HT should be
    discourage to become pregnant unless controlled

13
  • GENERAL
  • MILD CASES
  • Adequate rest
  • Low salt diet
  • Frequent check-ups
  • Routine investigation fundus examination
    regularly

14
  • SEVERE CASES
  • Hospitalisation
  • Managed as Pre-eclampsia

15
  • OBSTETRIC
  • Mild spontaneous labour is
  • awaited
  • Severe continue to atleat 34 wks
  • otherwise upto 37 wks
  • then to terminate it

16
RATIONALE OF ANTI-HT DRUGS
  • Routine use not favoured, since it may cause
    decrease placental perfusion
  • Advised when BP gt160/100mm Hg to prevent organ
    damage

17
  • Drugs that can be used are
  • - Methyl dopa
  • - Nifidipine
  • - Labetalol
  • - Hydralazine

18
  • Drugs which should not be used are
  • - Diuretics
  • - ACE- inhibitors
  • - Sod. Nitroprusside
  • - Non selective beta
  • blockers

19
THANK YOU
THANK YOU
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