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Hypertensive Disorder

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Hypertensive Disorder Complicating Pregnancy High-risk factors Tensity Age Social status Climate changes abruptly Fat High tension of uterus multiplets hydramnios ... – PowerPoint PPT presentation

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Title: Hypertensive Disorder


1
Hypertensive Disorder Complicating
Pregnancy
2
Overview
   1?onset after 20 weeks gestation   2?Incidence
rateabout 7-12(china 9.4) 3?specially occur
in pregnancy 4?A group of symptoms
3
Hypertensive states in pregnancy
  • Include
  • Gestational hypertension
  • Preeclampsia
  • Eclampsia
  • Chronic hypertension in pregnancy
  • (either essential or secondary to renal
    disease,
  • endocrine disease, or other causes)
  • Pre-eclampsia superimposed upon chronic
    hypertension
  • ?Transient hypertension

4
Transient hypertension
1.Transient hypertension is the development of
hypertension after midpregnancy or in the first
24 hours postpartum without other signs of
preeclampsia or preexisting hypertension. 2.This
condition is often predictive of the later
development of essential hypertension.
3.Transient hypertension is a retrospective
diagnosis and, if uncertainty exists
regarding the diagnosis, these patients should
be managed as if they had preeclampsia.
5
Cause

Chesley described preeclampsia as adisease of
theories, because the cause is unknown.
Some theories include 1?Genetic susceptibility
hypothesis 2?Immune maladaptation
hypothesis 3?Placental perfusion or Ischemia
Hypotheses 4?Oxidative stress hypotheses 5?Endothe
lial cell injury explains many of the clinical
findings in preeclampsia 6?.
6
High-risk factors
  • Tensity
  • Age
  • Social status
  • Climate changes abruptly
  • Fat
  • High tension of uterusmultiplets?hydramnios
  • Family history
  • Bad birth history
  • ComplicationsDM?chronic nephritis

7
Pathology
Blood pressure elevate
Higher periphery resistance
Vessel stenosis
Spasm of vessels
Injury of endotheliocyte
Proteinuria
Edema
Hypertension
8
These effects are separated into maternal and
fetal consequences however, these aberrations
often occur simultaneously.
9
Clinical findingsEdema
  • Dependent(??) edema is a normal finding in
    pregnancy
  • Undependent edema of the hands and face present
    upon
  • Morning arising is considered pathologic
  • Weight gain in excess of 2kg/week or particularly
    sudden weight gain over 1 or 2 days should raise
    the suspicion of preeclampsia
  • Preeclampsia may occur without edema.(39 of
    eclamptic patients in one series had no edema.)

10
Clinical findingsHypertension
  • Hypertension is the most important criterion for
    the diagnosis of preeclampsia
  • That too may occur suddenly
  • Many young primigravidas have 100-110/60-70mmHg
    duing the second trimester. An increase of 15mmHg
    or 30mmHg should be considered ominous
  • The blood pressure is often quite labile.It
    usually falls during sleep in patients with mild
    preeclampsia and chronic hypertension
  • But in patients with severe preeclampsia ,blood
    pressure may increase during sleep, eg, the most
    severe hypertion may occur at 200AM

11
Clinical findingsProteinuria
  • Proteinuria is the last sign to develop
  • Eclampsia may occur without proteinuria. Sibai
    and associates found no proteinuria will have
    glomeruloendotheliosis on kidney biopsy
  • Proteinuria in preeclampsia is an indicator of
    fetal jeopardy
  • The incidence of SGA infants and perinatal
    mortality is markedly increased in patients with
    proteinuric preeclampsia

12
Clinical findingsDiffering clinical picture
  • Preeclampsia-eclampsia is a multisystem disease
    with varying clinical presentations.
  • One patient may present with eclamptic seizures,
  • another with liver dysfunction and intrauterine
    growth retardation,
  • another with pulmonary edema,
  • stillanother with abruption placenta and renal
    failure

13
Classification
  • Gestational hypertension
  • Preeclampsia
  • Eclampsia
  • Preeclampsia superimposed upon
  • chronic hypertension
  • Chronic hypertension

14
Gestational hypertension
1?Blood pressure140/90mmHg first onset in
gestational period and recover within 12 weeks
post partum 2?Urine protein negative 3?Patients
may superimpose upper abdo- minal pain and
thrombocytopenia 4?Final diagnosis should be made
post partum
15
Preeclampsia
  • Minimum criteria
  • 1?Proteinuria 300mg/24 hours or 1 dipstick
  • 2?BP140/90mmHg after 20 weeks gestation

16
Preeclampsia
Increased certainty of preeclampsia
  • BP160/110mmHg
  • Proteinuria 2g/24 hours or 2 dipstick
  • Cr level of blood gt106 umol/L
  • Blood platelet lt100109/L
  • Persistent headache or other cerbral or visual
    disturbance
  • Persistent epigastric pain

17
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18
Eclampsia
Seizures that cannot be attributed to other
causes in a woman with preeclampsia
19
Pre-eclampsia superimposed upon
chronic hypertension
  • New-onset proteinuria 300mg/24 hours in
  • hypertensive women ,but no proteinuria
  • before 20 weeks gestation
  • A sudden increase in proteinuria or blood
  • pressure or platelet countlt 100,000 /mm3 in
  • women with hypertension and proteinuria
  • ,before 20 weeks gestation

20
Chronic Hypertension
1?BP140/90mmHg before pregnancy or
diagnosed before 20 weeks gestation
2?Hypertension first diagnosed after 20
weeks gestation and persistent after 12
weeks postpartum
21
Extremely severe preeclampsia
1?Systolic pressure160180mmHg,or diastolic
pressure110mmHg 2?Urine protein in 24 hours
gt5g 3?DIC 4?Oliguria,urine volume in 24 hours
lt500ml 5?Pulmonary edema 6?Microangiopathic
hemolysis 7?Thromocytoplets(lt10?/L) 8?Dysfunction
of liver 9?FGR ,oligohydramnios 10?Headache,visua
l disorder,upper abdominal pain
22
Diagnosis
  • Clinical symptoms and physical signs
  • Auxiliary examinations

Differential diagnosis
  • According to clinical manifestations.

23
Complications of mother
  • Heart failure
  • Cerebrova- scular accident
  • Placenta abruption
  • DIC
  • Renal failure
  • HELLPS syndrome
  • Postpartum hemorrhage

24
Complications of fetus
  • Fetus
  • FGR
  • fetal distress
  • fetal death
  • neonatal asphyxia

25
Basic management objectives
  • Termination of pregnancy with the least possible
    trauma to mother and fetus
  • Birth of an infant who subsequently thrives
  • Complete restoration of health to the mother

26
A systematic evaluation
  • Detailed examination
  • Weight on admittance and every day thereafter.
  • Analysis for proteinuria at least every 2 days
    thereafter
  • Blood pressure readings in sitting position with
    anappropriated-size cuff every 4 hours, except
    betweenmidnight and morning
  • Measurements of plasma or seru creatinine,hematocr
    it, platelets, and serum liver enzymes
  • Frequent evaluation of fetal size and amnionic
    fluid volume.

27
6 principles
  • Spasmolysis
  • conscious-sedation
  • Depressurization
  • fluid expansion
  • Diuresis
  • pregnancy termination

28
Mild Preeclampsia
  • Treatment Of Mother
  • Assessment of Fetal Status

29
Severe Preeclampsia
  • The goals of management are
  • Prevention of convulsions
  • Control of maternal blood pressure
  • Initiation of delivery
  •  

30
Eclampsia
  • Control of Seizures
  • Controln of Hypertension
  • Hydralazine
  • Labetalol
  • Nifedipine
  • Sodium nitroprusside

31
pregnancy termination
  • Blood pressure consistently higher than 100 mmHg
    diastolic in a 24-h period or confirmed higher
    than 110 mmHg
  • Rising serum creatinine
  • Persistent or severe headache
  • Epigastric pain
  • Abnormal liver function tests
  • Thrombocytopenia
  • HELLP syndrome
  • Eclampsia
  • Pulmonary edema
  • Abnormal antepartum fetal heart rate testing
  • SGA fetus with failure to grow on serial
    ultrasound examinations

32
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