obstetrics hypertension

8/13/2019 obstetrics hypertension

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W34 HTN

K. Grainger

- The term gestational is used to describe any form on new-onset pregnancy-related

hypertension

There are fie types of hypertensie disease that can complicate pregnancy

!. Gestational hypertension

". #reeclampsia3. $clampsia

4. #reeclampsia superimposed on chronic hypertension

%. &hronic hypertension

The classification of hypertensie disorders complicating pregnancy as outlined by the

National High 'lood #ressure $ducation #rogram Wor(ing Group )eport on High 'lood

#ressure in #regnancy

1. Gestational Hypertension

o '# * !4+,+ for the first time during pregnancy

o No proteinuria

o '# returns to normal !" wee(s/ postpartum

o 0inal diagnosis made only postpartum

o 1ay hae other signs or symptoms of preeclampsia2 for eample2 epigastric

discomfort or thrombocytopenia

2. Preeclampsia

1inimum criteria

o '# * !4+,+ mm Hg after "+ wee(s/ gestationo #roteinuria * 3++ mg,"4 hours or * ! 53+mg,d67 dipstic(

8ncreased certainty of preeclampsia

o '# * !9+,!!+ mm Hg

o #roteinuria * "g,"4 hours or * " dipstic(

o :erum creatinine * !." mg,d6 unless (nown to be preiously eleated

o #latelets !++2+++

o 1icroangiopathic hemolysis 5increased 6;H7

o $leated <6T or <:T

o #ersistent headache or other cerebral or isual disturbances

o #ersistent epigastric pain 5)=> pain is often accompanied by eleated 60T/s and

is usually a sign to terminate the pregnancy7

3. Eclampsia

o :ei?ures that cannot be attributed to other causes in a woman with preeclampsia

4. Superimposed Preeclampsia 5on chronic hypertension7



o New-onset proteinuria * 3++ mg,"4 hours in hypertensie women but no

proteinuria before "+ wee(s gestation

o < sudden increase in proteinuria or blood pressure or platelet count !++2+++,

mm3 in women with hypertension and proteinuria before "+ wee(s/ gestation

5. Chronic Hypertensiono '# * !4+,+ mm Hg before pregnancy or diagnosed before "+ wee(s/ gestation

not attributable to gestational trophoblastic disease

Risk factors

- Gestational hypertension more often affects nulliparous women

#reeclampsia

- &hronic hypertension- @besity 5)is( increases with increasing '187

- 1ultifetal gestation

- 1aternal age * 3% years

- 'lac( race- 0amily history of preeclampsia

Etioloy

!. <bnormal trophoblastic inasion of uterine essels. There is incomplete

trophoblastic inasion of the spiral arteries

". 8mmunologic intolerance between maternal and fetoplacental tissues 5similar toan acute grafe reAection

3. 1aternal maladaptation to cardioascular or inflammatory changes of normal

pregnancy.4. ;ietary deficiency

%. Genetic influences

Pre!ention

- &alcium supplementation

- 0ish oil capsules- 6ow-dose aspirin

- <ntioidants 5it & and $7

"S#$ "anaement for se!ere preeclampsia and eclampsia

Continous %& infusion

- Gie 4 to 9 g loading dose diluted in !++ ml of 8B fluid administered oer !% to"+ minutes

- 'egin " g,hr in !++ m6 of 8B maintenance infusion

- 1aintain leel between 4 C D m$E,6 54.F to F.4 m,d67

&a gluconate2 ! g 8B is the antagonist to 1g:@4 toicity



Chapter 25

Cesarean 'eli!ery and Peripartum Hysterectomy

$ "ost Common %ndications for C ( Section!. #reious cesarean

". ;ystocia

3. 'reech4. 0etal distress

<&@G Tas( force rcommended " benchmar(s for the year "+!+

!. < cesarean rate of !%.% for nulliparous women at 3D w(s or more with asingleton cephalic presentation

". < B'<& rate of 3D in women at 3D w(s or more with a singleton cephalic

presentation who had one prior low-transerse cesarean deliery

Reasons for increased Cesarean rate

!. The aerage maternal age is rising2 and older women2 especially nulliparas2 are atincreased ris( of cesarean deliery

". $01 5may increase &: rate by as much as 4+7

3. Women are haing fewer children2 thus2 a greater percentage of births are amongnulliparas2 who are at increased ris( for cesarean deliery

4. The maAority of breech babies are now deliered ia &:

%. The incidence of midpelic forceps and acuum delieries has decreased

9. )ates of labor induction continue to rise2 and induced labor2 especially amongnulliparas2 increases the ris( of cesarean deliery

D. @besity increases the ris( for &:

F. &oncern for malpractice litigation 5to aoid aderse neonatal neurologiccomplication or cerebral palsy7

. $lectie &: are increasing

Patient choice cesarean deli!ery

- <oid pelic floor inAury

- &onenience

- )educed ris( of fetal inAury

"aternal mor)idity and mortality

- $mergnecy &-section has an almost ninefold ris( of maternal death and electiecesarean deliery has an almost threefold ris( of maternal death relatie to that of

a aginal deliery

%ndications for classical CS

- 'ladder adheres to lower uterine segment from preious &:. 1yoma occupies the

lower uterine segment2 or ceri has been inaded by cancer

- Transerse lie 5especially bac( down7



- :ome cases of placenta preia with anterior implantation2 especially if

complicated by percreta

- < ery small fetus2 especially if breech- 1assie maternal obesity precluding access to the lower uterine segment

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obstetrics hypertension