Preg and HTN Lecture

8/13/2019 Preg and HTN Lecture

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PREGNANCYAND

HYPERTENSION

DR MOHAMMED ALMOGAHED

M.D


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REMEMBER THAT

A HEALTHY FETUS DEPENDS ON

A HEALTHY MOTHER


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Hypertension is a common medicalproblem during pregnancy, with a

prevalence of 6 to 8%. It isdiagnosed when blood pressure isgreater than 140/90 mm Hgmeasured with the patient in thesitting position on two occasions


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During a normal pregnancy, bloodpressure declines during the first

and second trimesters and risesto prepregnancy levels near term


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Hypertension during pregnancy can beclassified as

1- chronic hypertension(prepregnancy HTN)2-preeclampsia

3-gestational hypertension or nonproteinuric

hypertension of pregnancy4- chronic hypertension plus preeclampsia

5-antenatal unclassifiable hypertension


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Chronic hypertention

Present in 1 to 5% of pregnant

women.most cases are due toessential HTN.for the Unusualindividual with secondry HTN

(CTD,aortic coarctation,intrinsicrenal disease,renal artery stenosis,and cushings disease)


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gestational hypertension(GH)

Is hypertension that develops any timeduring pregnanacy without protein in urine

(nonproteinuric HTN of pregnancy)

(GH)resolves by 3 months postpartum,and

HTN often normalizes within 2 weeks ofdelivery


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Preeclampsia

Can occur any time after 20weeks of gestation and up to 6weeks postpartum


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TREATMENT


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Chronic hypertensinWomen with preexisting HTN the usual

Blood pressure decrease during theFirst trimester often allows discontinuti

On of antihypertensive drugs.BP

Can be monitored and medications

Reinstituted if needed


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Chronic HTN newly diagnosed during

Pregnancy can be differentiated from

Transient gestational HTN in that theFormer persists more than 3 months

postpartum


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European heart association guidline 2011

1-SBP 140-150mmHg

DBP 90-99 mmHgNon pharmacological management

2-SBP >170 mmHgEmergency hospitalisation

Pre-eclampsia associated with pulmonary oedema

Infusion i/v nitroglycerene


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3-In severe HTN

drug treatment with i/v labetolol

Or methyldopa or nifidepine tablet


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4-With continued pre-pregnancy HTN

Pre-pregnancy medication to be continued

(angiotensin converting enzyme-ACE-andAngiotensin receptor blockers-ARB-and

Direct renin inhibitors are strictly

contraindicated


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5-For delivery(in gestational HTN) with

Proteinuria with adverse condition

induction


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Gestational HTN

Transient gestational HTN is treated with

Bed rest,close monitoring of the mother andfetus.when to initiate antihypertensive drugs

Is controversial.many authorities

Recommend drug therapy when the bloodPressure exceeds 140/90 mmhg


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METHYLDOPA(CENTRAL SYMPATHOLYTIC)

Reduces vascular resistance while preserv-

Ing maternal cardiac output and uteroplacental perfusion.considered safe to use when

Breastfeeding

Dose 250mg 2-3times/day can be asNeeded (maximum dose 3g)DOSAGE FORMS(tablet 125Mg-250Mg-500Mg)ingection 50Mg/ML


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CLONIDINE (CENTRAL SYMPATHOLYTIC)

Dose 0.1mg 1-2 times/day

Onset of action:oral 0.5-1hourDuration:6-10 hours

(do not discontinue clonidineabruptly

because risk of rebound HTN.if needdecrease gradually)

DOSAGE FORMS(TABLET 0.1Mg-0.2Mg-0.3mg)ingection 100mcg/ml


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LABETALOL(ALPHA AND BETA BLOCKERS)

Used in several trials without adverse effects

-blocking results in vasodilation includingUteroplacental blood vessels.and-blockade

Prevents reflex tachycardia.cardiac output is

Unchanged.low concentration in breast milk


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LABETALOL(ALPHA AND BETA BLOCKERS)

Dose100mg twice daily,may increase as

Needed every 2-3days by 100mg untilDesired response is obtained(maximum 2g)

Onset of action:oral:20 min-2hours.

i/v 2-5 minDOSAGE FORMS(TABLET 100Mg-200Mg-300mg) ingection 5mg/ml


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-blockers

Probably safe for third-trimester use,but

Neonatal bradycardia,respiratory distress,

And hypoglycemia have been reported.Use earlier in gestation may result in intra-

Uterine grouth retardation.atenololand meto

Prolol are concentrated in breast milk

Propranololhas low concentrated in breast

milk


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Atenololtablet 25-100mg 1-2/day

Metoprololtablet 50-100mg 1-2/day

Pindololtablet 5-10mg twice/day as

Necessary every3-4 weeks maximum dose

60mg

Propranololtablet 20-40mg twice dailydose

As necessary every3-7days

Maximum dose


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Hydralazine(direct arterial vasodilator)

Extensively used during pregnancy.it causes

Vascular dilation and reflex tachycardia

Primarily used parenterallay for acute mana-

Gement of HTN or with methyldopa or

-blocking agent

Dose10-20mg i/v every4-6h,change to oral

Therapy as soon as possible(max.dose 250mg)DOSAGE FORMS(TABLET 10Mg-25Mg-50Mg-100Mg)ingection 20mg/ml


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NIFEDIPINE(calcium-channel blockers)

Probably safely used in the third trimester

Their use maintains uteroplacental perfusion

May also have tocolytic effect.S/L associatedWith hypotension and fetal distress.avoid use

With magnesium sulfate because combination

Risks profound hypotension

Dose10-30mg 3 times/day(capsules)

30-60mg once daily as sustained release tablet


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Angiotensin-converting enzymeinhibitors

And angiotensin receptor blockers

Contraindication.it affects renal development

In the second and third trimesters.miscarriage

Fetal death,malformations, and neonatal renalFailure can be result.


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THANK

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Preg and HTN Lecture