Hypertensive Disorders of Pregnancy Blok 25 Revisi 2013
Hypertensive Disorders of Pregnancy Blok 25 Revisi 2013
Hypertensive Disorders of Pregnancy Blok 25 Revisi 2013
HYPERTENSIVE
DISORDERS OF
PREGNANCY
General Classification
Diagnosis of Hypertension
PREECLAMPSIA
Eclampsia
Chronic Hypertension
Gestational Hypertension
Etiology Preeclampsia /
Eclampsia
Pathophysiology
Generalized vasospasm
GFR and renal blood flow are
significantly lower
Damage of glomerular membranes ,
increasing their permeability to proteins
and leading to proteinuria.
Cerebral vascular resistance is high in
patients with PE and Eclampsia
Pathology
PREVENTION
1. BMI and diet.
Several authors have shown that women with
BMI> 30 had an increase risk of gestational
hypertension, preeclampsia, gestational diabetes
and fetal macrosomia. The influence maybe due
to inflammation.
2. Low dose Aspirin
In PIH patients circulating levels of Thromboxane
A2(TXL-A2 vasoconstrictor) increased and
Prostacyclin (PGI, vasodilator) decreased. Low
dose Aspirin effectively inhibit TXA2 .
2.
3.
4.
Evaluation and
management
Control of convulsions
The anti convulsant of choice is
Magnesium Sulfate although some
prefer diazepam. The RCT has shown
the superiority of MgSO4 over
diazepam and phenytoin.
Give a loading dose of 4 Gm slow IV
bolus over 5 minutes followed by a
maintenance dose of 1-2 Gms per hour
IV drip.
2. Control of Hypertension
- Hydralazine initial dose 5 mg IV bolus
followed by 5 mg incremental increases
half hourly if diastolic BP does not
improve up to total dose of 20 mg
- Nifedipine
- Labetalol
- Methyldopa
- evidence of uncontrollable
hypertension of 160/110 mmHg, oliguria
< 40 cc hours, trombocytopenia <
100.000, pulmonary edema and
impending eclampsia
- evidence of fetal compromise based on
abnormal fetal movement counting,
CTG, BPS monitoring
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