HYPERTENSIVE DISORDERS OF PREGNANCY Part 01

Classification preeclampsia/eclampsia chronic hypertension chronic hypertension with superimposed preeclampsia/eclampsia transient o...

Classification

1. preeclampsia/eclampsia
2. chronic hypertension
3. chronic hypertension with superimposed preeclampsia/eclampsia
4. transient or gestational hypertension

Preeclampsia/Preeclamptic Toxemia/Eclampsia (PET)

1. hypertension accompanied by proteinuria and/or non-dependent edema with onset > 20 weeks
2. BP > 140/90 mmHg or an increment of 30 mmHg systolic and 15 mmHg diastolic over a nonpregnant or T1 BP
3. non-dependent edema (e.g. face, hands) is generalized and usually associated with excessive weight gain (> 2 kg/week)
4. proteinuria is defined as > 1+ protein on random dipstick analysis or > 300 mg in a 24 hour urine collection
5. 50% of all hypertension in pregnancy
6. due to an imbalance of thromboxane (vasoconstrictor) and prostaglandin (vasodilator), causing generalized arteriolar constriction
7. resultant vasospasm damages capillaries, leading to protein extravasation and hemorrhage

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Conditions Associated with Preeclampsia/Eclampsia

Maternal factors

1. 80-90% of cases in primagravidas
2. past history or family history of preeclampsia/eclampsia
3. diabetes, chronic hypertension, or renal disease
4. extremes of maternal age

Fetal factors

1. IUGR
2. hydatidiform mole
3. > 1 fetus
4. fetal hydrops

Fetal Complications

mainly due to placental insufficiency

1. fetal loss
2. IUGR
3. prematurity
4. abruptio placentae

Maternal Complications

1. cerebral hemorrhage (50% of deaths)
2. left ventricular failure/pulmonary edema
3. liver and renal dysfunction
4. abruption
5. seizures
6. DIC : release of placental thromboplastin, leading to a consumptive coagulopathy
7. HELLP



• hemolysis,
• elevated liver enzymes
• low platelets

may only respond to fresh frozen plasma with plasma exchange