Chronic HT &

Chronic HT with
super imposed
preeclampsia

Chronic HT
Chronic HT is defined as HIGH BP known to predate conception ordetected
before 20 weeks of gestation
Chronic HT present in 5 % off all patient with pregnancy
10% of Pregnancy with hypertension have renal/endocrine disorder

Chronic HT
During normal pregnancy,
maternal blood volume increases by 40% to 60%
Cardiac output and renal blood flow increase significantly
Blood pressure normally
decreases throughout the first half of pregnancy under the influence of
progesterone,
reaching a nadir in midpregnancy
returning to prepregnancy levels by the end of the third trimester.

Chronic HT - Warning
Greater risk of post partum Hemorrhage
End organ damage
Gestational Diabetes
Abruptio Placenta by 3 FOLD
Fetal Growth Restriction

Chronic HT
If patient with unknown BP get hypertension before 20 week >>> Chronic
hypertension
If BP is normal in 1st trimester and increase before 20 week >>> Most Likely
Gestational Hypertension

Chronic HT - Findings
The fifth Korotkoff sound should be used to determine diastolic pressure.
Auscultation of the flanks may reveal a renal artery bruit.
Funduscopic examination may reveal typical findings associated with longstanding hypertension or possibly diabetes.
An enlarged thyroid gland may indicate thyroid disease.
Absent peripheral pulses suggest coarctation of the aorta,.
further assessment is directed at end-organs and systems most likely to be
affected by hypertension, including the eyes, heart, kidneys, uteroplacental
circulation, and the fetus.

Chronic HT - LAB
a complete blood count, glucose screen, electrolyte panel, serum creatinine,
urinalysis, and urine culture
possible renal disease (serum creatinine 0.8 mg/dL, urine protein > 1+ on
dipstick
Antinuclear antibody may help confirm a diagnosis of collagen vascular
disease.
A suppressed thyroid-stimulating hormone level suggests hyperthyroidism.
Rarely, elevated urinary catecholamine levels may point to
pheochromocytoma.
An electrocardiogram may reveal left ventricular hypertrophy in the patient
with long-standing hypertension.
Chest radiography with abdominal shielding may reveal cardiomegaly.

Chronic HT
In pregnancy
Mild HT >>> 140-150 / 90-109
Severe HT >>> >160/>110

Mild Chronic HT Management

In pregnant women with mild hypertension and no evidence of renal disease,
serious medical complications are RARE
Avoidance of alcohol and tobacco is encouraged.
Sodium restriction may be considered (23 g/d).
Rigorous activity should be avoided, as should weight reduction.
.Prenatal visits are scheduled every 24 weeks until 3436 weeks, and
weekly thereafter
At each visit, blood pressure, urine protein, and fundal height are evaluated.
Patients are questioned regarding signs and symptoms of preeclampsia

Severe Chronic HT Management

Women with sustained blood pressure 180/110 mm Hg or those with
evidence of renal disease may be at higher risk for serious complications,
such as heart attack, stroke, or progression of renal disease, and are
candidates for antihypertensive medication
Frequent prenatal visits may be needed to check the effectiveness of the
medication.
Fetal growth, blood pressure, and proteinuria are assessed at each visit,
evidence of superimposed preeclampsia is aggressively sought

Severe Chronic HT Management

(2)
measure creatinine clearance and 24-hour urinary protein excretion each
trimester.
Sonographic assessment of fetal growth is performed every 24 weeks
antepartum testing is initiated by 3234 weeks
delivery is accomplished after 38 weeks or when fetal lung maturity is
demonstrated
If exacerbation of chronic hypertension necessitates preterm delivery,
corticosteroids should be considered in attempt to accelerate fetal maturity.

Chronic HT with Superimposed

Preeclampsia
Developed in 13 40 % women with Chronic Hypertension

Diagnosis
Women with hypertension only in early gestation who developed proteinuria
after20 weeks of gestation and women with proteinuria berfore 20 weeks of
gestation who
Experience sudden exacerbation of hypertension
Suddenly manifest other sign and symptom ( incerease liver enzyms to
abnormal level )
Present with a decrement in their platelet level below 100.000/microliter
Manifest symptom such as right upper quadrant pain and severe headche
Develop pulmonary congestion or edema
Develop renal insuffieciency ( creatine doubling or above 1.1mg/DL )
Sudden and sustained increase in protein excretion

Diagnosis
IF only BP = <160 mmHg Systolic and <110 mmHG diastolic with proteinuria
Superimposed preeclampsia without severe features
IF with presence of organ dysfunction
Superimposed preeclampsia with severe feature

HELLP Syndrome
HELLP usually begins during the third trimester; rare cases have been
reported as early as 21 weeks gestation.
Hemolysis
Elevated Liver Enzymes
Low platelet count

Management For SP
oAnti Hypertension
oAntenatal Corticosteroids. ( Prepare for preterm delivery )
oMagnesium sulfat for Seizure Prophylaxis
FOR SEVERE
Delivery as soon as possible after maternal stabilization
Only continue pregnancy under adequate maternal intensivecare
Expectant management beyond 34 0/7 weeks is not recommended

Post Partum SP
Controlled lifestyle
Anti Hypertension
Vital body recovery
Breastfeed