HYPERTENSION

IN
PREGNANCY
Nahar Taufiq
Bagian Kardiologi dan Kedokteran Vaskular FKUGM
SMF Jantung/ Pusat Jantung Terpadu RSUP DR Sardjito
Jogjakarta
 Introduction

Hypertension in Pregnancy:
Major cause of maternal and perinatal
morbidity and mortality
Complicates up to 10% of pregnancies
Second leading cause of maternal mortality
in the developed world (after VTE)
~1/3 of all maternal deaths are from HTNsive
disorders
 Physiologic adaptations
in normal pregnancy
Blood changes:
Plasma volume by 40%.
Platelets count can below 200 X 109/L due to normal
maternal blood-volume expansion.
Coagulation factors (Fibrinogen, Factor VII).

Cardiovascular changes:
Marked generalized vasodilation ( peripheral resistance)
a/w arterial resistance to constrictor actions of Angiotensin II.
CO & Stroke volume.
MAP by 10 mm Hg.
 Physiologic adaptations
in normal pregnancy
Renal changes:
Vasodilation Renal blood fow GFR (by
50%).
in Creatinine clearance with a concomitant in S-
Creatinine & urea.
Uric acid clearance & Ca+ excretion.
Glucosuria + aminoaciduria.

Respiratory changes.
Endocrine changes:
e.g. parathyroid, adrenal, weight, GI changes.
Definitions related
hypertensive disorders in pregnancy
 In 2000, the National High Blood Pressure
Education Program Working Group on
High Blood Pressure in Pregnancy defined
four categories of hypertension in
pregnancy:

Chronic hypertension
Gestational hypertension
Preeclampsia
Preeclampsia superimposed on chronic
hypertension
 Severe complications
Hypertension in Pregnancy

MATERNAL FETAL

CVA IUGR, Intra Uterine

DIC Growth Restriction
End-organ failure Prematurity
Placental abruption Intra-uterine death
Differentiating Hypertensive
in pregnant
Assesment of proteinuria
Reducing the risk hypertensive
disorders in pregnancy
Moderate to high Risk Preeclamsia
Pre-eclampsia
Pre-eclampsia
Pre-eclampsia
Pre-eclampsia
Chronic hypertension

X
Chronic hypertension
Chronic hypertension
Chronic hypertension
Gestasional Hypertension
Gestasional Hypertension
Gestasional Hypertension
Gestasional Hypertension
Gestasional Hypertension
Gestasional Hypertension
Severe Hypertension,
severe pre-eclamsia and eclamsia
Severe Hypertension,
severe pre-eclamsia and eclamsia
Severe Hypertension,
severe pre-eclamsia and eclamsia
 Drugs

A)Parentral drugs:
1) Hydralazine:
It is a peripheral VD.
The best Antihypertensive drug used during Pre-
eclampsia and Eclampsia.
Dose: 5-10mg IV or IM as initial dose.
Repeated every 20-30 minutes until blood
pressure is controlled.
 Drugs

2) Labetalol :
and non selective - adrenergic blocker resulting in VD.
Dose: 10-20mg IV .
The dose can be doubled every 10 minutes if proper
response is not achieved.
3) Diaz oxide :
Used in severe dangerous resistant hypertension as a
last resort.
Dose: 50-150mg IV bolus dose.
Repeated every 1-2 minutes until BP decreases.
 Drugs

A )Oral drugs:
1) -methyl DOPA :
It is the most commonly used.
It is -adrenergic agonist causing depletion of
catecholamine stores.
Dose: 500mg 3-4 times/day orally.
2) Monohydralazine :
It is a weak Antihypertensive when given alone.
It used in combination with - blockers to increase
its efficacy and decrease its side effects.
 Drugs

3) - adrenergic blockers:
Atenolol (tenormin) 50-100mg 4 times daily.
Labetalol (Trandate) 10-20mg 3 times daily.
4) Prazocin :
It is postsynaptic -adrenergic receptor blocker
resulting in VD and reflex tachycardia.
It is a weak Antihypertensive drug so used in
combination with other drugs.
5) Calcium Channel Blocker:
Nifedipine .
 Dr. Djumikan / PD III, Prof DR Koento Wibisono Rektor UNS
Prof dr Soetjipto Dekan FK UNS, Dr Sujarsono PD I,
Dr Muhardjo PD II

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