Hypertension in Pregnancy

Chronic hypertension

HTN existing before 20 weeks gestation + lasting >12 weeks PPM

Superimposed preeclampsia or eclampsia

preeclampsia/eclampsia in a patient who already has chronic gestational HTN

What are the new signs and symptoms that occur in superimposed preeclampsia or eclampsia?

proteinuria, thrombocytopenia, + elevated liver enzymes (ALT+AST)

Gestational hypertension

HTN without proteinuria that develops after 20 weeks gestation or <7 days after delivery

Preeclampsia

HTN with proteinuria after 20 weeks gestation

Eclampsia

preeclampsia (HTN/proteinuria >20 weeks) + seizures

What is the qualification for HTN?

140/90

What are some complications of gestational hypertension?

preterm birth, infants small for gestational age, and placental abruption

What are some fetal complications of pre-eclampsia or eclampsia?

oligohydramnios, prematurity, placental abruption, + intrauterine growth restriction

What are some maternal complications of pre-eclampsia?

renal disease, pulmonary edema, liver damage, cerebral edema, thrombocytopenia

What does cerebral edema mean for a patient with eclampsia?

it can cause seizures

How is pre-eclampsia diagnosed?

BP >140/90 on two occasions (at least 4hrs apart) AND proteinuria

What is a BP for severe pre-eclampsia?

>160/110

What happens (other than BP) with severe pre-eclampsia?

thrombocytopenia, elevated liver enzymes, high serum creatinine, pulmonary edema, + new-onset cerebral/visual changes

What is thrombocytopenia?

a platelet count less than 100,000

What happens to ALT and AST with severe pre-eclampsia?

they’re elevated 2-3x the normal amount

What are some examples of new-onset cerebral changes to look out for in severe pre-eclampsia?

headaches, blurry spots, etc.

Which symptoms of pre-eclampsia should you teach patients to look out for?

• severe headache (that won’t go away)

• facial/hand swelling

• weight gain of >2lbs/kg in one week

• gasping, panting, or difficulty breathing

• nausea later than mid-pregnancy

• vision changes

• upper-right belly/shoulder pain

What is the cure for eclampsia?

delivery

How is eclampsia treated?

magnesium sulfate (prevention of seizures by relieving cerebral edema) + antihypertensives

What should you remember when using antihypertensives for eclampsia?

use very slowly, since the baby is used to high BPs

What is HELLP syndrome?

hemolysis, elevated liver enzymes, + low platelets

When does HELLP syndrome occur?

severe preeclampsia + eclampsia

How is HELLP syndrome managed before 34 weeks?

IM corticosteroids for 48hrs, then delivery

How is HELLP syndrome managed after 34 weeks?

delivery

What is HELLP syndrome associated with?

acute renal failure + hepatic rupture, DIC , pulmonary edema, preterm birth, + fetal/maternal death