13 - Hypertensive Disease of Pregnancy

Chronic hypertension

BP ≥140/90 present before conception, before 20 weeks AOG, OR persisting > 12 weeks postpartum

Gestational Hypertension

SBP≥140 and/or DBP≥90 mmHg on two occasions at least 4 h apart after 20 weeks AOG in women with previously normal BP

Preeclampsia without severe features

Elevated BP

• SBP≥140 and/or DBP≥90 mmHg on two occasions at least 4 h apart after 20 weeks AOG in women with previously normal BP

AND proteinuria

• ≥300 mg/24 h or

• protein/creatinine ratio ≥0.3 or

• dipstick reading of +1 (used only if other quantitative methods are unavailable)

Preeclampsia with severe features

Elevated BP

• SBP≥140 and/or DBP≥90 mmHg on two occasions at least 4 h apart after 20 weeks AOG in women with previously normal BP

• SBP≥160 and/or DBP≥110 mmHg confirmed within a short interval (minutes) to facilitate antihypertensive therapy

AND proteinuria

• ≥300 mg/24 h or

• protein/creatinine ratio ≥0.3 or

• persistent dipstick reading of +1 (used only if other quantitative methods are unavailable)

OR in the absence of severe BP range and proteinuria, this is diagnosed with new onset hypertension + any severe feature

Platelet count <100,000/uL

Definition of thrombocytopenia in preeclampsia with severe features

• Serum creatinine concentrations >1.1 mg/dL or

• 2x baseline in the absence of other renal disease

Definition of renal insufficiency in preeclampsia with severe features

>2x ALT, AST

Definition of impaired liver function in preeclampsia with severe features

• Pulmonary edema

• Cerebral symptoms

• Visual symptoms

Aside from thrombocytopenia, renal insufficiency, and impaired liver function, what are the other severe features considered in the diagnosis of preeclampsia with severe features?

Preeclampsia

An encompassing syndrome due to abnormal development of placental vasculature and maternal systemic endothelial dysfunction

37 weeks

Timing of delivery for:

• Gestational hypertension

• Preeclampsia WITHOUT severe features

34 weeks

Timing of delivery for preeclampsia WITH severe features

Deliver regardless of AOG

Timing of delivery for eclampsia

38 weeks

Timing of delivery for chronic hypertension (uncomplicated)

37 weeks

Timing of delivery for chronic hypertension with superimposed preeclampsia

34 weeks

Timing of delivery for chronic hypertension with superimposed preeclampsia, with severe features

HELLP syndrome

Syndrome characterized by hemolysis, elevated liver enzymes, and low platelets

Evidence of liver failure

Feature used to distinguish acute fatty liver of pregnancy from HELLP syndrome

Maternal stabilization and prompt delivery

Management for HELLP and acute fatty liver of pregnancy

No, unless with severe features

Is MgSO4 recommended for seizure prophylaxis in preeclampsia?

4-7 mEq/L or

4.8-8.4 mg/dL or

2.0-3.5 mmol/L

Therapeutic levels of MgSO4

10 mEq/L

Serum MgSO4 level wherein patellar reflexes disappear

>10 mEq/L

Serum MgSO4 level wherein breathing weakens

≥12 mEq/L

Serum MgSO4 level wherein respiratory paralysis occurs

Calcium gluconate or calcium chloride

Antidote for MgSO4 toxicity

• Hydralazine

• Labetalol

• Nifedipine

Anti-hypertensives of choice for bringing BP out of severe elevated ranges

Eclampsia

Grand mal seizures in preeclamptic patient with no other causes

Before labor (59%)

Most common period wherein eclampsia develops