Hypertensive Disorders of Pregnancy

Etiology of Hypertensive Disorders in Pregnancy

Poorly understood but those with preexisting or chronic hypertension are susceptible. Placental malfunction (abnormal growth or function) can lead to this. Failure of spiral uterine arteries to facilitate placental blood flow causing ischemia and hypoperfusion.

Levels of soluble Fit1 are elevated, which can lead to defective cytophoblast invasion

Pathophysiology of Hypertension in Pregnancy

Result in pulmonary edema, oliguria, seizures, thrombocytopenia, and abnormal liver enzymes. Can also cause vasospams which will elevate blood pressure and reduce blood flow to the brain, liver, kidneys, placenta, and lungs

Small cerebral hemorrhages and cerebral arterial vasospams cause headaches, visual disturbances, blurred vision, and hyperactive deep tendon reflexes

Vasospasm

narrowing of the arteries caused by a persistent contraction of the blood vessels

Chronic Hypertension

Blood pressure exceeding 140/90 before pregnancy or before 20 weeks gestation. Occurs in about 20% of women of childbearing age and 25% of women with this will develop preeclampsia during pregnancy and should be started on therapy to fix

Gestational Hypertension

BP higher than 140/90 in a previously normotensive woman without proteinuria (no lab changes) after 20 weeks gestation resolving by 12 weeks postpartum. Pts can remain here without progressing to preeclamspia/eclampsia

Diagnostic criteria met when bp is higher than 140/90 on at least two separate occasions at least 4 to 6 hours apart

Preeclampsia

New onset hypertension accompanied by proteinuria and or maternal organ dysfunction that targets the cardiovascular, hepatic, renal, and central nervous system. Severe signs of this is BP great than 160/100 on 2 occasions at least 6 hours apart, hyperreflexia, headache, oliguria, blurred vision, pulmonary edema, and others

HELLP Syndrome

Worsening state of preeclampsia resulting in organ damage as evidenced by laboratory changes like hemolysis (decreased RBCs), elevated liver enzymes, and low platelets

Eclampsia

This is preeclampsia with the onset of seizure and coma

Laboratory Diagnostics

CBC indicates low platelets or RBCs

CMP indicates elevated BUN, AST, and ALT

Uric acid elevation

Urine proteins created

High Creatinine

Medical Management

Treated with aspirin, hydralazine hydrochloride, labetalol hydrochloride, nifedipine, magnesium sulfate, or steroid administration. Delivery is the only cure

Magnesium Sulfate Therapy

Prevention and treatment of eclamptic seizures which blocks neurotransmission and vasodilation. Is a CNS depressant