Hypertension in Pregnancy: Difference between revisions
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!Adverse conditions (that increase the risk of severe complications) | !Adverse conditions (that increase the risk of severe complications) | ||
!Severe complications (that warrant delivery) | !Severe complications (that warrant delivery) | ||
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|CNS | |CNS | ||
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* Eclampsia | * Eclampsia | ||
* PRES | |||
* Cortical blindness or retinal detachment | |||
* Glasgow coma scale < 13 | |||
* Stroke, TIA, or RIND | |||
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|Cardiorespiratory | |||
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:* Chest pain/dyspnoea | |||
:* Oxygen saturation < 97% | |||
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:* Uncontrolled severe hypertension (over a period of 12hr despite use of three antihypertensive agents), | |||
:* Oxygen saturation < 90%, need for ⩾ 50% oxygen for > 1hr, intubation (other than for Caesarean section), pulmonary oedema | |||
:* Positive inotropic support | |||
:* Myocardial ischaemia or infarction | |||
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|Haematological | |||
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: Elevated WBC count | : Elevated WBC count | ||
; ○ | ; ○ | ||
: Elevated INR or aPTT [80] | : Elevated INR or aPTT [80] | ||
; ○ | ; ○ | ||
: Low platelet count | | : Low platelet count | ||
| | |||
: Platelet count < 50x109/L | : Platelet count < 50x109/L | ||
; ○ | ; ○ | ||
: Transfusion of any blood product |- | : Transfusion of any blood product | ||
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|Renal | |||
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: Elevated serum creatinine [81] | : Elevated serum creatinine [81] | ||
; ○ | ; ○ | ||
: Elevated serum uric acid | | : Elevated serum uric acid | ||
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: Acute kidney injury (creatinine > 150 μM with no prior renal disease) | : Acute kidney injury (creatinine > 150 μM with no prior renal disease) | ||
; ○ | ; ○ | ||
: New indication for dialysis |- | : New indication for dialysis | ||
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|Hepatic | |||
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: Nausea or vomiting | : Nausea or vomiting | ||
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: Elevated serum AST, ALT, LDH, or bilirubin | : Elevated serum AST, ALT, LDH, or bilirubin | ||
; ○ | ; ○ | ||
: Low plasma | : Low plasma albumin | ||
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: Hepatic dysfunction (INR > 2 in absence of DIC or warfarin) | : Hepatic dysfunction (INR > 2 in absence of DIC or warfarin) | ||
; ○ | ; ○ | ||
: Hepatic haematoma or rupture |- | : Hepatic haematoma or rupture | ||
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|Feto-placental | |||
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: Non-reassuring FHR | : Non-reassuring FHR | ||
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: Oligohydramnios | : Oligohydramnios | ||
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: Absent or reversed end-diastolic flow by Doppler velocimetry | | : Absent or reversed end-diastolic flow by Doppler velocimetry | ||
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: Non-reassuring FHR | |||
; ○ | ; ○ | ||
: | : IUGR [83], [84] | ||
; ○ | ; ○ | ||
: | : Oligohydramnios | ||
; ○ | ; ○ | ||
: | : Absent or reversed end-diastolic flow by Doppler velocimetry | ||
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ST, aspartate aminotransferase; ALT, alanine aminotransferase; DIC, disseminated intravascular coagulation; FHR, fetal heart rate; LDH, lactate dehydrogenase; PRES, posterior reversible leukoencephalopathy syndrome; RIND, reversible neurological deficit < 48hr; RUQ, right upper quadrant; TIA, transient ischaemic attack.<ref name=":0" /> | |||
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== Causes and Risk factor == | == Causes and Risk factor == |
Revision as of 12:27, 27 August 2020
Original Editor - User Name
Top Contributors - Manisha Shrestha, Kirenga Bamurange Liliane, Nupur Smit Shah, Kim Jackson and Lucinda hampton
Introduction[edit | edit source]
Hypertensive disorders of pregnancy is a leading cause of maternal and neonatal morbidity and mortality. Hypertension in pregnancy should be defined as a hospital systolic blood pressure (SBP) ⩾ 140 mmHg and/or dystolic blood pressure (DBP) ⩾ 90 mmHg, based on the average of at least two measurements, taken at least 15 min apart, using the same arm.[1]
Classification[edit | edit source]
A. Pre-existing (chronic) hypertension | This is defined as hypertension that was present either pre-pregnancy or that develops at <20 weeks of gestation |
• With comorbid condition(s) | Comorbid conditions (e.g., pre-gestational type I or II diabetes mellitus or kidney disease) warrant tighter BP control outside of pregnancy because of their association with heightened cardiovascular risk |
• With evidence of preeclampsia | This is also known as ‘superimposed preeclampsia’ and is defined by the development of one or more of the following at ⩾ 20 weeks:
Severe preeclampsia is defined as preeclampsia with one or more severe complication(s) |
B. Gestational hypertension | This is defined as hypertension that develops for the first time at ⩾ 20 weeks of gestation. |
• With comorbid condition(s) | Comorbid conditions (e.g., pregestational type I or II diabetes mellitus or kidney disease) warrant tighter BP control outside of pregnancy because of their association with heightened cardiovascular risk |
• With evidence of preeclampsia | Evidence of preeclampsia may appear many weeks after the onset of gestational hypertension. |
C. Preeclampsia | Preeclampsia is defined by gestational hypertension and one or more of the following:
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Severe preeclampsia is defined as preeclampsia with one or more severe complication(s) | |
’Other hypertensive effects’∗ | |
Transient hypertensive effect | Elevated BP may be due to environmental stimuli or the pain of labour, for example |
White coat hypertensive effect | BP that is elevated in the office (sBP ⩾ 140 mmHg or dBP ⩾ 90 mmHg) but is consistently normal outside of the office (<135/85 mmHg) by ABPM or HBPM |
Masked hypertensive effect | BP that is consistently normal in the office (sBP < 140 mmHg or dBP < 90 mmHg) but is elevated outside of the office (⩾135/85 mmHg) by ABPM or repeated HBPM |
ABPM, ambulatory BP monitoring; BP, blood pressure; HBPM, home BP monitoring.[1]
Adverse conditions and severe complications of preeclampsia.[edit | edit source]
Organ system affected | Adverse conditions (that increase the risk of severe complications) | Severe complications (that warrant delivery) |
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CNS | Headache/visual symptoms |
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Cardiorespiratory |
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Haematological |
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Renal |
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Hepatic |
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Feto-placental |
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ST, aspartate aminotransferase; ALT, alanine aminotransferase; DIC, disseminated intravascular coagulation; FHR, fetal heart rate; LDH, lactate dehydrogenase; PRES, posterior reversible leukoencephalopathy syndrome; RIND, reversible neurological deficit < 48hr; RUQ, right upper quadrant; TIA, transient ischaemic attack.[1]
Causes and Risk factor[edit | edit source]
Pathological process[edit | edit source]
Epidemiology[edit | edit source]
Medical management[edit | edit source]
Physiotherapy intervention[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 2014 Apr 1;4(2):105-45.