Hypertensive Disorders of

Pregnancy
Jean Lafontaine Rivera
Classification
• Gestational Hypertension

• Preeclampsia

• Eclampsia
Gestational Hypertension

Diagnosis
• New-onset hypertension at ≥ 20 weeks gestation

• No signs and symptoms of preeclampsia

• BP must be measured twice ≥ 4hrs apart

• Considered severe if BP is ≥ 160/110

Gestational Hypertension

Risk Factors
• 6-17% of all pregnancies

• Risk factors
• History of preeclampsia
• Nulliparity
• Multiple gestation
• Overweight/obese
Gestational Hypertension

Management
• Monitor progression to preeclampsia weekly
• Symptoms
• Protein excretion
• CBC, creatinine, liver enzymes
• BPP or Non-stress test with amniotic fluid estimation
• If severe:
• Antihypertensives
• Early delivery
• MgSO4 peripartum
Gestational Hypertension

Prognosis
• 50% of patients progress to preeclampsia

• Higher risk of chronic hypertension

• Severe hypertension
• Preterm delivery
• SGA infants
• Abruptio placenta
Preeclampsia

Diagnosis
• Gestational hypertension plus proteinuria and/or end-organ dysfunction

• Severe features:
• BP ≥ 160/110
• Cerebral or visual disturbances
• Epigastric or RUQ pain
• Serum transaminase levels ≥ 2 times the upper limit
• <100,000 platelets
• Creatinine >1.1
• Pulmonary edema
Preeclampsia

Risk Factors
Risk Factor Relative Risk
Previous Preeclampsia 8.4
Family history of preeclampsia 2.9
Nulliparity 2.1
Pregestational diabetes 3.7
Chronic hypertension 5.1
SLE 1.8
Antiphospholipid syndrome 2.8
BMI > 25 2.1
Multiple gestation 2.9
Age ≥ 35 1.2
Preeclampsia

Complications
• Eclampsia • Pulmonary edema
• Hypertensive encephalopathy • Severe thrombocytopenia
• Stroke • HELLP syndrome
• Liver failure • DIC
• Renal failure • Abruptio placenta
• Retinal detachment • Death
• Cortical blindness
• Renal failure
Preeclampsia

Management
No severe features:
• Delivery at 37 weeks gestation
• If <37, conservative management
• Close monitoring
• Weekly labs
• Ultrasound every 3 weeks
• Daily fetal movement
• BPP or NST twice weekly
• Betamethasone if <34 weeks
With severe features:
• Immediate delivery
• If 24-34 weeks and stable
• In-patient monitoring
• Betamethasone
• MgSO4
• Labs twice weekly
• Kick count and NST daily
Preeclampsia

Prognosis
Mother Offspring
• Preeclampsia recurrence • SGA (91%)

• CVD • Preterm

• Diabetes Mellitus • Below-average IQ

• ESRD • Developmental delay

Eclampsia

Diagnosis
• New-onset seizures or coma in a woman with preeclampsia

• 2-3% of women with severe preeclampsia

• 0.6% women with mild preeclampsia

Eclampsia

Management
• Protect airway • MgSO4

• Supplemental O2 • Loading dose 6g IV in 15min

• Maintenance dose 2g/h IV
• Antihypertensive • Calcium gluconate for Mg
• Labetalol toxicity
• Hydralazine
• Nifedipine • Delivery
• Nicardipine
Eclampsia

Complications
Chronic hypertension
• Onset of HTN before week 20
• Duration of HTN after 12 weeks postpartum
• Treatment
• Labetalol
• Hydralazine
• Nifedipine
• Nicardipine
• Avoid ARB, ACEI, spironolactone and nitroprusside