HYPERTENSION IN PREGNANCY LEADING CAUSE OF MATERNAL DEATH AND PERINATAL MORTALITY / MORBIDITY BP MONITORING IS MAJOR ACTIVITY OF ANTENATAL CARE AFFECTS UP TO 10 % OF ALL PREGNANCIES

TERMINOLOGY dbs wks korotkofF V normal pregnancy ABNORMAL VALUES ? > 140 / 90 ( NELSON) DBP > 90 two readings systolic rise > 30 or diastolic > 15 PROTEINURIA > 0. 3 GM IN 24 HOURS

CLASSIFICATION PREGNANCY INDUCED HYPERTENSION DEVELOPING AFTER 20 / 40 PREVIOUSLY NORMOTENSIVE PROTEINURIC PIH ( PRE - ECLAMPSIA) > 0. 3 G / 24 HR CHRONIC HYPERTENSION DIAGNOSED BEFORE OR DURING PREGNANCY - essential - renal disease - phaeo / conn’s - coartation CHRONIC HYPERTENSION WITH SUPERIMPOSED PRE – ECLAMPSIA ECLAMPSIACONVULSION DURING PREGNANCY OR WITHIN 7 DAYS OF DELIV., NOT CAUSED BY EPILEPSY

PET AETIOLOGY GLYCEROPHOSPHOLIPIDS ARACHIDONIC ACID CYCLO OXYGENASE ASPIRIN PROSTAGLANDINS THROMBOXANES PROSTACYCINS ?IMMNUNOLOGIC MECHANISMS

PET RISK FACTORS PRIMIGRAVIDA OR NEW PARTNER AGE RACE LOW SOCIAL CLASS FAMILIAL TREND ? SINGLE GENE UNDERLYING HYPERTENSIVE DISORDER 20 % DIABETES 50 % TWINS ( MONO) 30 % HYDATIDIFORM MOLE PREVIOUS PET 30 %

SEVERE ( FULMINATING ) PET DBP > 110 WITH PROTEINURIA SYMPTOMS HEADACHE VISUAL SPOTS EPIGASTRIC PAIN VOMITING HYPER - REFLEXIA

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PET MANAGEMENT MILD-MONITOR, DELIVER NEAR TERM MODERATE-FETUS MATURE, DELIVER -FETUS IMMATURE, MONITOR MOTHERLFT URIC ACID, BUN CREATININE CLEARANCE COAGULATION SYMPTOMS BABYBIOPHYSICAL GROWTH DOPPLER NST

ANTIHYPERTENSIVES LONG TERM METHYL DOPA LABETOLOL ATENOLOL NIFEDIPINE HYDRALLAZINE ACUTE HYDRALLAZINE SODIUM NITRO – PRUSSIDE LABETOLOL

ANTICONVULSANTS PROPHYLAXIS MAGNESIUM SULPHATE PHENYTOIN DIAZEPAM TREATMENT DIAZEPAM

ECLAMPSIA RxControl airway Stop convulsion reduce BP Deliver ( GA C. Section) watch postnatally † FROM BRAIN HEMORRHAGE AND 60 % HAVE LIVER DYSFUNCTION

PREDICTION OF PET RISK FACTORS ROLL OVER TEST OF GANT ANGIOTENSION II PRESSOR TEST URIC ACID COAGULATION FACTORS SERUM RHUBARB DOPPLER ULTRASOUND