1. High blood pressure in pregnancy
Dr. Mohammed Karami

2. High blood pressure in pregnancy
34 years old G4 P3 + 0 … her previous deliveries all were SVD. She is 7 month pregnant unbooked presented to ER with sever headache. Her blood pressure was 170/100. fundal height correspond to 28 week gestation

3. Differential diagnosis
Chronic hypertention
Chronic hypertention with superimposed preeclampsia
Transient hyper tention
GTD
multiple gestation – plyhydromnias
anti phospho lipid syndrom
Chronic illness ((rena failure))

4. High risk Age ((more than 35 or less than 15)) Parity
Obstetric history – abortion, ectopic, GDM, PET, GTD, anti partum hemorrhage

5. etiology Uteroplacental ischemia is the central cause
Production of toxins released to the circulation
Imbalance bet vasoconstrictors and vasodilators (PGI2 TO Thromboxane A2 ratio)
Def of nitric oxide and increase in endothelin.

6. pathophysiology Generalized vasospasm (rise in BP)
Renal blood flow and GFR decrease , it leads to cons in the afferent then damage to membrane (cause of proteinuria)
Decrease in blood flow and increase vas resistance to uteroplacental circ.

7. Risk factor Age <15, >35 Nulliparous Previous PET Family hx
Chronic HTN
DM,SLE,APLA,Renal disease
Multiple gestations, polyhydramnios
GTD

8. complication Eclampsia Pul. Edema Renal, heart failure, CVA
DIC, thrombocytopenia
Prematurity,IUGR,placental abruption
Perinatal asphyxia

9. Other important point in history
headach analysis
Other sumptoms of increase blood pressure
Symptoms of the preeclampsia
Risk factor of preeclampsia
Cmplication of preeclampsia
Previus history
Family history
Past medical history
Drugs
Other problem in current pregnancy

10. juandice, pallor, cyanosis, swelling, chovestic sign head
General looks, petechia
Vitals , abnormal movement
Physical examination
juandice, pallor, cyanosis, swelling, chovestic sign
head
Lower zone crepitation, sign of pumonary odema
chest
Right upper quadrent tenderness, destintion, lepold maneouver
abdomen
Edema, reflexes, prephral pulse, clonus,
Lower limb

11. investigation: CBC --- low platelet, high HCT, low HG
Coagulation profile --- high PT,APTT low fib
U & E + creatinine --- high uric acid & CR
LFT --- high LE, alb, bil
Urine analysis --- protienurea .3 g per day
Urine output --- oligurea 500ml per day

12. investigation: Ultrasound --- IGUR((24W)), amniotic fluid CTG
BPP --- early 26-28W if at risk ((36))
Cord doppler --- reduced blood flow

13. 1 2 3 4 management delivery hypertention eclampsia Intrapartum
4 MAJOR STEPS 1
delivery 2
hypertention 3
eclampsia 4
Intrapartum

14. 1 delivery SVD unless C/S is indicated
if mild --- wait and observed, at 38 W
if sever --- period of stabilization
delivered immediately if there is worsen sign or fetal distress

15. 2 hypertention HTN crisis ((160/105)) --- hydralazine or labetalol
nefidipine, hypotention
IV sodium nitriprosside , fetal cyanide toxicity
if chronic, methyldopa is the safest
Ca channel blocker & labetalol also safe
ACE inhibitors & ARB, fetal toxicity

16. 3 eclampsia ABC & stabilization
control the blood pressure every 10 min
prevent convulsion , mgso4 ((check level))
once hypoxia , HTN and convulsion stabilized , induce delivery vaginally
asses urine output, reflexes and vitals for mg toxicity

17. 4
Intrapartum
careful monitoring for mother & baby, seziur prophylaxis (MGSO4)
placental abruption , failure to progress Nonreassuring NST necessitating C/S
Epidural anesthesia unless there is coagulapathy.