Pregnancy-induced hypertension

Mild Pre-eclampsia :

Hypertension > 140/90 mmHg

+

Proteinuria > 0.3g/24 h

After 20^th week of gestation

• At term or full lung maturity  delivery (most effective) - Away from term or No lung maturity :

  1. Bed rest + observation

  2. Methyldopa if BP > 160/110

  3. Dexamthasone between 24^th – 34^th weeks  delivery once mature lung.

• The most appropriate initial medication to treat her hypertension & proteinuria : Methyldopa.

Severe

Pre-eclampsia :

Hypertension > 160/110 mmHg

+

Proteinuria > 5g/24 h

+

Oliguria / HEELP / headache, blurred vision / P.edema /

1. Stabilize the patient , is the most appropriate next step:

- Hypertension:  Hydralazine or labetalol (diuretics should be avoided). - Seizure:  MgSo4 (ttt in eclampsia / prophylaxis in severe)

2. Terminate immediately once stabilization By C.S or induction labor.

The cause of RUQ pain is liver capsule(Glisson's) distention.

Eclampsia

Mild or Severe preeclampsia

+

Grand mal convulsions

Chronic hypertension

• Hypertension that's not pregnancy induced (as essential hypertension).

• It's diagnosed when : 1- hypertension exists prior to pregnancy or 2- when appears < 20^th GA.

• If proteinuria occurred during pregnancy  chronic hypetension with superimposed pre-eclampsia -- Contraindicated antihypertensives during pregnancy: ACEIs & ARBs ( Teratogenic) -- Drugs used for essential hypertension during pregnancy: labetalol & methyldopa.

Transient hypertension

• occurs in the second half of pregnancy or during labor & delivery.

• Proteinuria may present BUT doesn't exceed 0.3g/24hr  if exceeded, diagnosis : pre-eclampsia.