MDT Surgical Mx Hypertension in Pregnancy Pre-existing HTN Women with known HTN before pregnancy and those diagnosed with HTN in 1st trimester Risk factors Age DM FHx Renal disease Ethnic group Medical disorders Pregnancy induced HTN Non-proteinuric HTN diagnosed in second half of pregnancy Typically resolves within 6 weeks of delivery Complications of HTN Increased risk of cerebral haemorrhage Increased risk of developing pre-eclampsia Increased susceptibility to IUGR Management of HTN Pre-pregnancy counselling Drug treatment to decrease risk of Identify cause cerebral haemorrhage Warned about pre-eclampsia Regular BP & urinalysis Uterine artery dopplers Regular fetal growth scans Pre-eclampsia Multisystem disorder of the endothelium causing Peripheral haemorrhagic necrosis Proteinuria High resistance vessels ↑AST/ALT vascular resistance Oligohydramnios ↑Cerbral Leaky glomerular capillaries IUGR Risk factors Primip Multiple pregnancy 35 + yrs Previous pre-eclampsia HTN FHx Diagnosis BP 160/110 + proteinuria 2+ ≥ ≥ BP 140/90 + proteinuria and at least one of ≥ ≥2+ Oliguria Platelts < 100, ALT > 50 Visual disturbance, headaches, Creatinine > 100 RUQ pain 3+ of clonus Management Deliver baby if at term (IoL) Fluid restriction if severe Continuous CTG in labour Complications Eclampsia HELLP Renal Failure Cerebral Haemorrhage Hepatic Rupture DIC
MDT Surgical Mx Hypertension in Pregnancy Pre-existing HTN Women with known HTN before pregnancy and those diagnosed with HTN in 1st trimester Risk factors Age FHx Medical disorders DM Renal disease Ethnic group Pregnancy induced HTN Non-proteinuric HTN diagnosed in second half of pregnancy Typically resolves within 6 weeks of delivery Complications of HTN Increased risk of cerebral haemorrhage Increased susceptibility to IUGR Increased risk of developing pre-eclampsia Management of HTN Pre-pregnancy counselling Identify cause Warned about pre-eclampsia Uterine artery dopplers Drug treatment to decrease risk of cerebral haemorrhage Regular BP & urinalysis Regular fetal growth scans Pre-eclampsia Multisystem disorder of the endothelium causing Peripheral haemorrhagic necrosis ↑AST/ALT ↑Cerbral vascular resistance Leaky glomerular capillaries Proteinuria High resistance vessels Oligohydramnios IUGR Risk factors Primip 35 + yrs HTN Multiple pregnancy Previous pre-eclampsia FHx Diagnosis BP ≥ 160/110 + proteinuria ≥ 2+ BP ≥ 140/90 + proteinuria ≥2+ and at least one of Oliguria Visual disturbance, headaches, RUQ pain Platelts < 100, ALT > 50 Creatinine > 100 3+ of clonus Management Deliver baby if at term (IoL) Continuous CTG in labour Fluid restriction if severe Complications Eclampsia Renal Failure Hepatic Rupture HELLP Cerebral Haemorrhage DIC
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