فشار خون بارداری - اکلامپسی، پره اکلامپسی و سندرم HELLP

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In the name of Allah High Blood pressure in pregnancy A.M. Karimi Medical student 

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Epidemiology and classification * The most common medical complication of pregnancy (Most common complication of pregnancy: Abortion) * Classification: 1- Gestational hypertension v Pre-eclampsia syndrome vEclampsia syndrome v Transient hypertension 2- Chronic hypertension 

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Gestational Hypertension (G. HTN) ition: sustained systolic blood pressure at or Ommuig, or a diastolic blood pressure of 90mmHg or greater in BP must be present on at least two separate occasions; fter the first BP assessment Or within a week.) in late pregnancy (>20 weeks Gestation or the first 24 hours after delive bsence of other findings suggestive of preeclampsia er G.HTN Criteria: BP above 160/110mmHg in the absence of ed to treat. Consider follow up & weekly visit 

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Etiology of Pre-eclampsia Mechanisms that are currently considered important include: 1.Placental implantation with abnormal trophoblastic invasion of uterine vessels 2.Ilmmunological maladaptive tolerance between maternal , paternal (placental), and fetal tissues 3.Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy 4.Genetic factors including inherited Deeg Manac and aninanatic influancac Generalizesd vasospasm 3 Hyper-viscosity of blood ات۱ ‎agents‏ (Leads to 600-10 

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Risk f Obesity Multifetal g Maternal a Thrombop ۱ 505 Nulliparity | nulliparity Fetal hydri ! ۳ | Molar preg ۷ i Insulin resis, Nephropathy Fetal aneuplo. Maternal infecti. APS syndrome rm related factors ART(IVF , etc. ) 

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1۱۳3۰ uri cua Cummpucations Maternal 1. DIC 1. Pre-term labor 2. HELLP syndrom~ QMACD, 3. Placental ab’ 1emic Encephalopathy 4. Pulmonary «= ‏أنسن‎ > iplications 5. Acute renal i ‏و‎ childbirth 6. MAHA(f# LDH, Suustocyecs un a es, 

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نم دح ابن عات إن ان ral an Pulsed Doppler ultrasound shows reverset flow rows) in the um| ry (UA).1 2 ince is blooc 5 = o ۳ 9 1 ۳-3 0 ~ iD) ۳ = 5 

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Prevention ly Calcium intake(1.5 gr daily) >>» NO PREVENTIVE EFFECT w dose Aspirin + LMWHeparin only in High-risk pregnancies>>> SS PREVENTIVE EFFECT eatment of Chronic HTN»»pDecreases risk of Sever HTN 

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* Seco ndly یش ‎Eclampsia‏ میب 

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Approach to Mild Pre-Eclampsia تاه ریت۱ ‎Para-clinical evaluation‏ قلرت روت اکتا Gestation ع ادمع عم باط او 

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MANAGEMENT OF MILD PRE- ECLAMPSIA DURING DELIVERY Sulfate administration during and 24 hours after delivery nal anesthesia ider administration of Hydralazine if BP goes above 160/110 m ODE st be maintained between 140/90 to 160/110 But aetiess+he 

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evere Pre-Eclampsia Headach ache ‏اهنادالا‎ ‎disturba 0 Epigastri c pain 

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Watchful waiting & Corticosteroid a Corticost NVD administration eroids Or administra ‏ول‎ ) راب يي نا دازا ‎DIC‏ ‎Placental abruption‏ تیا قغمععوام ‎Gestational age §‏ 23w Stabl Not stable Delivefy at ‏تن گرگ‎ a oids week adminictratin 

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1 2..Regional Or Epidural anesthesia 3.Consider administration of Hydralazine if BP goes above 160/110 mmHg 4.Urine output must be more than 100cc/4h 5 .Assessment of the signs of HELLP syndrome 6.Postpartum hemorrhage management: Oxytocin (Methylergenovine) P must be maintained between 140/90 to عجوي دا و ده ا 

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Eclampsia Definition: Generalized Tonic clonic seizure (for at least 1 to 2 minutes) in a patient diagnosed with preeclampsia Management of Eclampsia 1, Making sure the airwayoltescfestages:the woman can breathe. 2. Controlling the fits (with Mg sulfate:padditional 2gr® additional 29۳ 3. IV Amobarbital Na » Induction & intubation) 3. Controlling the blood pressure (with Hydralazine, Labetalo! or Nifedipine) 4. General care and monitoring Delivering the baby Care after delivery. 

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Medication: °Mg Sulfate is the drug of choice v Loading dose IV: 4-6gr of 20%MgSO4 in 200cc 5%DW f minutes. hours IM: 5gr of 50%MgSO4 in each buttock failure v Maintenance dose absolute contra- IV: 2-3gr of 20%MgSO4 in 1000cc 5%DW hours M: 5gr 50%MgSO4 every 4 hours for 24 hour: 

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ما۳ 1600 3 اأ8 .ماما 112 HELLP SYNDROME VISION PROBLEMS SEVERE HEADACHES SEIZURE SHOULDER PAIN CHEST TENDERNESS HIGH BLOOD PRESSURE VOMITING FATIGUE SWELLING 

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RISK FACTORS & COMPLICATIONS © Risk factors: Multiparity, White people, #35 years old © Complications: v Sub-capsular hematoma of liver: -Sings: RUQ/Epigastric pain, Hepatomegaly, referral pain(shoulders, esophagus, pleura, gall bladder) -Best diagnostic modality: CT-Scan -Treatment 1.Stable hemodynamic: F/U 2.Unstable hemodynamic: Laparotomy, Management of oagulation disturbances 

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Watchful waiting & i 1 NVD Corticosteroid OF dministrati administration Gs (EE, 

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els de HeEBY Fre XPSE SBS ood My Messure above 140/90 KRERAN before pregnancy Or before 20 weeks of gestation. * Complications: ¥ Superimposed Pre-eclampsia(Chronic HTN for more than 4 years , Renal failure, positive history of HTN in previous pregnancies) Y Placental abruption Pre-term labor 

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Management ۱ سس سسوم 7 اويا ‎th | ige SBP measurements of‏ نا ۰ ‎mm Hg or ACE & ARB dg Or in the presence of‏ 2160 * Methyldopa (Oral) is the * Hydralazine (IV) is the d Side effects and comp ilpitation, Headache, Drug induced SLE, Neonatal thi ۱ * Labetalol is safe in preg CHE not recommended ed with Maternal hypotension ‘ption it would be safe for her they should not be nt is diagnosed with 12 O1 

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Approach to Chronic HTN risk/Group ‏یرون الب‎ risk/Group ۲ -Mild HTN Involves: ‏ات يا ا ل مياه‎ -Patients with BP t 160/105 -No need treat ministration of Anti-hypertensive -End-organ damage drugs must be stopped | -In the first Pre-natal visit Administration of Pt 160/110 Anti-hypertensive Hfid-organ damage ‏كت‎ ‎Pre-eclampsia ‎Administration NVD Or C/S of Anti- In 40% week hypertiensive NVD Or C/S Well tontrotied In 41* week No signs of preeci: 1 1 

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ASSESSMENTS: ٠ LOW RISK PATIENTS / GROUP 1 * HIGH RISK PATIENTS / GROUP 2 ‎trimester: 2 visits every‏ ”2 200 **1- ادا ااا الم ‎trimester month‏ ‎ ‎ ‎ ‎ ‎ ‎-24 hours urine collection every-3* trimester: weekly visit ‎week -24 hours urine collection for every ‎-Weekly NST (since 34 weeks of visit ‎pregnancy) -Weekly NST or BPP (since 28 -Sonographic evaluation every Weeks of ‏اد ین‎ ۱ month(since 32 weeks of -Sonographic evaluation every ‎gnancy) month(since 26 weeks of pregnancy) 

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THANK YOU for your patience & |