Hypertension is a common complication of pregnancy that can lead to increased maternal and neonatal morbidity and mortality if not properly managed. It includes conditions like chronic hypertension, pre-eclampsia, and gestational hypertension. Pre-eclampsia affects 5-15% of pregnancies and is characterized by new onset hypertension and proteinuria developing after 20 weeks of gestation. Risk factors include primigravidas, family history, chronic hypertension, and obesity. Treatment involves monitoring, medication to control blood pressure, delivery after 36 weeks gestation, and magnesium sulfate in severe pre-eclampsia to prevent eclampsia. Close antenatal surveillance and multidisciplinary care are important to optimize outcomes.
2. Introduction
Hypertension is one of the most common complication
during pregnancy
Increased maternal and perinatal morbidity and
mortality
It is a sign of an underlying pathology that may be pre-
existing or appears for the first time during pregnancy
that is why it is also called asTOXEMIA OF PREGNANCY
Journals of the American college of obstetricians and gynecologists
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3. Hypertension
Blood pressure of 140/90 mmHg or more or an increase of 30 mmHg
in systolic and/or 15 mmHg in diastolic blood pressure over the pre-
or early pregnancy level.
DC Dutta`s textbook of obstetrics 8th edition, p- 255
4. Incidence
6% to 8% of all the pregnancies
Complicates 10-20% of pregnancies
District I ACOG Medical Student Education Module 2011
5. Prevalence
Hypertensive disorders during pregnancy occur in women with
preexisting primary or secondary chronic hypertension, and in
women who develop new-onset hypertension in the second half
of pregnancy
The present study was undertaken to study the prevalence and
correlates of hypertension in pregnancy in a rural area
6. Prevalence (cont.)
• A total of 931 pregnant women were included in the
present study. Prevalence of hypertension in pregnancy
was found to be 6.9%. Maternal age ≥25 years,
gestational period ≤20 weeks, history of cesarean section,
history of preterm delivery, and history of hypertension in
previous pregnancy were found to be significantly
associated with prevalence of hypertension in pregnancy
7. Risk Factors for
Hypertension in Pregnancy
Nulliparity
Pre-eclampsia in a previous pregnancy
Age >40 years or <18 years
Family history of pregnancy-induced hypertension
Chronic hypertension
Chronic renal disease
Anti-phospholipid antibody syndrome or inherited
thrombophilia
DC Dutta`s textbook of obstetrics 8th edition, p- 256
8. Vascular or connective tissue disease
Diabetes mellitus (pre-gestational and gestational)
Multi-fetal gestation
High body mass index
Male partner whose previous partner had preeclampsia
Hydrops-fetalis
Unexplained fetal growth restriction
Risk Factors for
Hypertension in Pregnancy (cont.)
DC Dutta`s textbook of obstetrics 8th edition, p- 256
9. Classification of Pregnancy induced
hypertension
According to national high blood pressure education program
2000 and ACOG-2013
1. Chronic hypertension
2. Pre-eclampsia
3. Chronic hypertension with superimposed pre-eclampsia and
eclampsia
4. Gestational Hypertension
5.Transient Hypertension
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
DC Dutta`s textbook of obstetrics 8th edition, p- 255
10. Classification (cont.)
6. HELLP syndrome-
a. Hemolysis (H)
b. Elevated liver enzymes (EL)
c. Low platelet count (LP)
7. Eclampsia
8. Superimposed pre-eclampsia or eclampsia
9. Proteinuria
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
DC Dutta`s textbook of obstetrics 8th edition, p-255
11. Chronic hypertension in pregnancy
The presence of hypertension of any cause antedating or before the
20th week of pregnancy beyond the 12 weeks after delivery
Women with CH are low risk and have satisfactory maternal and fetal
outcome without any hypertensive therapy by life-style modification
With life-style modification, aerobic exercise should be restricted based
on theoretical concerns.
Risk factors:
Age (>40 years)
Duration of hypertension (>15 years)
Level of BP (>160/110 mm of Hg)
Presence of any medical disorder
Presence of thrombophilias
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
DC Dutta`s textbook of obstetrics 8th edition, p- 277
12. Effect of Chronic Hypertension on Pregnancy
Maternal:
superimposed pre-eclampsia/
eclampsia in 15-20% of cases
Foetal:
Intrauterine growth
retardation.
Intrauterine foetal death.
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13. Prenatal Care for Chronic Hypertensives
Electrocardiogram should be obtained in women with long-
standing hypertension.
Baseline laboratory tests
Urinalysis, urine culture, and serum creatinine,
glucose, and electrolytes
Tests will rule out renal disease, and identify
comorbidities such as diabetes mellitus.
Women with proteinuria on a urine dipstick should
have a quantitative test for urine protein
The American college of obstetricians and gynocolists
14. Treatment
General and medical treatment
As pre-eclampsia regarding the following:
Rest
Antihypertensives
Observation
DC Dutta`s textbook of
obstetrics 8th edition, p- 277
15. The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
17. Definition
It is a multisystem disorder of unknown etiology characterized by
development of hypertension to the extent of 140/90 mm of Hg or
more with proteinuria after the 20th week in a previously
normotensive and non-proteinuric women
DC Dutta`s textbook of obstetrics 8th edition, p- 256
18. Incidence:
In hospital:
varies widely from 5% to 15%
The incidence in primi-gravidae is about 10% and in multi-gravidae is
5%
More common in women with chronic hypertension, with an incidence
of approximately 25%
DC Dutta`s textbook of obstetrics 8th edition,p-256
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
19. Pre-disposing factors
Primigravidae more than multi-gravidae.
Pre-existing hypertension.
Previous pre-eclampsia.
Family history of pre-eclampsia.
Hyperplacentosis i.e. excessive chorionic tissue as in hydatidiform
mole, multiple pregnancy, uncontrolled diabetes mellitus and foetal
haemolytic diseases.
Obesity.
New paternity
Thrombophilias
DC Dutta`s textbook of obstetrics 8th edition.p-256
20. Pathophysiology
The uteroplacental bed
Immunological factor
Genetic factor
Renin- angiotensin system
Atrial natriuretic peptide (ANP)
Prostaglandins
Neutrophils
DC Dutta`s textbook of obstetrics 8th edition,p-258
22. Clinical features:
Symptoms:
Mild:
slight swelling over the ankle
Gradually swelling may be extend to the face, abdominal wall, vulva
even the whole body.
Alarming:
Headache
Disturbed sleep
Diminished urinary output
Epigastric pain
Eye symptoms- blurring, scotomata, dimness of vision or at times
complete blindness.Vision usually regained within 4-6 weeks following
delivery.
DC Dutta`s textbook of obstetrics 8th edition, p-261
23. Signs:
Abnormal weight gain
Rise of blood pressure
Edema
There is no manifestation of chronic cardiovascular or renal
pathology
Pulmonary edema
Abdominal examination my reveal evidences of chronic
placental insufficiency such as scanty liquor or growth retardation
of the fetus
DC Dutta`s textbook of obstetrics 8th edition,p-261
24. Investigations:
Urine:
24 hours urine collection for protein measurement is done.
Urine become solid on boiling (10-15 g/L)
A few hyaline cast, epithelial cells or few red cells.
Ophthalmoscopic examinations:
In severe cases- retinal edema, constriction of arterioles,
alteration of normal ration of vein, nicking the veins,
hemorrhage.
DC Dutta`s textbook of obstetrics 8th edition,p-262
25. Blood values:
Serum uric acid level >4.5
mg/dl indicates presences of
pre-eclampsia
Blood urea level remains
normal
Abnormal coagulation
profile
Raised hepatic enzyme
levels
Antenatal fetal monitoring:
Done by clinical examination
Daily fetal kick count
USG of fetal growth
Liqour pockets
Cardiotocography
Umbilical artery flow
velocimetry
Bio-physical profile
DC Dutta`s textbook of obstetrics 8th edition,p-262
26. Complications
Immediate:
Maternal:
During prengnancy:
a. Eclampsia (2%)
b. Accidental hemorrhage
c. Oliguria and anuria
d. Dimness of vision even blindness
e. Pre-term labour
f. HELLP syndrome
g. Cerebral hemorrhage
h. Acute respiratoy distress syndrome
(ARDS)
During labour:
a. Eclampsia
b. Post partum hemorrhage (PPH)
Puerperium:
a. Eclampsia
b. Shock
c. Sepsis
DC Dutta`s textbook of obstetrics 8th edition,p-263
27. Fetal:
a. Intrauterine death (IUD)
b. Intrauterine growth
retardation (IUGR)
c. Asphyxia
d. prematurity
Remote:
a. Residual hypertension
b. Recurrent pre-eclampsia
c. Chronic renal disease
d. Risk of placental abruption
DC Dutta`s textbook of obstetrics 8th edition,p-263
28. Prediction
No screening test is really helpful
Various screening methods are:
Diastolic notch at 24weeks by Doppler ultrasonography
Absence or reversal of end diastolic flow
Average mean arterial pressure ≥ 90 mmHg in second trimester
Infusion test: angiotensin infusion required to raise the blood
pressure >20 mm Hg from baseline
Roll over test:
Rise in blood pressure >20 mmHg from baseline on turning supine at
28-32 weeks gestation is positive
DC Dutta`s textbook of obstetrics 8th edition,p-263
30. General measures:
Maternal
Blood pressure twice daily
Urine volume and proteinuria
daily
Oedema daily
Body weight twice weekly
Fundus oculi once weekly
Blood picture including platelet
count, liver and renal functions
particularly serum uric acid on
admission
Daily foetal movement count
Serial sonography
Non-stress and stress test if
needed
Observation
Fetal
DC Dutta`s textbook of obstetrics 8th edition,p-265
31. Medical treatment
Antihypertensives:
Decrease the maternal cerebral and cardiovascular complications but do
not affect the foetal outcome
Alpha-methyl-dopa:
It reduces the central sympathetic drive
Dose: 250-500 mg every 6-8 hours up to a maximum dose of 4 gm/day. Its
effect appears after 48 hours
A loading single dose of 2 gm may act within 1-2 hours
Side effects: headache, athenia and nightmares
DC Dutta`s textbook of obstetrics 8th edition,p-265
32. Medical treatment (cont.)
Hydralazine:
It is a vasodilator, increases renal and uteroplacental blood flow
Dose: 20 mg slowly IV initially followed by 5mg every 20 min. until
diastolic blood pressure is 100-110 mmHg.This regimen is used for
severe and acute hypertension. Oral hydralazine can be used in the
chronic situation as a second line treatment in a dose of 25-75 mg/ 6
hours
Side effects: tachycardia, headache, flushing, nausea and vomiting
Calcium channel blockers (Nifedipine):
It is a vasodilator acting by blocking the Ca influx into smooth muscle
cells
It can be given sublingually (acts within 10 minutes) or orally (acts
within 30 minutes) in a dose of 10-20 mg 2-3 times daily
The higher the starting blood pressure the greater is the hypotensive
effect.
Side effects: headache and flushing
DC Dutta`s textbook of obstetrics 8th edition,p-265
33. The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
34. Prophylactic
Proper antenatal care:
To detect the high risk patients who may develop PIH through the
screening tests
Early detection of cases who have already developed PIH and
examine them more frequently
Low dose aspirin:
It inhibits thromboxane production from the platelets and the AII
binding sites on platelets
A low dose (60 mg daily) selectively inhibits thromboxane due to
higher concentration of such a low dose in the portal circulation
than systemic affecting the platelets when they pass through the
portal circulation.The Prostacyclin production from the systemic
vessels will not be affected
DC Dutta`s textbook of obstetrics 8th edition,p-265-66
35. Curative
Delivery of the foetus and placenta is the only real treatment of pre-
eclampsia. As the conditions are not always suitable for this, the
treatment aims to prevent or minimize the maternal and foetal
complications till reasonable maturation of the foetus.
DC Dutta`s textbook of obstetrics 8th edition,p-265-66
36. Obstetric measures
Timing of delivery
Method of delivery
Intrapartum care
Postpartum care
DC Dutta`s textbook of obstetrics 8th edition,p-267
37. Obstetric measures
Timing of delivery:
Severe pre-eclampsia is usually treated conservatively till the end of
the 36th week to ensure reasonable maturation of the foetus.
Indications of termination before 36th week include:
1. Aggravation of pre-eclamptic features
2. Hypertension persists
3. Acute fulminating pre-eclampsia
4. Tendency of pregnancy to overrum the expected date
DC Dutta`s textbook of obstetrics 8th edition,p-266-67
38. Method of delivery
Vaginal delivery may be commenced in vertex presentation by:
Amniotomy + oxytocin if the cervix is favorable
Prostaglandin vaginal tablet (PGE2) if the cervix is not favorable
Caesarean section is indicated in:
Foetal distress
Late deceleration occurs with oxytocin challenge test
Failure of induction of labour
Other indications as contracted pelvis, and malpresentations
DC Dutta`s textbook of obstetrics 8th edition,p-266-67
39. Intrapartum care
Close monitoring of the foetus is indicated
Proper analgesia to the mother
Anti-hypertensives may be given if needed
2nd stage of labour may be shortened by forceps
DC Dutta`s textbook of obstetrics 8th edition,p-266-67
40. Postpartum care
Methergin (Ergometrine) is better avoided as it may increase the blood
pressure
Continue observation of the mother for 48 hours
Anti- hypertensive drugs are continued in a decreasing dose for 48 hours
DC Dutta`s textbook of obstetrics 8th edition,p-266-67
41. Prevention of preeclampsia
• Identification of high-risk women
• Close clinical and laboratory monitoring aimed at its early
recognition
• Institution of intensive monitoring or delivery when indicated.
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
42. Note
Imminent eclampsia: It is a state in which the patient is about to
develop eclampsia. Usually there are:
Blood pressure much higher than 160 /110 mmHg
Heavy proteinuria (+++or ++++)
Hyperreflexia
Severe continuous headache
Blurring of vision
Epigastric pain
Fulminating pre-eclampsia: a rapidly deteriorating pre-eclampsia to
be imminent eclampsia
DC Dutta`s textbook of obstetrics 8th edition, p-267
43. Chronic hypertension with
superimposed pre-eclampsia or
eclampsia
The common cause of chronic hypertension:
- Essential hypertension
- Chronic renal disease
- Coarctation of aorta
- Endocrine disorders (DM, pheochromocytoma,
thyrotoxicosis)
- Connective tissue disease (SLE)
Criteria for diagnosis of superimposed pre-eclampsia:
- New onset of proteinuria >0.5 g/24 hours specimen
- Aggravation of hypertension
- Development of HELLP syndrome
- Development of headache scotoma, epigastric pain
The American college of obstetricians and gynocolists
44. Gestational hypertension
A sustained rise of blood pressure to 140/90 mm of Hg or more on
at least two occasions 4 or more hours apart beyond the 20th week
of pregnancy or within the first 48 hours of delivery in a previously
normotensive women
DC Dutta`s textbook of obstetrics 8th edition, p- 276
45. Gestational hypertension (cont.)
It should fulfill the following criteria:
- Absence of any evidences for the underlying cause of hypertension
- Generally unassociated with other evidences of pre-eclampsia (edema
or proteinuria)
- Majority of cases are more than or equal to 37 weeks of pregnancy
- Generally not associated with hemo-concerntation or
thrombocytopenia, raised serum uric acid level or hepatic dysfunction
-The blood pressure should come down to normal within 12 weeks
following pregnancy
DC Dutta`s textbook of obstetrics 8th edition, p- 256
46. Gestational hypertension:
Pathophysiology
Cardiovascular effects
Elevated BP
Increased cardiac output
Hematologic effects
Third spacing of fluid due to increased blood
pressure and decreased plasma oncotic
pressure
Renal effects
Atherosclerotic like changes in renal vessels
(glomerular endotheliosis) decreased
glomerular filtration rate and proteinuria
Uric acid filtration is decreased
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47. Pathophysiology (cont.)
Neurologic effects
Hyper-reflexia/hypersensitivity (does not correlate with
severity of disease)
In severe cases, grand mal seizures
Pulmonary effects
Pulmonary edema may occur due
to decreased colloid oncotic pressure
Fetal effects (severe gestational HTN)
Vasospasm Decreased intermittent placental perfusion
IUGR, oligo-hydramnios, low birth weight
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48. Pathophysiology (cont.)
Mechanisms
Uterine vascular changes
Trophoblastic-mediated vascular changes decreased
musculature in spiral arterioles development of low
resistance, low pressure, high-flow system
Inadequate maternal vascular response
Endothelial damage is also noted within the vessels
Hemostatic changes
Increased PLT activation with increased endothelial fibro-nectin
and decreased anti-thrombin III and alpha-2-antiplasmin
further endothelial damage is thought to promote further
vasospasm
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49. Pathophysiology (cont.)
Mechanisms
Changes in prostanoids
During pregnancy, both PGI2 (vasodilation and decreased PLT
aggregation) andTXA2 (vasoconstriction and PLT aggregation)
are increased with balance favored to PGI2
In preeclampsia,TXA2 is favored
Changes in endothelium-derived factors
Decrease in Nitric oxide promoting vasoconstriction
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50. Transient Hypertension
• Retrospective diagnosis
• BP normal by 12 weeks postpartum
• May recur in subsequent pregnancies
• Predictive of future primary hypertension
The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation andTreatment of High Blood Pressure
52. HELLP Syndrome (cont.)
Is a variant of severe preeclampsia
Platelets < 100,000
LFT’s - 2 x normal
May occur against a background of what appears to be
mild disease
DC Dutta`s textbook of obstetrics 8th edition, p-258
53. Management of HELLP syndrome:
Immediate hospitalisation
Stabilise mother
Antihypertensive
Anti-seizure prophylaxis
Correct coagulation abnormalities
Assess foetal condition- FHR, Doppler ultrasound,
biophysical profile
DC Dutta`s textbook of obstetrics 8th edition,p-258
55. Definition
Pre-eclampsia when complicated with grandmal seizures
(generalized tonic clonic seizures) and/or coma is called eclampsia
DC Dutta`s textbook of obstetrics 8th edition,p- 268
56. Incidence and prevalence
•0.1- 5.5 per 10,000 pregnancies
•Decreasing incidence with time
•Antepartum(50%): mostly in third trimester
•Intrapartum (30%):
•Postpartum(20%): usually within 48hours, fits beyond
7days generally rules out eclampsia
The American college of obstetricians and gynocolists
DC Dutta`s textbook of obstetrics 8th edition,p- 268
57. Risk factors:
• Maternal age less than 20 years
• Multigravida
• Molar pregnancy
•Triploidy
• Pre-existing hypertension or renal disease
• Previous severe Preeclampsia or Eclampsia
• Nonimmune hydrops fetalis
• Systemic Lupus Erythematosus
DC Dutta`s textbook of obstetrics 8th edition,p-268
58. Clinical Features
Eclamptic convulsions are epileptiform and consist of four stages
• Premonitory stage: twitching of muscles of face, tongue, limbs
and eye. Eyeballs rolled or turned to one side
•Tonic stage: opisthotonus, limbs flexed, hands clenched
• Clonic stage: 1-4 min, frothing, tongue bite, stertorous
breathing
• Stage of coma: variable period
DC Dutta`s textbook of obstetrics 8th edition,p-270
59. Pathogenesis:
Loss of normal cerebral auto regulatory mechanisms cerebral
hyperperfusion leading to Edema & ↓cerebral blood flow.
DC Dutta`s textbook of obstetrics 8th edition,p-268
60. Diagnosis:
Lab Investigations:
• Complete Blood Count
• Platelet count
• LFT
• RFT
• Urine analysis
• Serum electrolytes
• Peripheral blood smear
• Prothrombin time
• Type and screen antibody if present
• Angiotensin II test: a dose of 8mk/kg/body weight to increase
Diastolic Blood pressure by 20 mm of Hg is taken as positive
The American college of obstetricians and gynocolists
62. Management
Control Hypertension
Improve intravascular volume
Prevent convulsions
Prevent complications
Deliver viable fetus
DC Dutta`s textbook of obstetrics 8th edition,p-271
63. Control Hypertension:
Most commonly, for acute control:
Hydralazine
Labetalol
Nifedipine may be used, but unexpected hypotension may occur
when given with MgSO4
For refractory hypertension: nitroglycerin or nitroprusside may be
used
Nitroprusside dose and duration should be limited to avoid fetal
cyanide toxicity
Usually require invasive arterial pressure monitoring
Angiotensin-converting enzyme (ACE) inhibitors contraindicated
due to severe adverse fetal effect
DC Dutta`s textbook of obstetrics 8th edition,p-271-72
67. Improve intravascular volume:
Main aim is to increase CVP & PCWP range 4-6 cm H2O & 5-10
mm HG and to increase urine output to 1 ml/kg/hr.
There is a controversy between colloid and crytalloid as both
complicates the condition causing low colloid oncotic
pressure and leaky capillary predisposing them to risk of non-
carcinogenic pulmonary oedema
Fluid recommendation: crystalloids to be administered at
the rate of 1-2 ml/kg/hr. and alternating according to CVP,
PCWP and Urine Output.
DC Dutta`s textbook of obstetrics 8th edition,p-272-73
The American college of obstetricians and gynocolists
68. Seizure Prophylaxis &Treatment: Magnesium
sulphate therapy. Magnesium sulfate has many
effects; its mechanism in seizure control is not clear.
It is an NMDA (N-methyl-D-aspartate) antagonist
vasodilator
Brain parenchymal vasodilation demonstrated in
preeclamptics by Doppler ultrasonography increases
release of prostacyclin
DC Dutta`s textbook of obstetrics 8th edition,p-272-73
The American college of obstetricians and gynocolists
69. Potential adverse effects:
• Toxicity from overdose (respiratory, cardiac)
• Bleeding
• Hypotension with haemorrhage
• Uterine contractility
Renally excreted
Preeclamptics prone to renal failure
Magnesium levels must be monitored frequently either clinically
(patellar reflexes) or by checking serum levels for 6-8 hours
DC Dutta`s textbook of obstetrics 8th edition,p-272-73
The American college of obstetricians and gynocolists
70. Treatment of magnesium toxicity:
- Stop MgSO4
- IV 1 g 10% calcium gluconate slow
- Administer Oxygen
- Secure airway
- Ventilation
DC Dutta`s textbook of obstetrics 8th edition,p-273
The American college of obstetricians and gynocolists
71. Anaesthetic Implication:
MgSo4 potentiate and prolongs both actions of depolarizing and
non-depolarizing Muscle relaxants. Intubating dose of
succinylcholine should not be decreased as onset and duration of
action of single dose does not alter in preeclamptic patients. NDMR
when used neuromuscular monitoring with peripheral nerve
stimulation and dose titration should be done accordingly.
DC Dutta`s textbook of obstetrics 8th edition
The American college of obstetricians and gynocolists
72. Various Regime of Magnesium
Therapy
• Pritchard Regime:
- Loading dose: 4g (20 ml of 20%) MgSo4 IV over 4 min. immediately
followed by 10g (20 ml of 50%) IM i.e. 5 gm in each buttocks
- If convulsion persists after 15 min 2 g IV over 2 min
- Maintenance dose: 5g IM every 4 hours alternate side
• Zuspan or Sibai regime:
- Loading dose: 6 g IV over 20 min
- Maintenance dose: 2-3 g/hr. IV every 6 hr
The American college of obstetricians and gynocolists
73. Treatment of Eclampsia:
Seizures are usually short-lived.
• If necessary, small doses of barbiturate or benzodiazepine
(STP, 50 mg, or midazolam, 1-2 mg) and supplemental oxygen
by mask
• If seizure persists or patient is not breathing, rapid sequence
induction with cricoid pressure and intubation should be
performed
• Patient may be extubated once she is completely awake,
recovered from neuromuscular blockade, and magnesium
sulfate has been administered
The American college of obstetricians and
gynocolists
74. Superimposed pre-eclampsia or eclampsia
Occurrence of new onset of proteinuria in women with chronic
hypertension
Risk factors:
Renal insufficiency
History of hypertension for 4 years or more
Hypertension in previous pregnancy
DC Dutta`s textbook of obstetrics 8th edition,p- 255
75. Proteinuria (albuminuria)
It is urinary protein greater than 0.3gm/L in 24 hours
collection or greater than 1gm/L in two random samples
obtained at least 6 hours apart
It indicates glomerular damage and almost always occurs
after hypertension
Proteinuria is usually in the range of 1-3 gm daily, of
which 50-60% is albumin but in severe cases it may
exceed 15gm
DC Dutta`s textbook of obstetrics 8th edition, p- 256
76. Treating hypertension during
lactation
Hypertensive mothers can usually breast-feed safely.
Antihypertensive drugs are excreted into human breast milk.
Therefore, in mothers with stage 1 hypertension who wish to
breast-feed for a few months, it might be prudent to withhold
antihypertensive medication, with close monitoring of BP, and
reinstitute antihypertensive therapy following discontinuation of
nursing. No short-term adverse effects have been reported from
exposure to methyldopa or hydralazine. Propanolol and labetalol
are preferred if a beta-blocker is indicated. ACEIs and ARBs
should be avoided, based on reports of adverse fetal and
neonatal renal effects. Diuretics may reduce milk volume and
thereby suppress lactation. Breast-fed infants of mothers taking
antihypertensive agents should be closely monitored for
potential adverse effects.