Hypertension during pregnancy

Chapter 19 HYPERTENSION DURING PREGNANCY



Kathleen Dor


Hypertension is defined as systolic blood pressure of 140 or higher, a diastolic blood pressure of 90 or higher, or both. Women with hypertension during pregnancy need to be monitored carefully because of the significant risk of morbidity and mortality in the mother, fetus, and newborn. Hypertension during pregnancy is classified as gestational hypertension, preeclampsia, eclampsia, or chronic hypertension.


Gestational hypertension is hypertension that develops after 20 weeks of pregnancy and resolves by 12 weeks post partum. About 25% of women with gestational hypertension develop preeclampsia. Preeclampsia is gestational hypertension that is associated with proteinuria (≥0.3 g of protein/24 hours). Eclampsia is the presence of seizures in a pregnant woman with preeclampsia.


Risk factors for preeclampsia include first pregnancy, multiple fetuses, chronic hypertension, diabetes, renal disease, thrombophilia, vascular and connective tissue disease, obesity, maternal age of greater than 35 years, or maternal age of less than 20 years.


Chronic hypertension is hypertension that starts before the 20th week of pregnancy. Patients with chronic hypertension are at considerable risk of developing superimposed preeclampsia. Possible complications of chronic hypertension include preterm labor, intrauterine growth restriction, fetal death, and placental abruption.



Medications and Supplements Associated with Hypertension during Pregnancy




Bitter orange


Cyclooxygenase-2 (COX-2) inhibitors


Cyclosporine


Ephedra


Erythropoietin


Ma huang


Nonsteroidal anti-inflammatory drugs (NSAIDs)


Oral contraceptives


Steroids


Sympathomimetic drugs


• Anorectics

• Decongestants

Tacrolimus



Causes of Hypertension During Pregnancy




Alcohol intake


Chronic hypertension


Coarctation of the aorta


Cushing syndrome


Essential hypertension


Pheochromocytoma


Primary aldosteronism


Renal artery disease


Renal disease


Sleep apnea


Thyroid disease


Chronic hypertension with superimposed preeclampsia or eclampsia


Diet (licorice)


Eclampsia


Gestational hypertension


Illicit drug use


• Amphetamines

• Cocaine

Medications


Obesity


Preeclampsia


• Mild preeclampsia

• Severe preeclampsia

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Jun 4, 2016 | Posted by in GYNECOLOGY | Comments Off on Hypertension during pregnancy

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