HYPERTENSION IN PREGNANCY

1. Nahar Taufiq Bagian Kardiologi dan Kedokteran Vaskular FKUGM SMF Jantung/ Pusat Jantung Terpadu RSUP DR Sardjito Jogjakarta HYPERTENSION IN PREGNANCY

2. Introduction Hypertension in Pregnancy: • Major cause of maternal and perinatal morbidity and mortality • Complicates up to 10% of pregnancies • Second leading cause of maternal mortality in the developed world (after VTE) • ~1/3 of all maternal deaths are from HTN’sive disorders

3. Physiologic adaptations in normal pregnancy • Blood changes: • ↑ Plasma volume by ≈ 40%. • Platelets count can ↓ below 200 X 109/L due to normal maternal blood-volume expansion. • ↑ Coagulation factors (Fibrinogen, Factor VII). • Cardiovascular changes: • Marked generalized vasodilation (↓ peripheral resistance) • a/w arterial resistance to constrictor actions of Angiotensin II. • ↑ CO & Stroke volume. • MAP ↓ by 10 mm Hg.

4. Physiologic adaptations in normal pregnancy • Renal changes: • Vasodilation ↑ Renal blood flow  ↑ GFR (by 50%). • ↑ in Creatinine clearance with a concomitant ↓ in S-Creatinine & urea. • ↑ Uric acid clearance & Ca+ excretion. • ↑ Glucosuria + aminoaciduria. • Respiratory changes. • Endocrine changes: • e.g. parathyroid, adrenal, weight, GI changes.

5. Definitions related hypertensive disorders in pregnancy

6. In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: • Chronic hypertension • Gestational hypertension • Preeclampsia • Preeclampsia superimposed on chronic hypertension

7. Severe complications Hypertension in Pregnancy MATERNAL • CVA • DIC • End-organ failure • Placental abruption FETAL • IUGR, Intra Uterine Growth Restriction • Prematurity • Intra-uterine death

8. Differentiating Hypertensive in pregnant

9. Assesment of proteinuria

10. Reducing the risk hypertensive disorders in pregnancy

11. Moderate to high Risk Preeclamsia

12. Pre-eclampsia

13. Pre-eclampsia

14. Pre-eclampsia

15. Pre-eclampsia

16. Chronic hypertension X

17. Chronic hypertension

18. Chronic hypertension

19. Chronic hypertension

20. Gestasional Hypertension

21. Gestasional Hypertension

22. Gestasional Hypertension

23. Gestasional Hypertension

24. Gestasional Hypertension

25. Gestasional Hypertension

26. Severe Hypertension,severe pre-eclamsia and eclamsia

27. Severe Hypertension,severe pre-eclamsia and eclamsia

28. Severe Hypertension,severe pre-eclamsia and eclamsia

29. Drugs • A)Parentral drugs: • 1) Hydralazine: • It is a peripheral VD. • The best Antihypertensive drug used during Pre-eclampsia and Eclampsia. • Dose: 5-10mg IV or IM as initial dose. • Repeated every 20-30 minutes until blood pressure is controlled.

30. Drugs • 2) Labetalol: • α and non selective β- adrenergic blocker resulting in VD. • Dose: 10-20mg IV . • The dose can be doubled every 10 minutes if proper response is not achieved. • 3) Diaz oxide : • Used in severe dangerous resistant hypertension as a last resort. • Dose: 50-150mg IV bolus dose. • Repeated every 1-2 minutes until BP decreases.

31. Drugs • A )Oral drugs: 1) α-methyl DOPA : • It is the most commonly used. • It is α-adrenergic agonist causing depletion of catecholamine stores. • Dose: 500mg 3-4 times/day orally. 2) Monohydralazine : • It is a weak Antihypertensive when given alone. • It used in combination with β- blockers to increase its efficacy and decrease its side effects.

32. Drugs • 3) β- adrenergic blockers: • Atenolol (tenormin) 50-100mg 4 times daily. • Labetalol (Trandate) 10-20mg 3 times daily. • 4) Prazocin : • It is postsynaptic α-adrenergic receptor blocker resulting in VD and reflex tachycardia. • It is a weak Antihypertensive drug so used in combination with other drugs. • 5) Calcium Channel Blocker: • Nifedipine .

33. Dr. Djumikan / PD III, Prof DR Koento Wibisono Rektor UNS Prof dr Soetjipto Dekan FK UNS, Dr Sujarsono PD I, Dr Muhardjo PD II Selamat kepada adik adik angk 180