文档介绍：Hypertension in Pregnancy
District I ACOG Medical Student Education Module 2011
Etiology & Definition
Complicates 10-20% of pregnancies
Elevation of BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, on two occasions at least 6 hours apart.
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Categories
Chronic Hypertension
Gestational Hypertension
Preeclampsia
Preeclampsia superimposed on Chronic Hypertension
Chronic Hypertension
“Preexisting Hypertension”
Definition
Systolic pressure ≥ 140 mmHg, diastolic pressure ≥90 mmHg, or both.
Presents before 20th week of pregnancy or persists longer then 12 weeks postpartum.
Causes
Primary = “Essential Hypertension”
Secondary = Result of other medical condition (ie: renal disease)
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.
Treatment for Chronic Hypertension
Avoid treatment in women with uncomplicated mild essential HTN as blood pressure may decrease as pregnancy progresses.
May taper or discontinue meds for women with blood pressures less than 120/80 in 1st trimester.
Reinstitute or initiate therapy for persistent diastolic pressures >95 mmHg, systolic pressures >150 mmHg, or signs of hypertensive end-organ damage.
Medication choices = Oral methyldopa and labetalol.
Preeclampsia
Definition = New onset of hypertension and proteinuria after 20 weeks gestation.
Systolic blood pressure ≥140 mmHg OR diastolic blood pressure ≥90 mmHg
Proteinuria of g or greater in a 24-hour urine specimen
Preeclampsia before 20 weeks, think MOLAR PREGNANCY!
Categories
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