GESTATIONAL HYPERTENSION

A sustained rise of B.P to 140/90 mm of Hg or more on at least two occasions

4 or more hours apart beyond the 20 th week of pregnancy or during the first
24 hours after delivery in a previously hormotensive woman is called
Gestational Hypertension .

It is associated with a much higher incidence of essential hypertension in later

life than pre eclampsia (Pre-ecalmpsia)

It should fulfill the following criteria,

1) Absence of any evidences for the underlying cause of hypertension
2) Unassociated with other evidences of pre eclampsia.
3) Majority of cases are, > 37 wks pregnancy
4) Not associated with haemoconcentration, thrombocytopenia, raised
serum uric acid level or hepatic dysfunction.
5) The BP should come down to N within 6 wks following delivery.

 The hypertensive effect may be a stress response

 These patients are more likely to develop the hypertension with the use
of oral contraceptives or in subsequent pregnancies.
 Gestational hypertension is not associated with oedema, proteinuria or
or other haematological changes.
 Blood pressure usually subsides within 12 wks following delivery.
 Chronic Hypertension in Pregnancy
Chronic hypertensive disease (CHD) is defined as the presence of
hypertension of any cause antedating or before the 20th wks of pregnancy and
its presence beyond the 12 wks after delivery.

The condition poses a difficult problems as regards the diagnosis and

management when seen for the first time, beyond the 20th wks of pregnancy.

Incidence is 2-4% of which 90% are due to essential hypertension

High Risks factors for CHD are ,

1) Age (> 40 yrs)
2) Duration of Hypertension (>15 yrs )
3) Level of BP (>160 / 110 mm of Hg)
4) Presence of any medical disorders
5) Presence of thrombophilias.

Essential Hypertension in Pregnancy

Essential hypertension is the common hypertensive state in pregnancy .
Its incidence varies from 1-3%

Diagnosis :
The diagnostic criteria are
1) Rise of BP to the extent of 140/90 mm Hg
2) Cardiac enlargement on chest radiograph and ECG
3) Presence of Medical disorder
 4) Prospective follow up shows persistent rise of BP even after 42 days
following delivery

Effects of disease on Pregnancy :

1) Maternal Risk : In milder form the risk remains unaltered but in severe
form the risk is increased
2) Fetal Risk : Growth retardation and preterm babies are risk factors .

Management

General Obstetric
In mild cases In mild cases spontaneous labour is
Rx – adequate rest awaited
Low salt diet In severe or complicated cases the
In severe cases aim is to try to continue pregnancy to
Pt. is hospitalized at least 34 wks otherwise upto 37th
week to attain fetal maturity and
them to terminate the pregnancy.