Notes by Prof.Dr.

Nasima Akter Ma’am

Head of the Department, Gynae and Obs

Southern Medical College & Hospital

Hypertensive Disorder in pregnancy

HTN is one of the common medical disorder which complicates the pregnancy & responsible for
increased maternal perinatal mortality & morbidity.

Classification:

1) Pregnancy induced HTN(PIH)

Cause-
 Gestational HTN
 Pre-eclampsia
 Eclampsia
 Proteinuria
 Oedema
2) Chronic HTN
Cause-
 Essential HTN
 Chronic Renal Disease
 Thyrotoxicosis
 SLE etc.
3) Superimposed Chronic HTN + Pre-eclampsia or eclampsia

♣Pre-Eclampsia:

It is a multisystem disorder of unknown aetiology characterized by development of

HTN to the extent of 140/90 mmHg or more with proteinuria after the 20 week of gestation in a
previously normotensive & nonproteinuric women.

►Incidence: 5 to 10%

 Primigravidae 10%
 Multigravidae 5%

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►Risk Factor:

 Age Young and elderly

 Para More in primi and grand multipara
 Family history of HTN
 Obesity
 Antiphospholipid Antibody Syndrome (APAS)
 Preexisting vascular Disease
 Hyper placentosis In multiple pregnancy, Molar pregnancy & DM etc.
►Pathophysiology:

a) In Normal Pregnancy:
 Circulating pressor Agent (angiotensin-II)
 Sensitivity to pressor agent
 Production of angiotensinogen enzyme by placenta ANG II
 Vasodilatation (PG,NO,I2 )
b) In Pre-Eclampsia:
 Pressor Agent, Sensitivity, Vasoconstriction PG,Thromboxane A2
 Inflammatory mediator, Cytokine, interleukin.

Ultimately Causes:
1. Intense Vasospasm ***
2. Endothelial Dysfunction***

That leads to rise of BP, Proteinuria & other pathological change into mothers body.

Types:
1. Mild to severe:
Sustained rise of BP 140/90mmhg more(but less than 160/110)without significant
proteinuria.
2. Severe pre eclampsia:
 Persistent rise of BP>160/110
 Significant proteinuria
 Oliguria(<400ml/day)
 Headache
 Epigastric pain
 Elevated liver enzymes
 Low platelet
 Visual disturbance
 IUGR(intrauterine growth of the fetus)
 Serum creatinine

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  Pulmonary oedema

 Why oedema??
Ans:
1. Vasospasm endothelial injury Permeability
2. Osmotic pressure (due to proteinuria)

 Why Proteinuria??
Ans:
Spasm of afferent arteriole glomerular endotheliosis Capillary permeability
leakage of protein

S/S: Nausea, vomiting, right upper quadrant pain,

H E L L P Syndrome epigastric pain, jaundice.
Hemolysis
Investigations:
ss
Elevated liver Low platelet
Anemia
enzymes
Increased liver enzymes
Low platelet count USG: Sub capsular hematoma (liver
rupture may happen)
Management: Terminations of pregnancy

Diagnosis:
Patient profile-

 Too younger or elderly

 Primi

History of - DM, multiple pregnancy, polyhydramnios

 appear after 20 weeks

Symptom:

May remain asymptomatic

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  Mild case:
1. Slight oedema over ankle rising from bed which later on spread
2. Tightness of ring on finger
 Severe alarming symptom:
1. Headache
2. Sleep disturbance
3. Blurring of vision
4. Visual disturbance
5. Epigastric pain
6. Vomiting
7. Oliguria(<400/day)

Sign:

1. Abnormal weight gain>4kg/month (4lb/week)

2. Rise of BP: Usually slowly after 20 weeks may causes sudden rise also diastolic rise
appear first.
3. Oedema: When it present after rising from bed -pathological

In severe case: Sign of pulmonary oedema

P/A:

 SFH
 Oligohydramnios-due to each placenta insufficiency.

(Weight gain HTN oedema Proteinuria)

Investigations:

 Urine :24 hours urinary protein

Mild -3mg/litre
Severe-(10-15gm/litre)
 Blood: Blood urea, serum creatinine, liver enzymes

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