HYPERTENSION IN

PREGNANCY
PRESENTER:
Khairah binti Mohd Khalid
Raymond Ng
Zatu

SUPERVISOR: Dr Azureen
DEFINITION
HYPERTENSION Systolic BP >140 & Diastolic BP > 90

SEVERE HYPERTENSION Systolic BP > 160 & Diastolic BP > 110

CHRONIC HYPERTENSION Hypertension that is present at the booking visit, or before 20 weeks, or if the woman is
already taking antihypertensive medication when referred to maternity services

GESTATIONAL New hypertension presenting after 20 weeks of pregnancy without significant proteinuria.
HYPERTENSION

PRE-ECLAMPSIA New hypertension presenting after 20 weeks gestation with significant proteinuria

SEVERE PRE-ECLAMPSIA Pre-eclampsia with severe hypertension that does not respond to treatment
or
Associated with symptoms of IE with deterioration in lab test or failure of fetal growth or
abnormal doppler finding

ECLAMPSIA A convulsive condition associated with pre-eclampsia.

CLASSIFICATION

MILD HYPERTENSION MODERATE HYPERTENSION SEVERE HYPERTENSION

Systolic BP 140–149 mmHg Systolic BP 150–159 mmHg Systolic BP >160 mmHg

Diastolic BP: 90–99 mmHg Diastolic BP 100-109mmHg Diastolic BP >110 mmHg

According to NICE guideline

RISK FACTORS
HIGH RISKS WOMEN:

• Hypertensive disease during a previous pregnancy

• Chronic kidney disease
• Autoimmune disease such as Systemic Lupus Erythematosis or Antiphospholipid
Syndrome
• Diabetes Mellitus Type I or II
• Chronic hypertension.

* Advise women at high risk of pre-eclampsia to take

75 mg of aspirin daily
from 12 weeks until the baby born
MODERATE RISK:

• FIrst pregnancy
• Age 40 years or older
• Pregnancy interval of more than 10 years
• Body mass index (BMI) of 35 kg/m2 or more at first visit
• Family history of pre-eclampsia
• Multiple pregnancy.

*Advise women with more than one moderate risk factors

take 75 mg of aspirin daily
from 12 weeks until the birth of the baby.
CLINICAL PICTURES OF PRE ECLAMPSIA
1. Severe headache
2. Blurring of vision or flashing before the eyes
3. Severe pain just below the ribs
(due to hepatic swelling and inflammation, with stretch of the liver capsule).
1. Epigastric tenderness
2. Vomitting
3. Swelling of the face, hands or feet.
PRE PREGNANCY ADVICE (DO & DONT)
1. NUTRITIONAL SUPPLEMENT
• Avoid taking magnesium, folic acid, antioxidant (Vit C /E), fish oil or garlic
supplement
2. DIET
• Salt restriction, encourage high calcium intake
• Advice to maintain BMI 18.5-24.9 kg/m2
3. LIFESTYLE
• Advice to eat more, exercise more & work
• Avoid smoking
4. MEDICATIONS
• Progesterone, diuretics or low molecular weight heparin
ASSESSMENT OF PROTEINURIA
METHOD :

1. Automated reagent-strip reading device (Urine disptick screening)

2. Spot urinary protein (urine biochem )
3. Protein : Creatinine ratio
4. 24 hours urine protein
=> *for estimating proteinuria in a secondary care setting.

RESULT

If urine dipstick +1 or more -> then use Protein : Creatinine ratio to quantify
the proteinuria in pregnant women
-> significant proteinuria : 30mg/mmol
HEMATO & BIOCHEMICAL MONITORING
(PE PROFILE)

FBC HELLP Syndrome, hemolysis, thrombocypenia

Coagulation Profile Can be deranged due to liver dysfunction &
thrombocytopenia
Liver Functiuon Elevated liver enzyme, low albumin, bilirubin raised
Test (LFT) (HELLP syndrome))
Renal Profile (RP) Elevated urea, serum creatinine (indicate reanl
involvement)
Uric Acid
FETAL MONITORING
INDICATION:
1. At diagnosis of severe gestational hypertension or pre-eclampsia
2. Repeat CTG if patient complaint of
CARDIOTOCOGRAPHY ○ Change in fetal movement
○ vaginal bleeding
○ abdominal pain
○ deterioration of maternal condition

Ultrasound
ULTRASOUND & DOPPLER
Monitor fetal growth paramenters & Amniotic fluid index & repeat every 2 weeks
Doppler
Between 28-30 weeks gestational age & repeat 4 weeks later
Women who need additional fetal monitoring

1. Severe pre-eclampsia
2. Pre-eclampsia that resulted in birth before 34 week
3. Pre-eclampsia with a baby birth weight less than 10th centile
4. Intrauterine death
5. Placental abruption