ESSENTIAL HYPERTENSION

CLASSIFICATION
According to Severity:
A] Mild
B] Severe (>160/110)

MATERNAL RISK
Superimposed PET.
Abruptio.
Cerebral hemorrhage
Exacerbation of HTN
Renal failure
Congestive heart
failure.

FETAL RISK
IUGR.
IUFD.
Prematurity.
PNMM directly related
to HTN severity.

According to Complications
A] Uncomplicated
B] Complicated. Any of the following:
Cardiomyopathy; Age >40; Duration of HTN >15yrs; Renal disease; DM,
CT disease or coarctation of aorta; Previous hx of perinatal loss.
MANAGEMENT
PRENATAL
ANTENATAL
DURING LABOR
POSTNATAL
Assess cause & severity.
Mild uncomplicated HTN, stop drugs &
Observe BP.
Observe BP esp 48h
Look for risk factors.
observe 3months. If BP stayed mild,
Strict fluid control.
postpartum.
Review drugs.
dont give drugs.
Continue AHD if taking Observe for pulm edema.
Establish baseline CBC,
If BP >160/110, give drugs.
them.
Observe for hypertensive
urine analysis, 24h urine
Observe fetal growth (IUGR/IUFD)
Continuous fetal heart
encephalopathy.
collection test, KFT, Echo,
Observe maternal condition.
monitoring.
Reassess cardiac & renal
ECG, CXR.
No indication to induce labor before
f(x).
41wks.
CARDIAC DISEASES
Predictors (NYHA Functional Classification) #
Risk of
Complicates 1% of pregnancies.
predictors complications
Complications during pregnancy: HF,
Cardiac dysf(x) EF>60 or <40
0 3%
arrhythmia, stroke & death.
1 30%
Presence of pulm HTN
Assessment before pregnancy is essential.
2 60%
Presence of cyanosis (low Hb saturation)
Can be congenital, rheumatic & ischemic.
Presence of aortic or mitral valve stenosis
Hx of CHF, arrhythmia or TIA
MANAGEMENT
PRENATAL
ANTENATAL
DURING LABOR
Classify patients (predictors of
Monitor signs & sx of HF.
Avoid pain coz pain EF acute HF. Avoid
complications).
Serial Echo.
hypotension.
Investigations.
Serial fetal monitoring.
Left lateral position with oxygen mask.
Review drugs.
Continuous saturation monitoring.

Give predictions (safe to go thru

pregnancy?)

Shorten 2nd stage labor (instrumental?).

Prophylactic antibiotics.
Careful fluid therapy. Continuous CTG. Continuous
ECG.

HYPERTHYROIDISM
OVERVIEW
MANAGEMENT
95% cases due to Graves. 50% have +ve family hx.
Carbimazole & PTU are most commonly used drugs.
Clinical picture similar to non-pregnant.
Both cross placenta, to a lesser extent does PTU, so even in
Most discriminatory features in pregnancy are weight
moderate doses may cause fetal hypothyroidism.
loss, tremor & lid lag.
Both not teratogenic.
Thryotoxicosis usually improves in pregnancy as other
blockers used in thyroid crisis. Thyroidectomy rarely
autoimmune.
indicated in pregnancy.
Exacerbations may occur esp in 1st trimester ( subunit
Radioiodine contraindicated in pregnancy (also 4months
of hCG resembles TSH)
before) & during lactation.
Thyrotoxicosis associated with infertility, recurrent
Check for neonatal & fetal thyrotoxicosis.
pregnancy loss, IUGR, preterm labor, higher PNMM.
HYPOTHYROIDISM
OVERVIEW
MANAGEMENT
Commoner than thyrotoxicosis. Associated with other autoimmune like DM & pernicious
Thyroxine supplements are the
anemia.
only replacement therapy.
Clinical picture similar to non-pregnant.
Crosses placenta but only very
Most discriminatory feature are cold intolerance, slow pulse & delayed relax of tendon
little amount will reach fetus, so
reflexes.
fetus not at risk of dev
Pregnancy itself has no effect on hypothyroidism.
hyperthyroidism.
Associated with infertility, miscarriages, anemia, fetal loss, IUGR & PET.
Association b/w untreated hypothyroidism & reuced IQ & neurodev delay in offspring.
EPILEPSY
OVERVIEW
MANAGEMENT
Most cases are idiopathic and no underlying cause.
The lowest effective dose. Try with 1 drug & give full dose of folic
30% familial.
acid 5mg.
All types of seizures can occur in pregnancy.
Try stopping AED, if she is fit free for >2yrs.
Most AED are teratogenic.
Detailed anomaly scan at around 2owk gestation.
In majority of cases, frequency of seizure are not
Vit K supplement for the last 4wks of pregnancy for pts taking
altered by pregnancy.
valproic acid.
Risk of seizures are highest in peripertum period.
Avoid pain & long course of labor.
5-10% risk of transmitting epilepsy.
Major malformations caused by AED are NTD, orofacial defects &
The fetus is relatively resistant to short episodes of
congenital heart defects.
hypoxia.
Minor malformations are dysmorphic features, hypertelorism,

hypoplastic nails & digits.