PREGNANCY AND HYPERTENSION

DR MOHAMMED ALMOGAHED M.D

REMEMBER THAT A HEALTHY FETUS DEPENDS ON A HEALTHY MOTHER

Hypertension is a common medical problem during pregnancy, with a prevalence of 6 to 8%. It is diagnosed when blood pressure is greater than 140/90 mm Hg measured with the patient in the sitting position on two occasions

During a normal pregnancy, blood pressure declines during the first and second trimesters and rises to prepregnancy levels near term

Hypertension during pregnancy can be classified as 1- chronic hypertension(prepregnancy HTN) 2-preeclampsia 3-gestational hypertension or nonproteinuric hypertension of pregnancy 4- chronic hypertension plus preeclampsia 5-antenatal unclassifiable hypertension

Chronic hypertention Present in 1 to 5% of pregnant women.most cases are due to essential HTN.for the Unusual individual with secondry HTN (CTD,aortic coarctation,intrinsic renal disease,renal artery stenosis, and cushings disease)

gestational hypertension(GH) Is hypertension that develops any time during pregnanacy without protein in urine (nonproteinuric HTN of pregnancy) (GH)resolves by 3 months postpartum,and HTN often normalizes within 2 weeks of delivery

Preeclampsia Can occur any time after 20 weeks of gestation and up to 6 weeks postpartum

TREATMENT

Chronic hypertensin
Women with preexisting HTN the usual Blood pressure decrease during the First trimester often allows discontinuti On of antihypertensive drugs.BP Can be monitored and medications Reinstituted if needed

Chronic HTN newly diagnosed during Pregnancy can be differentiated from Transient gestational HTN in that the Former persists more than 3 months postpartum

European heart association guidline 2011 1-SBP 140-150mmHg DBP 90-99 mmHg Non pharmacological management 2-SBP >170 mmHg
Emergency hospitalisation Pre-eclampsia associated with pulmonary oedema Infusion i/v nitroglycerene

3-In severe HTN drug treatment with i/v labetolol Or methyldopa or nifidepine tablet

4-With continued pre-pregnancy HTN Pre-pregnancy medication to be continued (angiotensin converting enzyme-ACE-and Angiotensin receptor blockers-ARB-and Direct renin inhibitors are strictly contraindicated

5-For delivery(in gestational HTN) with Proteinuria with adverse condition

induction

Gestational HTN Transient gestational HTN is treated with Bed rest,close monitoring of the mother and fetus.when to initiate antihypertensive drugs Is controversial.many authorities Recommend drug therapy when the blood Pressure exceeds 140/90 mmhg

METHYLDOPA (CENTRAL SYMPATHOLYTIC)

Reduces vascular resistance while preservIng maternal cardiac output and uteroplacen tal perfusion.considered safe to use when Breast feeding Dose 250mg 2-3times/day can be as Needed (maximum dose 3g)
DOSAGE FORMS(tablet 125Mg-250Mg-500Mg)ingection 50Mg/ML

CLONIDINE (CENTRAL SYMPATHOLYTIC)

Dose 0.1mg 1-2 times/day Onset of action:oral 0.5-1hour Duration:6-10 hours (do not discontinue clonidine abruptly because risk of rebound HTN.if need decrease gradually)
DOSAGE FORMS(TABLET 0.1Mg-0.2Mg-0.3mg)ingection 100mcg/ml

LABETALOL(ALPHA AND BETA BLOCKERS)

Used in several trials without adverse effects -blocking results in vasodilation including Uteroplacental blood vessels.and-blockade Prevents reflex tachycardia.cardiac output is Unchanged.low concentration in breast milk

LABETALOL(ALPHA AND BETA BLOCKERS)

Dose 100mg twice daily,may increase as Needed every 2-3days by 100mg until Desired response is obtained(maximum 2g) Onset of action:oral:20 min-2hours. i/v 2-5 min
DOSAGE FORMS(TABLET 100Mg-200Mg-300mg) ingection 5mg/ml

-blockers Probably safe for third-trimester use,but Neonatal bradycardia,respiratory distress, And hypoglycemia have been reported. Use earlier in gestation may result in intraUterine grouth retardation.atenolol and meto Prolol are concentrated in breast milk Propranolol has low concentrated in breast milk

Atenolol tablet 25-100mg 1-2/day Metoprolol tablet 50-100mg 1-2/day Pindolol tablet 5-10mg twice/day as Necessary every3-4 weeks maximum dose 60mg Propranolol tablet 20-40mg twice dailydose As necessary every3-7days Maximum dose <320mg

Hydralazine (direct arterial vasodilator) Extensively used during pregnancy.it causes Vascular dilation and reflex tachycardia Primarily used parenterallay for acute manaGement of HTN or with methyldopa or -blocking agent Dose 10-20mg i/v every4-6h,change to oral Therapy as soon as possible(max.dose 250mg)
DOSAGE FORMS(TABLET 10Mg-25Mg-50Mg-100Mg)ingection 20mg/ml

NIFEDIPINE(calcium-channel blockers)
Probably safely used in the third trimester Their use maintains uteroplacental perfusion May also have tocolytic effect.S/L associated With hypotension and fetal distress.avoid use With magnesium sulfate because combination Risks profound hypotension Dose 10-30mg 3 times/day(capsules) 30-60mg once daily as sustained release tablet

DIURETICS
Use during pregnancy is controversial and Often discontinued as blood pressure decrease early in pregnancy Concentrations in breast milk are low.may Reduce milk production

Angiotensin-converting enzyme inhibitors And angiotensin receptor blockers Contraindication.it affects renal development In the second and third trimesters.miscarriage
Fetal death,malformations, and neonatal renal Failure can be result.

THANK YOU