PREGNANCY INDUCED

HYPERTENSION – PIH
The term “pregnancy induced hypertension (PIH)” is
defined as the hypertension that develops as a direct result
of a gravid state. It includes
• Pre-eclampsia
• Eclampsia - Pre eclampsia complicated with
seizures and / or coma
• Gestational hypertension – B P greater than 140/90
mm hg or more for the first time in pregnancy after 20
weeks , without proteinuria
 DEFINITION
•Preeclampsia is a multiple system disorder of unknown
etiology characterized by development of hypertension to the
extent of 140/90 mm hg or more with proteinuria after 20th
week in a previously normotensive and non-proteinuric
woman.
DIAGNOSTIC CRITERIA OF
PREECLAMPSIA

EDEMA
RISK
FACTORS
 Primigravida
 Family history
 Placental
abnormalities
 Obesity
 Pre-existing
vascular disease
 Thrombophilias
 CLINICAL TYPES
PRE-ECLAMPSIA
MILD
 Diastolic BP is above 90 mm
hg but less than 110 mm hg.
 Systolic BP is 30 mm hg above
the pregnancy reading in
early pregnancy.
 The mean arterial pressure
exceeds 105 mm hg.
SEVERE
 Systolic BP more than 160mm hg
or diastolic more than 110 mm hg.
 Proteinuria > 5 gm/24 hours.
 Oliguria < 400 ml/24 hours.
 Platelet count < 100000 / mm3.
 HELLP syndrome.
 Cerebral or visual disturbances.
 IUGR
 CLINICAL FEATURES

PRE-ECLAMPSIA

WARNING SIGNS SIGNS

 Severe headache or blurred vision

 Nausea or vomiting  Abnormal weight gain
 Dizziness or double vision  Raise blood pressure
 Excessive swelling of the hands or feet  Oedema
 Decreased frequency of urination
 Rapid pulse
 Pulmonary oedema

MILD SYMPTOMS ALARMING SYMPTOMS

 Headache
 Slight swelling over the ankles.  Diminished urine output.
 Swelling may extend to face,  Disturbed sleep.
abdominal wall, vulva and even  Epigastric pain.
the whole body.  Eye symptoms
 Blurring vision
INVESTIGATIO
N
CONT….
.
 COMPLICATIONS
IMMEDIATE
Maternal complication during pregnancy
 Eclampsia
 Accidental hemorrhage
 Oliguria and anuria
 Preterm labour
 HELLP syndrome
 Dimness of vision and even blindness
 Cerebral hemorrhage
 Acute respiratory distress syndrome
(ARDS)
 CONT….
.
During labour
 Eclampsia
 Postpartum hemorrhage
Puerperium
 Eclampsia Remote complications
 Shock  Recurrent pre-eclampsia
 Sepsis.
Fetal complications  Chronic renal disease
 Intrauterine death  Placental abruption
 Asphyxia
 Prematurity
 IUGR
 SCREENING TESTS

 Doppler ultrasound
 Presence of diastolic notch at 24 weeks gestation.
 Absence of end diastolic frequencies.
 Average mean arterial pressure (MAP) in second
trimester more than 90 mm hg.
PROPHYLACTIC MEASURES
 Regular antenatal check-up - To detect rapid weight
gain / rise in BP
 Antithrombotic agents – Low dose Aspirin ( 60 mg )
 Heparin
 Calcium supplementation (2 gms per day).
 Antioxidants, vitamins E, C, and nutritional
supplementation with magnesium, zinc, fish oil and
low salt diet.
 Balanced diet. – Rich in Protein
 MANAGEMENT
Objectives
 To stabilize the hypertension and to prevent severe
pre-eclampsia.
 To prevent the complications.
 To prevent eclampsia.
 Delivery of a healthy baby in optimal time.
 Restoration of the health of the mother in
Puerperium.
 HOSPITAL MANAGEMENT
• REST
- Left Lateral Position

DIET

- Adequate amount of
daily protein ( about 100
gm )
 CONT….
 DIURETICS
.
Furosemide ( Lasix )
40 mg

ANTIHYPERTENSIVE

DRUGS
Commonly Used Drugs In The Management Of Pre
Eclampsia
DRUG DOSE

METHYLDOPA 250 – 500 mg tid or qid

LABETOLOL 100 mg tid or qid

NIFEDIPINE 10 – 20 mg bid

HYDRALAZINE 10 – 25 mg bid
Antihypertensive crisis
The following drugs can be used when the BP is more than 160/110
mm hg or the MAP is more than 125 mm hg :
DRUGS DOSE SCHEDULE MAXIMUM DOSE MAINTAINANCE DOSE

LABETALOL 10-20 mg, IV every 300 mg, IV 40 mg/hour

10 min

HYDRALAZINE 5 mg, IV every 30 30 mg, IV 10 mg/ hour

min
NIFEDIPINE 10-20 mg, orally, 240 mg/ 24 hour 4-6 hour interval
can be repeated in
30 min

NITROGLYCERIN 5 µg/ min IV Short term therapy only when the other
drugs
SODIUM 0.25-5 µg/kg/min have failed.
NITROPRUSSIDE IV
 MANAGEMENT

METHODS OF
DELIVERY

INDUCTION OF
LABOUR

GROUP-
B

I
CESAREAN SECTION
CAESAREAN
SECTION
Management during labour

 Progress of labour recorded in partograph.

 Abdominal and vaginal examination at regular

intervals.

 Bed rest in first stage of labour.

 Cut short the second stage of labour

HELLP SYNDROME
 This is an acronym for haemolysis, elevated liver enzymes
and low platelet count (< 100000 mm3).
 This is rare complications in pre-eclampsia.
 HELLP syndrome are developed even without maternal
hypertension.
 The symptoms are nausea, vomiting, Epigastric pain, right
upper quadrant pain along with biochemical and
hematological changes.
 Antiseizure prophylaxis with magnesium sulphate
(MgSO4) are started.

 Anticorticosteroids administered to improve the perineal and

maternal outcome.
 Caesarean section are common mode of delivery.
 Epidural anaesthesia can be used very safely if platelet
count more than 100000 /mm3.
 Platelet transfusion if count less than 50,000/mm3.
 Recurrent risk of HELLP syndrome 3-19 %.
 Abruptio placentae
 Cerebral oedema
 Pulmonary oedema
 Laryngeal oedema
 ARDS
 Sepsis
 Acute renal failure
 Severe ascites
 Retinal detachment
 Subcapsular hematoma
 Death