79 Hypertensive Disorders in Pregnancy

Annennette 08/11/18

79.1 Preeclampsia

Ususally mothers present with severe preeclampsia

Severe HTN (>160/110)
Fits (eclampsia)
HELLP (Haemolysis, Elevated Liver Enzymes, Low Platelets)
Other: Headache, Epigastric Pain, Difficulty Breath, Visual Disturbances

In East African setting the majority of preeclampsia mums are multiparous

79.1.1 Management

Admit to preeclampsia unit (either to observe or plan delivery)
Treat with anti-hypertensives (mild: oral nifedipine or aldomet, severe: hydralazine, nifepine, labetalol - labetalol is way more expensive than hydralazine)
Prevent/Treat Fits with MgSO4 (IV/IM)
Plan delivery
Manage complications

Treat hypertension when >140/90 (severe >160/110)

79.1.2 Complications

79.1.2.1 Maternal

Death (biggest contributor to maternal death when you start to control bleeding)
Fits
Stroke
Bleeding (mainly cos of abruption of placenta)
AKI
Pulm Oedema

These complications don’t finish at time of delivery. Women can remain HTN for another 3 months after delivery

79.1.2.2 Foetal

Death
Prematurity (particularly this one)
Growth Restriction
Foetal distress
Birth Asphyxia

These neonates end up with low birth weigh and born preterm. Significant rates of foetal/early neonatal death (~20% in a high resource setting in Uganda)

79.1.3 Challenges

Delayed presentation so present w late disease
Patients understanding, myths, misconceptions
Poor antenatal attendance
Lack of counselling
Low contraceptive use
Drug dosing/Availability of effective drugs