GESTATIONAL HYPERTENSION PREECLAMPSIA ESTATIONAL HYPERTENSION PREECLAMPSIA Dr PAUL GLEASON 14.pptVIP

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GESTATIONAL HYPERTENSION PREECLAMPSIA ESTATIONAL HYPERTENSION PREECLAMPSIA Dr PAUL GLEASON 14.ppt

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GESTATIONAL HYPERTENSION PREECLAMPSIA PAUL GLEASON, MD ST. JOHN’S RIVERSIDE HOSPITAL YONKERS, NEW YORK DEFINITIONS Gestational HTN (NHBPEP)- Previously normotensive - New onset HTN during pregnancy, without proteinuria - May include patients with un’Dx CHTN and those destined to develop preeclampsia - Return to normotensive by 3m post partum - Previously described as PIH or transient HTN DEFINITIONS Preeclampsia - Onset of HTN with proteinuria 20wk EGA Mild Severe Minimum criteria HELLP syndrome Eclampsia CHTN with Superimposed preeclampsia DEFINITIONS Mild Preeclampsia HypertensionBP= 140/90mmHg Proteinuria = 300mg/24hr or = +1 dipstick(30mg/dl) DEFINITIONS Severe PreeclampsiaBP = 160/110mmHgProteinuria = 2-5g/24hr or = +2/+3 dipstick Persistent headache, right upper quadrant/epigastric pain, nausea/vomiting (unless otherwise explained) Oliguria (500ml/24hr) and/or Serum creatinine 1.2mg/dl (unless previously elevated) Pulmonary edema IUGR, Oligohydramnios, NRFS, Fetal demise DEFINITIONS Severe Preeclampsia- HELLP (2-12% of preeclamptics) Microangiopathic hemolysis Elevated LDH (600U/L) Elevated total bilirubin (1.2mg/dL) Elevated AST/ALT (2x upper limit normal) Platelets 100,000mm3 (unless previously decreased)- Eclampsia Seizures that cannot be otherwise explained in patient with preeclampsia. PATHOPHYSIOLOGY Inadequate spiral artery invasion- Failed low pressure, low resistance, high flow Vasoconstriction- TXA2 : PGI2 imbalance Hemoconcentration Decreased intravascular volume Organ Ischemia Dysfunction - 25% GFR, IUGR Activation of coagulation system- Endothelial injury, platelet consumption OUTCOMES Dependent on - Gestational age at onset- Severity of condition- Gestation at delivery- Presence of comorbidity Risk Factors Nulliparity (3-7% vs 0.8-5%