Hypertension in Pregnancy - Department of Family and Preventive ...课件.ppt

Hypertension in Pregnancy OBJECTIVES Know criteria for the diagnosis of chronic hypertension, gestational hypertension and preeclampsia List criteria for the diagnosis of severe preeclampsia/HELLP syndrome Discuss current management considerations Introduction Most common medical complication of pregnancy 6 to 8 % of gestations in the US. In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: Chronic hypertension Gestational hypertension Preeclampsia Preeclampsia superimposed on chronic hypertension Chronic Hypertension Defined BP measurement of 140/90 mm Hg or more on two occasions Before 20 weeks of gestation OR Persisting beyond 12 weeks postpartum Chronic Hypertension Treatment of mild to moderate chronic hypertension neither benefits the fetus nor prevents preeclampsia. Excessively lowering blood pressure may result in decreased placental perfusion and adverse perinatal outcomes. When BP is 150 to 180/100 to 110 mm Hg, pharmacologic treatment is needed to prevent maternal end-organ damage. Treatment of Chronic Hypertension Methyldopa , labetalol, and nifedipine most common oral agents. AVOID: ACEI and ARBs, atenolol, thiazide diuretics Women in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine. Gestational Hypertension Formerly called PIH (Pregnancy Induced HTN) HTN without proteinuria occurring after 20 weeks gestation and returning to normal within 12 weeks after delivery. 50% of women diagnosed with gestational hypertension between 24 and 35 weeks develop preeclampsia. Older Criteria for Gestational HTN 30/15 increase in BP over baseline levels No longer appropriate 73% of patients will exceed 30 mm systolic and 57% will exceed 20 mm diastolic Preeclampsia New onset hypertension with proteinuria after 20 weeks gestation. Resolves by 6 weeks postpartum. Characterized