Post on 04-Mar-2016
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HYPERTENSIVE DISORDERSHYPERTENSIVE DISORDERS
IN PREGNANCYIN PREGNANCYDR. SALWA NEYAZI
ASSISSTANT PROF KSU/ CONSULTANT OBGYN
PEDIATRIC & ADOLESCENT GYNECOLOGIST
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TYPES OF HYPERTENSIVE DISEASE INTYPES OF HYPERTENSIVE DISEASE IN
PREGNANCYPREGNANCY
1-Gestati!a" #$%ete!si!1-Gestati!a" #$%ete!si!
'-PET'-PET
(-E)"a*%sia(-E)"a*%sia
+-C#!i) #$%ete!si!+-C#!i) #$%ete!si!
,-PET s%ei*%se ! )#!i) #$%ete!si!,-PET s%ei*%se ! )#!i) #$%ete!si!
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11--Gestational hypertensionGestational hypertension
BP 1+0/0 ** 23 4 t#e 4ist ti*e i!3 %e3!a!)$BP 1+0/0 ** 23 4 t#e 4ist ti*e i!3 %e3!a!)$
N %tei!iaN %tei!ia
BP et!s t N 5 1' W6 %st%at*BP et!s t N 5 1' W6 %st%at*
Fi!a" D7 *ae !"$ %st%at*Fi!a" D7 *ae !"$ %st%at*
8a$ #a9e t#e si3!s 4 PET e3. 2eaa)#e: e%i3asti)8a$ #a9e t#e si3!s 4 PET e3. 2eaa)#e: e%i3asti)
is)*4t t#*;)$t%e!iais)*4t t#*;)$t%e!ia
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PETPET
ini!"! #riteriaini!"! #riteria
BP 1+0/0 ** 23 a4te '0 W6 3estati!BP 1+0/0 ** 23 a4te '0 W6 3estati!
Ptei!ia (00 *3/'+ #s 1Ptei!ia (00 *3/'+ #s 1++ i%sti)6i%sti)6
In#rease$ #ertainty o% PETIn#rease$ #ertainty o% PET
BP 1<0/110 ** 23BP 1<0/110 ** 23
Ptei!ia ' 3*/'+ #s 'Ptei!ia ' 3*/'+ #s '++ i%sti)6i%sti)6
Se* )eati!i!e = 1.' *3/" !"ess 6!>! t ;eSe* )eati!i!e = 1.' *3/" !"ess 6!>! t ;e
%e9is"$ e"e9ate%e9is"$ e"e9ate
P"ate"ets 5 100 000/**?P"ate"ets 5 100 000/**?
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In#rease$ #ertainty o% PETIn#rease$ #ertainty o% PET
8i)a!3i%at#i) #e*"$sis @i!)ease LD28i)a!3i%at#i) #e*"$sis @i!)ease LD2E"e9ate ALT ASTE"e9ate ALT AST
Pesista!t #eaa)#e t#e )ee;a"/ 9isa" ist;a!)ePesista!t #eaa)#e t#e )ee;a"/ 9isa" ist;a!)e
Pesista!t e%i3asti) %ai!Pesista!t e%i3asti) %ai!
EC&APSIAEC&APSIA
Sei'"res that #an not (e attri("te$ to other #a"ses inSei'"res that #an not (e attri("te$ to other #a"ses ina )o!an )ith PET* 1+ o% Pt )ith PET $e,elop ECa )o!an )ith PET* 1+ o% Pt )ith PET $e,elop EC
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CHRONIC HYPERTENSIONCHRONIC HYPERTENSION
BP BP 1+0/0 ** 23 ;e4e %e3!a!)$ D7 ;e4e '01+0/0 ** 23 ;e4e %e3!a!)$ D7 ;e4e '0
W6 3estati!W6 3estati!
2PT 4ist D7 a4te '0 W6 3estati! & %esista!t a4te 1'2PT 4ist D7 a4te '0 W6 3estati! & %esista!t a4te 1'
W6 %st%at*W6 %st%at*
PET SPERIPOSED ON CHRONIC HYPERTENSIONPET SPERIPOSED ON CHRONIC HYPERTENSION
Ne> !set %tei!ia (00 *3/'+ #s i! #$%ete!si9eNe> !set %tei!ia (00 *3/'+ #s i! #$%ete!si9e>*e! ;t ! %tei!ia ;e4e '0 W6 3estati!>*e! ;t ! %tei!ia ;e4e '0 W6 3estati!
A se! i!)ease i! %tei!ia BP A se! i!)ease i! %tei!ia BP
P"t )!t 5 100 000/ **?i! >*e! >it# 2PT &P"t )!t 5 100 000/ **?i! >*e! >it# 2PT &
%tei!ia ;e4e '0 W6 3estati!%tei!ia ;e4e '0 W6 3estati!
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INCIDENCE . RIS/ FACTORSINCIDENCE . RIS/ FACTORS
PET ))s i! <- 4 a"" "i9e ;it#PET ))s i! <- 4 a"" "i9e ;it#
RISK FACTORSRISK FACTORS
E7te*es 4 e%)ti9e a3eE7te*es 4 e%)ti9e a3e
1, 5 & =(, Y1, 5 & =(, Y
N""i%ait$N""i%ait$
B"a)6 a)eB"a)6 a)e27 4 PET i! a 127 4 PET i! a 1stst e3ee 4e*a"ee3ee 4e*a"e
e"ati9ee"ati9e
27 4 PET i! %i %e3!a!)$27 4 PET i! %i %e3!a!)$
D8D8
C#!i) e!a" iseaseC#!i) e!a" isease
C# 2PTC# 2PT
8"ti%"e %e3!a!)$8"ti%"e %e3!a!)$ t>i!s 1(t>i!s 1(
9s <9s <
2$atii4* *"e2$atii4* *"e
N!i**!e #$%s 4eta"isN!i**!e #$%s 4eta"isO;esit$O;esit$ +.(+.( B8I 5 1.B8I 5 1.
63/*63/*
1(.(1(.( B8I (,B8I (,
63/*63/*
S*6i!3S*6i!3 is6 4 2PT is6 4 2PT
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PATHOGENESISPATHOGENESIS
E!t#e"ia" )e"" i!$E!t#e"ia" )e"" i!$
%sta)$)"i! & t#*;7a!eA' %sta)$)"i! & t#*;7a!eA'
Ree)ti! %#e!*e!! @i!aeHate *ate!a" A; es%!seRee)ti! %#e!*e!! @i!aeHate *ate!a" A; es%!se
C*%*ise %"a)e!ta" %e4si!C*%*ise %"a)e!ta" %e4si!
A"tee 9as)"a ea)ti9it$ A"tee 9as)"a ea)ti9it$ se!siti9it$ t 9as%essi! EPN:se!siti9it$ t 9as%essi! EPN:
NEPN & a!3ite!si!NEPN & a!3ite!si! GFR >it# ete!ti! 4 sa"t & >ate GFR >it# ete!ti! 4 sa"t & >ate
i!ta9as)"a 9"*ei!ta9as)"a 9"*e
CNS iita;i"it$CNS iita;i"it$
DICDIC
Utei!e *s)"e stet)# & is)#e*iaUtei!e *s)"e stet)# & is)#e*ia
Dieta$ 4a)tsDieta$ 4a)ts
Ge!eti) 4a)tsGe!eti) 4a)ts
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PATHOGENESISPATHOGENESIS
S**a$ 4 )e!t #$%t#esisS**a$ 4 )e!t #$%t#esis
I**!"3i)a" ist;a!)eI**!"3i)a" ist;a!)e a;!*a" %"a)e!ta"a;!*a" %"a)e!ta"
i*%"a!tati!i*%"a!tati! %"a)e!ta" %e4si! %"a)e!ta" %e4si! %)ti! 4 %)ti! 4
s;sta!)es t#at a)ti9ate i!e e!t#e"ia" )e""s 4 t#es;sta!)es t#at a)ti9ate i!e e!t#e"ia" )e""s 4 t#e
;" 9esse"s;" 9esse"s *"ti%"e 3a! s$ste* i!9"9e*e!t*"ti%"e 3a! s$ste* i!9"9e*e!t
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PATHOPHYSIO&OGYPATHOPHYSIO&OGY
8ULTIPLE ORGAN SYSTE88ULTIPLE ORGAN SYSTE8
INJOLJ8ENTINJOLJ8ENT
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11--CNSCNS
Si*i"a t #$%ete!si9e e!)e%#a"%at#$Si*i"a t #$%ete!si9e e!)e%#a"%at#$
Pete)#ia" 23Pete)#ia" 23Gss #e*#a3es e t %te ateiesGss #e*#a3es e t %te ateies
T#*;sis 4 t#e atei"esT#*;sis 4 t#e atei"es
8i)i!4a)ts8i)i!4a)ts
Fi;i!i !e)sis i! t#e >a""s 4 ;" 9esse"sFi;i!i !e)sis i! t#e >a""s 4 ;" 9esse"s
Cee;a" ee*aCee;a" ee*a )!4si!: ;"e 9isi! / )*a)!4si!: ;"e 9isi! / )*a
Bai! ste* #e!iati! is a seis )*%"i)ati! 4 )ee;a"Bai! ste* #e!iati! is a seis )*%"i)ati! 4 )ee;a"
ee*aee*a eat#eat#
8EC2ANIS88EC2ANIS8 )ee;a" #$%e%e4si! :9ass%as*)ee;a" #$%e%e4si! :9ass%as*
&4)e i"ati!&4)e i"ati!
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11--CNSCNS
CT S)a!CT S)a! 4 t#e %t 4 t#e %t 4)a" #$%e!sities i! t#e >#ite4)a" #$%e!sities i! t#e >#ite
*atte / %st #a"4 4 t#e )ee;a" #e*is%#ee &*atte / %st #a"4 4 t#e )ee;a" #e*is%#ee &
))asi!a""$ i! t#e 3e$ *atte))asi!a""$ i! t#e 3e$ *atte *a$ e%ese!t %ete)#ia"*a$ e%ese!t %ete)#ia"
2323
Se9ee )asesSe9ee )ases IJ 23 s;aa)#!i 23IJ 23 s;aa)#!i 23
8RI8RI A;!*a"ities i! t#e )ti)a" & s;)ti)a" >#ite A;!*a"ities i! t#e )ti)a" & s;)ti)a" >#ite
*atte 4 t#e ))i%ita" & %aieta" aeas*atte 4 t#e ))i%ita" & %aieta" aeas
EEGEEG !!s%e)i4i) )#a!3es!!s%e)i4i) )#a!3es
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00--P&ONARY SYSTEP&ONARY SYSTE
P"*!a$ ee*aP"*!a$ ee*a
8a$ )) >it# se9e PET OR EC8a$ )) >it# se9e PET OR EC
Usa""$ %st%at*Usa""$ %st%at*
8a$ ;e e t e7)essi9e 4"i a*i!istati! >it#8a$ ;e e t e7)essi9e 4"i a*i!istati! >it#)$sta""is)$sta""is ++ %"as*a )""i %esse e t %"as*a )""i %esse e t
%tei!ia%tei!ia
i! Pt >it# )# 2PT & #$%ete!si9e )aia) iseasei! Pt >it# )# 2PT & #$%ete!si9e )aia) isease
As%iati! 4 3asti) )!te!t >it# EC As%iati! 4 3asti) )!te!t >it# EC
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-CVS-CVS
P"as*a 9"*e is e)e: t#e )ase is !6!>!P"as*a 9"*e is e)e: t#e )ase is !6!>! t#eiest#eies
1-Ge!ea"ie 9as)!sti)ti! >it# 9as)"a1-Ge!ea"ie 9as)!sti)ti! >it# 9as)"a
%e*ea;i"it$%e*ea;i"it$ A9)ate t#e se 4 9asi"ats A9)ate t#e se 4 9asi"ats
'-1$ #$%9"e*ia'-1$ #$%9"e*ia #$%%e4si! 4 t#e tes#$%%e4si! 4 t#e tes
e"ease 4 %ess s;sta!)ese"ease 4 %ess s;sta!)es 2PT2PT
A9)ate t#e se 4 9"*e e7%a!es & a9ia!)e A9)ate t#e se 4 9"*e e7%a!es & a9ia!)e
4 ieti)s4 ieti)s
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--CVSCVS
2i3# s$ste*i) 9as)"a esista!)e & #$%e$!a*i)2i3# s$ste*i) 9as)"a esista!)e & #$%e$!a*i)9e!ti)"a 4!)ti!9e!ti)"a 4!)ti! a9i a33essi9e 4"ia9i a33essi9e 4"i
a*i!stati!a*i!stati!
Lss 4 t#e !*a" e4a)ti!ess t a!3ite!si! IILss 4 t#e !*a" e4a)ti!ess t a!3ite!si! II
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22--3&OOD3&OOD
2e*)!)e!tati!2e*)!)e!tati!
T#*;)$t%e!ia 5 1,0 000T#*;)$t%e!ia 5 1,0 000 1,-'0 4 PT1,-'0 4 PT
Fi;i!3e! Fi;i!3e!
T#*;i! ti*e i! 1/( 4 t#e Pt>it# ECT#*;i! ti*e i! 1/( 4 t#e Pt>it# EC
FDP FDP '0 4 t#e Pt'0 4 t#e Pt
DICDIC
,,8i)a!3i%at#i) #e*"$ti) a!e*ia8i)a!3i%at#i) #e*"$ti) a!e*ia ,,
2EELP2EELP #e*"$ti) a!e*ia: "i9e e!$*es: "> P"t#e*"$ti) a!e*ia: "i9e e!$*es: "> P"t
-LD2 = <00 U/L-LD2 = <00 U/L
-T ;i"i;i! =1.' *3/"-T ;i"i;i! =1.' *3/"
-AST = M0U/L-AST = M0U/L -P"t 5 100 000/**?-P"t 5 100 000/**?
F! i! 10 4 t#e Pt >it# se9ee PETF! i! 10 4 t#e Pt >it# se9ee PET
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4-/IDNEY4-/IDNEY
C#aa)teisti) "esi!C#aa)teisti) "esi! 3"*e"e!t#e"isis3"*e"e!t#e"isis s>e""i!3s>e""i!34 t#e 3*e""a )a%i""a$ e!t#e"i*4 t#e 3*e""a )a%i""a$ e!t#e"i* GFRGFR
)eati!i!e )"eaa!)e/ %"as*a )eati!i!e)eati!i!e )"eaa!)e/ %"as*a )eati!i!e
i) a)ii) a)i
Ptei!iaPtei!ia
Re!a" t;"a !e)sis &e!a" 4ai"eRe!a" t;"a !e)sis &e!a" 4ai"e
5-Eyes5-Eyes
Jisa" ist;a!)esJisa" ist;a!)es e t eti!a" ate$ 9ass%as*e t eti!a" ate$ 9ass%as*
Reti!a" eta)#*e!tReti!a" eta)#*e!t
Cti)a" ;"i!!essCti)a" ;"i!!ess ))i%ita" ";e is)#e*ia i!4a)ti! ))i%ita" ";e is)#e*ia i!4a)ti! ee*a "asti!3 #s % t a$see*a "asti!3 #s % t a$s
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66--&i,er &i,er
8i!i*a" i!9"9e*e!t >it# 4i;i! e%siti!8i!i*a" i!9"9e*e!t >it# 4i;i! e%siti!
Pei%ta" #e*#a3i) !e)sisPei%ta" #e*#a3i) !e)sis se* "i9e se* "i9e
e!$*ese!$*es
B"eei!3 4* t#ese "esi!sB"eei!3 4* t#ese "esi!s S;)a%s"a #e*at*aS;)a%s"a #e*at*a #e%ati) %te#e%ati) %te
2e%ati) i!4a)ti!2e%ati) i!4a)ti!
2EELP SYNDRO8E2EELP SYNDRO8E
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77--En$o#rine . !eta(oli# #han8esEn$o#rine . !eta(oli# #han8es
%"as*a e!i!: a!3ite!si! II & a"ste!e t t#e%"as*a e!i!: a!3ite!si! II & a"ste!e t t#e
!*a" %e%e3!a!)$ 9a"es!*a" %e%e3!a!)$ 9a"es
Jas%essi! "e9e"s ae NJas%essi! "e9e"s ae N
Atia" !atieti) %e%tie Atia" !atieti) %e%tie
J"*e e7%a!si! i! PETJ"*e e7%a!si! i! PET ANP ANP COP & COP &%eie%#a" 9as)"a esista!)e%eie%#a" 9as)"a esista!)e
E7%a!si! 4 t#e e7ta)e"""a 4"i 9"*e @ee*aE7%a!si! 4 t#e e7ta)e"""a 4"i 9"*e @ee*a
Ptei!iaPtei!ia %"as*a !)ti) %esse %"as*a !)ti) %esse
is%"a)e*e!t 4 i!ta9as)"a 4"i t i!testiti*is%"a)e*e!t 4 i!ta9as)"a 4"i t i!testiti*
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99--teropla#ental per%"sionteropla#ental per%"sion
Jass%as*Jass%as* )*%*ise %"a)e!ta" %e4si!)*%*ise %"a)e!ta" %e4si!
%ei!ata" *;iit$ & *ta"it$%ei!ata" *;iit$ & *ta"it$
D%%"e 9e")i*et$ @s$st"i) /iast"i) 9e")it$ ati 4D%%"e 9e")i*et$ @s$st"i) /iast"i) 9e")it$ ati 4
*;i"i)a"& tei!e ateies *;i"i)a"& tei!e ateies '0 N'0 N
1, N U*;i"i)a" / A;!*a" tei!e1, N U*;i"i)a" / A;!*a" tei!e
+0 Bt# A;!*a"+0 Bt# A;!*a"
2ist"3i)a" )#a!3es i! %"a)e!ta" ;e2ist"3i)a" )#a!3es i! %"a)e!ta" ;e
De4e)ti9e t%#;"asti) i!9asi! 4 s%ia" ateies / e)ia"De4e)ti9e t%#;"asti) i!9asi! 4 s%ia" ateies / e)ia"
9esse"s ;t !t *$*etia" 9esse"s ae i!9ae ;$9esse"s ;t !t *$*etia" 9esse"s ae i!9ae ;$
t%#;"astt%#;"ast
C#ae)teisti) "i%i i)# "esi!s i! t#e te%"a)e!ta" ateiesC#ae)teisti) "i%i i)# "esi!s i! t#e te%"a)e!ta" ateies
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PREVENTIONPREVENTION
Ca")i* s%%"e*e!tati!Ca")i* s%%"e*e!tati!Fis# i"Fis# i" i!e44e)ti9ei!e44e)ti9e
L> se as%ii!L> se as%ii! se"e)ti9e s%essi! 4 t#;7a!ese"e)ti9e s%essi! 4 t#;7a!e
s$!t#esis ;$ t#e %"t & s%ai!3 e!t#e"ia" %sta)$)"i!s$!t#esis ;$ t#e %"t & s%ai!3 e!t#e"ia" %sta)$)"i!
%)ti!%)ti!Nt e44e)ti9e i! %e9e!ti!3 PETNt e44e)ti9e i! %e9e!ti!3 PET A!ti7ia!ts A!ti7ia!ts Jit C & E s%%"e*e!tati!Jit C & E s%%"e*e!tati! si3!i4i)a!tsi3!i4i)a!t
e)ti! i! PETe)ti! i! PET
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SYPTOS . SIGNSSYPTOS . SIGNS
BPBP
Ptei!iaPtei!ia
Ee*a 4 t#e 4a)e & #a!s @ ;t it #as ;ee! %%e 4Ee*a 4 t#e 4a)e & #a!s @ ;t it #as ;ee! %%e 4
t#e e4i!iti! e t % %ei)ti9e 9a"et#e e4i!iti! e t % %ei)ti9e 9a"e
2eaa)#e2eaa)#eJisa" ist;a!)eJisa" ist;a!)e
E%i3asti) %ai!E%i3asti) %ai!
E7a33eate e4"e7esE7a33eate e4"e7es
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Fetal . !aternal ris:sFetal . !aternal ris:s
Feta"Feta"
IUGRIUGR
O"i3#$a*!isO"i3#$a*!is
P"a)e!ta" i!4a)tsP"a)e!ta" i!4a)ts
P"a)e!ta" a;%ti!P"a)e!ta" a;%ti!Pe*atit$Pe*atit$
Ute%"a)e!ta"Ute%"a)e!ta"
i!s44i)ie!)$i!s44i)ie!)$
Pei!ata" eat#Pei!ata" eat#
8ate!a"8ate!a"
CNSCNS seies & st6eseies & st6e
DICDIC
CSCS
Re!a" 4ai"eRe!a" 4ai"e2e%ati) 4ai"e %te2e%ati) 4ai"e %te
Deat#Deat#
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C&ASSIFICATION OF PETC&ASSIFICATION OF PET
SEJERE PETSEJERE PET
S$st"i) BP =1<0 **23 iast"i) =110 **23 ! t>S$st"i) BP =1<0 **23 iast"i) =110 **23 ! t>
))asi!s at "east < #s a%at))asi!s at "east < #s a%at
Ptei!ia , 3/'+ #sPtei!ia , 3/'+ #s
O"i3ia 5 ,00 )) /'+ #sO"i3ia 5 ,00 )) /'+ #s
Cee;a" 9isa" s$*%t*sCee;a" 9isa" s$*%t*sE%i3asti) Rt %%e Haa!t %ai!E%i3asti) Rt %%e Haa!t %ai!
P"*!a$ ee*a )$a!sisP"*!a$ ee*a )$a!sis
L> PLtL> PLt
"i9e e!$*es"i9e e!$*esIUGRIUGR
8ILD PET8ILD PET a!$ PET t#at is !t )!siee se9eea!$ PET t#at is !t )!siee se9ee
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ANEGEENT OF PET .ANEGEENT OF PET .
ECEC
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ane8e!entane8e!ent
OBECTIJESOBECTIJES
Te*i!at! 4 %e3!a!)$ >it# t#e "east %ssi;"e ta*aTe*i!at! 4 %e3!a!)$ >it# t#e "east %ssi;"e ta*a
t t#e *t#e & 4etst t#e *t#e & 4ets
Bit# 4 a! i!4a!t ># s;seHe!t"$ t#i9esBit# 4 a! i!4a!t ># s;seHe!t"$ t#i9es
C*%"ete estati! 4 #ea"t# t t#e *t#e C*%"ete estati! 4 #ea"t# t t#e *t#e
1- 2s%ita"iati!1- 2s%ita"iati!
W*e! >it# !e> !set BP 1+0/0W*e! >it# !e> !set BP 1+0/0
Wse!i!3 BPWse!i!3 BP
De9e"%*e!t 4 %tei!ia i! aiti! t e7isti!3 BPDe9e"%*e!t 4 %tei!ia i! aiti! t e7isti!3 BP
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INITIA& HOSPITA& ANAGEENTINITIA& HOSPITA& ANAGEENT
O;se9e 4 #eaa)#e : 9isa" ist;a!)e: e%i3asti)O;se9e 4 #eaa)#e : 9isa" ist;a!)e: e%i3asti)
%ai! & a%i >t 3ai!%ai! & a%i >t 3ai!
Wt ai"$Wt ai"$
A!a"$sis 4 %tei!ia e9e$ ' a$s / ai"$ A!a"$sis 4 %tei!ia e9e$ ' a$s / ai"$
BP i! sitti!3 %siti! e9e$ + #s e7)e%t i!3 s"ee%BP i! sitti!3 %siti! e9e$ + #s e7)e%t i!3 s"ee%B" i!9esti3ati!sB" i!9esti3ati!s 2)t: P"t: S )eati!i!e: "i9e2)t: P"t: S )eati!i!e: "i9e
e!$*ese!$*es
FeHe!t e9a"ati! 4 4eta" sie & AFFeHe!t e9a"ati! 4 4eta" sie & AF
Re)e %#$si)a" a)ti9it$ ;t !t a;s"te ;e estRe)e %#$si)a" a)ti9it$ ;t !t a;s"te ;e estN iet & 4"i i!ta6eN iet & 4"i i!ta6e
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FRTHER ANAGEENTFRTHER ANAGEENT
De%e!s !De%e!s !
Se9eit$ 4 PETSe9eit$ 4 PET
Dati! 4 3estati!Dati! 4 3estati!
C!iti! 4 t#e C7C!iti! 4 t#e C7
C*%"ete es"ti! 4 t#e si3!s & s$*%t*s es !tC*%"ete es"ti! 4 t#e si3!s & s$*%t*s es !t
)) ti"" a4te e"i9e$)) ti"" a4te e"i9e$
Li!es 4 *a!a3e*e!tLi!es 4 *a!a3e*e!t
Te*i!ati! 4 %e3!a!)$Te*i!ati! 4 %e3!a!)$
A!ti#$%ete!si9e t#ea%$ A!ti#$%ete!si9e t#ea%$
A!ti)!9"sa!t t#ea%$ A!ti)!9"sa!t t#ea%$
2*e #ea"t# )ae2*e #ea"t# )ae i4 BP i*%9e >it#i! 4e> a$s Pti4 BP i*%9e >it#i! 4e> a$s Pt)a! ;e *a!a3e as t%atie!t)a! ;e *a!a3e as t%atie!t 2*e BP & i!e2*e BP & i!e%tei! *!iti!3 . I!st)ti! t )*e t #s%ita" i4 s#e%tei! *!iti!3 . I!st)ti! t )*e t #s%ita" i4 s#e
#as >a!i!3 s$*%t*s . Rest at #*e#as >a!i!3 s$*%t*s . Rest at #*e
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Ter!ination o% pre8nan#yTer!ination o% pre8nan#y
I!i)ati!sI!i)ati!s
Te* %e3!a!)$ >it# *i" se9ee PETTe* %e3!a!)$ >it# *i" se9ee PET
Se9ee PET e3a"ess 4 t#e 3estati!a" a3eSe9ee PET e3a"ess 4 t#e 3estati!a" a3e
Wa!i!3 si3!sWa!i!3 si3!s #eaa)#e : 9isa" ist;a!)e: e%i3asti)#eaa)#e : 9isa" ist;a!)e: e%i3asti)%ai!: "i3ia%ai!: "i3ia
E)"a*%siaE)"a*%sia Pt *st ;e sta;i"ie & e"i9ee i**eiate"$Pt *st ;e sta;i"ie & e"i9ee i**eiate"$
Pete* >it# *i" PETPete* >it# *i" PET Assess 4eta" >e"";ei!3 ;$ NST: Assess 4eta" >e"";ei!3 ;$ NST:BPP: D%%"e BPP: D%%"e
8et#s 4 te*i!ati!8et#s 4 te*i!ati!
IOL >it# %sta3"a!i!es t i%e! t#e C7 4"">e ;$ IJIOL >it# %sta3"a!i!es t i%e! t#e C7 4"">e ;$ IJ7$t)i!7$t)i!
E"e)ti9e CSE"e)ti9e CS Se9ee PET >it# !4a9a;"e C7Se9ee PET >it# !4a9a;"e C7
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Antihypertensi,e therapyAntihypertensi,e therapy
8i" PET8i" PET
T#ee is ! ;e!e4it 4 a!ti#$%ete!si9e t#ea%$T#ee is ! ;e!e4it 4 a!ti#$%ete!si9e t#ea%$
Re)ti! i! t#e *ate!a" BP >it# "a;eta"" !i4ei%i!eRe)ti! i! t#e *ate!a" BP >it# "a;eta"" !i4ei%i!e
IUGRIUGR
ACI ACI )!tai!i)ate)!tai!i)ate IUGR: ;!e$ *a"4*ati!s: "i*;IUGR: ;!e$ *a"4*ati!s: "i*;
)!ta)te: PDA: %"*!a$ #$%%"asia: RDS: #$%te!si!)!ta)te: PDA: %"*!a$ #$%%"asia: RDS: #$%te!si!&eat#&eat#
Se9ee PETSe9ee PET
A!ti#$%ete!si9e t#ea%$ is se t )!t" BP !ti"" t#e Pt A!ti#$%ete!si9e t#ea%$ is se t )!t" BP !ti"" t#e Pt
e"i9es i! %ete* 4 + #s t a""> ti*e 4e"i9es i! %ete* 4 + #s t a""> ti*e 43"))ti)i a*i!istati! 4 4eta" "!3 *atit$ t#e!3"))ti)i a*i!istati! 4 4eta" "!3 *atit$ t#e!
e"i9e$e"i9e$
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Antihypertensi,e therapy %or se,ere PET . ECAntihypertensi,e therapy %or se,ere PET . EC
2$a"ai!e2$a"ai!e
IJ i!4si! IJ ,-10 *3 ;"s at 1,-'0 *i! i!te9a"IJ i!4si! IJ ,-10 *3 ;"s at 1,-'0 *i! i!te9a"
>#e! iast"i) BP 100-110 ** 23 s$st"i) BP >#e! iast"i) BP 100-110 ** 23 s$st"i) BP
1<0 **231<0 **23
Ni4ei%i!e 10 *3 % e%eate i! (0 *i!Ni4ei%i!e 10 *3 % e%eate i! (0 *i!
La;eta"" 10 *3 IJ / '0 *3 a4te 10 *i!/ +0*3 a4teLa;eta"" 10 *3 IJ / '0 *3 a4te 10 *i!/ +0*3 a4te
10*i!/0 *3 @!t t e7)ee ''0 *310*i!/0 *3 @!t t e7)ee ''0 *3
Nit%ssieNit%ssie se !"$ i! PT !t es%!i!3 t t#ese !"$ i! PT !t es%!i!3 t t#e
3s3s
Dieti)s !t e)**e!e ;e)ase i!ta9as)"aDieti)s !t e)**e!e ;e)ase i!ta9as)"a
9"*e e%"eti! a"ea$ e7ists i! PET9"*e e%"eti! a"ea$ e7ists i! PET
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Fl"i$ therapyFl"i$ therapy
2$%es*ti) a3e!ts !t e)**e!e ;e)ase2$%es*ti) a3e!ts !t e)**e!e ;e)asei!ta9as)"a i!4"7 4 4"ii!ta9as)"a i!4"7 4 4"i s;seHe!t es)a%e 4s;seHe!t es)a%e 4
4"i t 9ita" 3a!s4"i t 9ita" 3a!s %"*!a$ ee*a & )ee;a"%"*!a$ ee*a & )ee;a"
ee*aee*a
LR <0-1'0 *"/# E7)essi9e 4"i a*i!istati!LR <0-1'0 *"/# E7)essi9e 4"i a*i!istati!
%"*!a$ ee*a & )ee;a" ee*a%"*!a$ ee*a & )ee;a" ee*a
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PREVENTION ;CONTRO& OF CONV&SIONSPREVENTION ;CONTRO& OF CONV&SIONS
8a3!esi* s"4ate IJ i!4si!8a3!esi* s"4ate IJ i!4si! + 3* "ai!3 se i! 100+ 3* "ai!3 se i! 100
*" 4 IJ 4"i 9e '0 *i!*" 4 IJ 4"i 9e '0 *i!
' 3* /# *ai!te!a!)e' 3* /# *ai!te!a!)e8ease se* 8G "e9e" at +-<#s *ai!tai! at +-M *EH /L8ease se* 8G "e9e" at +-<#s *ai!tai! at +-M *EH /L
D/C '+ #s a4te e"i9e$D/C '+ #s a4te e"i9e$', 4 sei )) %st %at*', 4 sei )) %st %at*
A9i t7i)it$ ;$ A9i t7i)it$ ;$
-*!iti!3 %ate""a e4"e7es-*!iti!3 %ate""a e4"e7es
-es%iat$ ate-es%iat$ ate
-i!e t%t-i!e t%t
A!tite A!tite)a")i* 3")!ate 13* IJ)a")i* 3")!ate 13* IJ
83S *$*etia" )!ta)ti"it$83S *$*etia" )!ta)ti"it$
C*%ae t %#e!$ti! iae%a*C*%ae t %#e!$ti! iae%a* ,0 i! *ate!a",0 i! *ate!a"
*ta"it$ :<M i! )!9"si!s*ta"it$ :<M i! )!9"si!s
I!4a!ts >ee "ess "i6e"$ t ;e a*itte t NICU/ i!t;ati!I!4a!ts >ee "ess "i6e"$ t ;e a*itte t NICU/ i!t;ati!
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Pro8nosisPro8nosis
8ate!a" eat# ae8ate!a" eat# ae e t )ee;a" 23: as%iati!e t )ee;a" 23: as%iati!
%!e*!ia: #$%7i) e!)e%#a"%at#$: t#*;e*;"is*:%!e*!ia: #$%7i) e!)e%#a"%at#$: t#*;e*;"is*:
#e%ati) %te: e!a" 4ai"e: a!st#esia#e%ati) %te: e!a" 4ai"e: a!st#esia
Re)e!)eRe)e!)e ',-(( %i*i%aa',-(( %i*i%aa
M0 *"ti%aaM0 *"ti%aa
PG: PET ;e4e (0 >6PG: PET ;e4e (0 >6 +0+0
2EELP2EELP ,,
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CHRONIC HYPERTENSIONCHRONIC HYPERTENSION
in pre8nan#yin pre8nan#y
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CHRONIC HYPERTENSIONCHRONIC HYPERTENSION
I!)ie!)e 4 )# 2PT 0.,-+I!)ie!)e 4 )# 2PT 0.,-+
0 esse!tia" 2PT0 esse!tia" 2PT
'0 e t e!a" isease'0 e t e!a" isease
S$*%t*s & si3!sS$*%t*s & si3!s
is6 i!is6 i! A3e = (0: ;ese: *"ti%aa: D8: e!a" isease: A3e = (0: ;ese: *"ti%aa: D8: e!a" isease:
;"a)6 a)e: 4a*i"$ 27;"a)6 a)e: 4a*i"$ 27
Di44i)"t t e44ie!tiate 2PT >it# s%ei*%se PET 4*Di44i)"t t e44ie!tiate 2PT >it# s%ei*%se PET 4*2PT >it# e!a" isease2PT >it# e!a" isease ;t# #a9e %tei!ia;t# #a9e %tei!ia
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INJESTIGATIONSINJESTIGATIONS
C#est 7 a$C#est 7 a$ )ai*e3a"$)ai*e3a"$
ECGECG Lt 9e!t #$%et%#$Lt 9e!t #$%et%#$
se* )eati!i!e: )eati!i!e )"eaa!)e & %tei!iase* )eati!i!e: )eati!i!e )"eaa!)e & %tei!ia
,-10,-10
8ATERNAL CO8PLICATIONS8ATERNAL CO8PLICATIONS
S%ei*%se PET i! 1/( 4 PtS%ei*%se PET i! 1/( 4 Pt
is6 4 a;%ti %"a)e!tae 0.+-10is6 4 a;%ti %"a)e!tae 0.+-10 DIC: a)teDIC: a)te
t;"a & )ti)a" !e)sist;"a & )ti)a" !e)sis
I4 e!a" 4!)ti! is >e"" )eati!i!e 5 1., *3/"I4 e!a" 4!)ti! is >e"" )eati!i!e 5 1., *3/"
%e3!a!)$ es !t )#a!3e t#e )ase 4 e!a"%e3!a!)$ es !t )#a!3e t#e )ase 4 e!a"
iseaseisease
I4 e!a" 4!)ti! is a44e)te %i t %e3!a!)$I4 e!a" 4!)ti! is a44e)te %i t %e3!a!)$
eteiati! 4 e!a" 4!)ti! )) *e a%i i!eteiati! 4 e!a" 4!)ti! )) *e a%i i!
%e3!a!)$%e3!a!)$
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FETAL CO8PLICATIONSFETAL CO8PLICATIONS
Pe*atit$ ',-(0Pe*atit$ ',-(0
IUGR 10-1,IUGR 10-1,
Sti"";it# & 4eta" istess e t a;%ti %"a)e!tae )#Sti"";it# & 4eta" istess e t a;%ti %"a)e!tae )#
i!tatei!e as%#$7iai!tatei!e as%#$7ia
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TREATENTTREATENT
N ;e!e4it 4 teati!3 *i" C2 2PT @ 1+0-1M/0-10N ;e!e4it 4 teati!3 *i" C2 2PT @ 1+0-1M/0-10
i! %e3!a!)$i! %e3!a!)$ s#" ;e *!itee 4 >se!i!3 2PT s#" ;e *!itee 4 >se!i!3 2PT
s%ei*%se PETs%ei*%se PET
Pt >it# se9ee C2 2PT s#" #a9e t#ei BP )!t""ePt >it# se9ee C2 2PT s#" #a9e t#ei BP )!t""e
;e4e %e3!a!)$ & )!ti!e R7 i! %e3!a!)$;e4e %e3!a!)$ & )!ti!e R7 i! %e3!a!)$
αα Methyle DopaMethyle Dopa
Calcium channel blockersCalcium channel blockers
B blockers can be used butB blockers can be used but IUGRIUGR
LabetalolLabetalol
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O(stetri# !ana8e!entO(stetri# !ana8e!ent
Seia" U/S 4 4eta" 3>t#. BPP: NSTSeia" U/S 4 4eta" 3>t#. BPP: NST(+>6(+>6
F""> % e9e$ ' >6s ti"" (0 t#e! >ee6"$F""> % e9e$ ' >6s ti"" (0 t#e! >ee6"$
Wa! t#e *t#e a;t s$*%t*s 4 s%ei*%se PETWa! t#e *t#e a;t s$*%t*s 4 s%ei*%se PET
I!9esti3ati!sI!9esti3ati!sRe!a" 4!)ti! test:i) a : )a")i* :LFT: '+#sRe!a" 4!)ti! test:i) a : )a")i* :LFT: '+#s
i!e 4 )eati!i!e )"eaa!)e & %tei!: CBC: Ui!a"$sis:i!e 4 )eati!i!e )"eaa!)e & %tei!: CBC: Ui!a"$sis:
ECG.GTTECG.GTTEa"$ U/S 4 ati!3 4 %e3Ea"$ U/S 4 ati!3 4 %e3
Nt a"">e t )!ti!e %ast +0>6sNt a"">e t )!ti!e %ast +0>6s
IOL at+0 >6sIOL at+0 >6s
Re3"a iet ! sa"t esti)ti!Re3"a iet ! sa"t esti)ti!IOLIOL4 s%ei*%se PET:IUGR: 4eta" istess: >se!i!34 s%ei*%se PET:IUGR: 4eta" istess: >se!i!3
e!a" 4!)ti!e!a" 4!)ti!