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PREGNANCYAND
HYPERTENSION
DR MOHAMMED ALMOGAHED
M.D
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REMEMBER THAT
A HEALTHY FETUS DEPENDS ON
A HEALTHY MOTHER
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Hypertension is a common medicalproblem during pregnancy, with a
prevalence of 6 to 8%. It isdiagnosed when blood pressure isgreater than 140/90 mm Hgmeasured with the patient in thesitting position on two occasions
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During a normal pregnancy, bloodpressure declines during the first
and second trimesters and risesto prepregnancy levels near term
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Hypertension during pregnancy can beclassified as
1- chronic hypertension(prepregnancy HTN)2-preeclampsia
3-gestational hypertension or nonproteinuric
hypertension of pregnancy4- chronic hypertension plus preeclampsia
5-antenatal unclassifiable hypertension
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Chronic hypertention
Present in 1 to 5% of pregnant
women.most cases are due toessential HTN.for the Unusualindividual with secondry HTN
(CTD,aortic coarctation,intrinsicrenal disease,renal artery stenosis,and cushings disease)
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gestational hypertension(GH)
Is hypertension that develops any timeduring pregnanacy without protein in urine
(nonproteinuric HTN of pregnancy)
(GH)resolves by 3 months postpartum,and
HTN often normalizes within 2 weeks ofdelivery
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Preeclampsia
Can occur any time after 20weeks of gestation and up to 6weeks postpartum
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TREATMENT
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Chronic hypertensinWomen with preexisting HTN the usual
Blood pressure decrease during theFirst trimester often allows discontinuti
On of antihypertensive drugs.BP
Can be monitored and medications
Reinstituted if needed
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Chronic HTN newly diagnosed during
Pregnancy can be differentiated from
Transient gestational HTN in that theFormer persists more than 3 months
postpartum
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European heart association guidline 2011
1-SBP 140-150mmHg
DBP 90-99 mmHgNon pharmacological management
2-SBP >170 mmHgEmergency hospitalisation
Pre-eclampsia associated with pulmonary oedema
Infusion i/v nitroglycerene
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3-In severe HTN
drug treatment with i/v labetolol
Or methyldopa or nifidepine tablet
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4-With continued pre-pregnancy HTN
Pre-pregnancy medication to be continued
(angiotensin converting enzyme-ACE-andAngiotensin receptor blockers-ARB-and
Direct renin inhibitors are strictly
contraindicated
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5-For delivery(in gestational HTN) with
Proteinuria with adverse condition
induction
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Gestational HTN
Transient gestational HTN is treated with
Bed rest,close monitoring of the mother andfetus.when to initiate antihypertensive drugs
Is controversial.many authorities
Recommend drug therapy when the bloodPressure exceeds 140/90 mmhg
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METHYLDOPA(CENTRAL SYMPATHOLYTIC)
Reduces vascular resistance while preserv-
Ing maternal cardiac output and uteroplacental perfusion.considered safe to use when
Breastfeeding
Dose 250mg 2-3times/day can be asNeeded (maximum dose 3g)DOSAGE FORMS(tablet 125Mg-250Mg-500Mg)ingection 50Mg/ML
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CLONIDINE (CENTRAL SYMPATHOLYTIC)
Dose 0.1mg 1-2 times/day
Onset of action:oral 0.5-1hourDuration:6-10 hours
(do not discontinue clonidineabruptly
because risk of rebound HTN.if needdecrease gradually)
DOSAGE FORMS(TABLET 0.1Mg-0.2Mg-0.3mg)ingection 100mcg/ml
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LABETALOL(ALPHA AND BETA BLOCKERS)
Used in several trials without adverse effects
-blocking results in vasodilation includingUteroplacental blood vessels.and-blockade
Prevents reflex tachycardia.cardiac output is
Unchanged.low concentration in breast milk
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LABETALOL(ALPHA AND BETA BLOCKERS)
Dose100mg twice daily,may increase as
Needed every 2-3days by 100mg untilDesired response is obtained(maximum 2g)
Onset of action:oral:20 min-2hours.
i/v 2-5 minDOSAGE FORMS(TABLET 100Mg-200Mg-300mg) ingection 5mg/ml
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-blockers
Probably safe for third-trimester use,but
Neonatal bradycardia,respiratory distress,
And hypoglycemia have been reported.Use earlier in gestation may result in intra-
Uterine grouth retardation.atenololand meto
Prolol are concentrated in breast milk
Propranololhas low concentrated in breast
milk
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Atenololtablet 25-100mg 1-2/day
Metoprololtablet 50-100mg 1-2/day
Pindololtablet 5-10mg twice/day as
Necessary every3-4 weeks maximum dose
60mg
Propranololtablet 20-40mg twice dailydose
As necessary every3-7days
Maximum dose
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Hydralazine(direct arterial vasodilator)
Extensively used during pregnancy.it causes
Vascular dilation and reflex tachycardia
Primarily used parenterallay for acute mana-
Gement of HTN or with methyldopa or
-blocking agent
Dose10-20mg i/v every4-6h,change to oral
Therapy as soon as possible(max.dose 250mg)DOSAGE FORMS(TABLET 10Mg-25Mg-50Mg-100Mg)ingection 20mg/ml
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NIFEDIPINE(calcium-channel blockers)
Probably safely used in the third trimester
Their use maintains uteroplacental perfusion
May also have tocolytic effect.S/L associatedWith hypotension and fetal distress.avoid use
With magnesium sulfate because combination
Risks profound hypotension
Dose10-30mg 3 times/day(capsules)
30-60mg once daily as sustained release tablet
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Angiotensin-converting enzymeinhibitors
And angiotensin receptor blockers
Contraindication.it affects renal development
In the second and third trimesters.miscarriage
Fetal death,malformations, and neonatal renalFailure can be result.
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THANK
YOU