Hypertension in Pregnancy

approximates 6%

A. Gestational HPT= new onset of BP elevation after 20 weeks AOG without signs of preeclampsia; resolves by 12 weeks postpartum

B. Chronic HPT= It is hypertension of any cause that predates pregnancy. BP≥140/90 before pregnancy or before 20 weeks gestation, or both

C. Preeclampsia = elevated BP + proteinuria; OR if proteinuria is absent, + thrombocytopenia, renal insufficiency, liver involvement, cerebral symptoms, or pulmonary edema

D. Preeclampsia with Severe Features = preeclampsia + 160 SBP or 110 DBP, thrombocytopenia, doubling of liver enzymes, progressive renal insufficiency, pulmonary edema, or new onset of cerebral or visual disturbances

E. Eclampsia = preeclampsia + generalized convulsions, generally occurring within 48h postpartum but may occur before, during, or after labor

F. Chronic hypertension superimposed with preeclampsia = Chronic HPT + symptoms of preeclampsia

G. Delta Hypertension = an acute rise in mean arterial pressure of a pregnant woman not reaching 140/90 mm Hg from a normotensive patient before pregnancy

H. HELLP Syndrome = hemolysis, elevated liver enzyme levels, low platelet count syndrome, while normotensive.

Primiparity

Risk factors of Preeclampsia

Patients with maternal personal risks:

1. Primiparity

2. Primipaternity

3. With Hx of preeclampsia

4. Obese (BMI>=30)

5. Fam Hx of preeclampsia >>> sisters (37%), daughters (26%), and granddaughters (16%) than it was in daughters-in-law (6%)

6. Black women (twice as high as white women)

7. 40 years old and above

8. Smokers

9. Interpregnancy intervals < 2 years or > 10 years

10. Previous miscarriage and induced abortions

1. Vascular and connective tissue disorders or renal implications: DM, APAS, SLE

2. Maternal infection: UTI, peridontal disease

Patients with placental/fetal risk factors:

1. Multiple Pregnancies

2. Molar Pregnancies

Hypertension in pregnancy = a systolic pressure ≥140 mm Hg or a diastolic pressure ≥90 mm Hg, in more than 1 occasion, same arm

1. Pregestational diabetes—6.6 %

2. Thyroid disorders—4.1 %, and

3. Collagen vascular disease—0.6%

Low dose aspirin: initiating 81 mg between 12 and 28 weeks’ gestation and continuing therapy until deliver