Hypertension in Pregnancy

#med #disease #y2023

Presentation :

Hypertension before the 20th week of gestation is most consistent with previously undiagnosed chronic hypertension.
Gestational hypertension is hypertension that develops after 20 weeks of pregnancy without preexisting hypertension, proteinuria, or other end-organ damage.
- Gestational hypertension is a risk factor for preeclampsia and the development of chronic hypertension.
Preeclampsia is new-onset hypertension after 20 weeks of pregnancy with proteinuria.
- Eclampsia is the presence of generalized, tonic-clonic seizures in a woman with preeclampsia.

Drugs that may be used during pregnancy:
- Labetalol
- CCBs (e.g., long-acting nifedipine)
- ?Methyldopa
CONTRAINDICATED during pregnancy:
- ACE/ARBs
- Renin inhibitors (Aliskiren)
Preeclampsia:
- Definitive treatment is delivery, including induction of labor in women at or near term. Maternal risk for complications diminishes in the hours after delivery, although proteinuria may take months to resolve
- In the event of a hypertensive crisis, maternal BP stabilization should occur before delivery, even in urgent circumstances.
- Low-dose (81 mg/d) aspirin started after 12 weeks of pregnancy reduces the rate of preeclampsia in women at high risk.
- Antihypertensive medications do not prevent preeclampsia but reduce complications of stroke, heart failure, and kidney injury