Obs Chapter 5: Hypertension Related Problems in Pregnancy

	OB Traid	Risk factor	Lab findings	Management
Gestational Hypertension	1.      Pregnancy>20wk 2.      Nonsustained HTN 3.      No proteinuria		unremarkable	Conservative (after you have ruled out preeclampsia)
Mild Preeclampsia	1.      Pregnancy >20weeks 2.      Sustained HTN 3.      Proteinuria (>300mg/24 h)	8 times more common in primiparas	Elevation of Hb, BUN, creatinine, serum uric acid	Conservative before 36 week Deliver after 36 weeks
Severe Preeclampsia	1.      Sustained HTN (>160/110mg) 2.      Proteinuria (>5grams/24h) 3.      Headache or epigastric pain or visual changes	Same as above	Same as above with evidence of DIC and hepatic injury	Aggressive ·         IV MgSO4 ·         IV Hydralazine/labetalol ·         Attempt vaginal delivery with IV oxytocin
Ecclampsia	Same as above + unexplained seziures	Same as above	Same as above	·         First step is to protect mother airway and tongue ·         Than administer IV MgSO4 with IV bolus of 5 g to stop seizures than 2g/hr maintenance dose ·         IV hydralazine/and or labetalol
HELLP	1.      Hemolysis 2.      Inc. liver enzyme 3.      Dec. platelet count	More common in multigravida		Prompt delivery

Pathophysiology of Preeclampsia/eclampsia:

Diffuse vasospasm caused by

1)      Normal pregnancy related refractioness to vasoactive substance such as angiotensin

2)      Increase in thromboxane along with decrease in vasodilator prostacyclin