2. • Classification of hypertensive disorders of
pregnancy
• Diagnosis of preeclampsia
• Risk factors
• Obstetric and Anaesthetic management
• Complications of preeclampsia
• Diagnosis and risk factors of Eclampsia
• Obstetric and Anaesthetic management in
Eclampsia
• Complications of Eclampsia
4. Gestational Hypertension
• Blood Pressure ≥ 140/90 on two or more
occasions
- In a previously normotensive
patient
- After 20 weeks gestation
-Without proteinuria
- Returning to normal 12 weeks
after delivery
5. Chronic Hypertension
• Blood Pressure ≥ 140/90 before 20 weeks of
gestation
Or
• Persistence of hypertension beyond 12 weeks
after delivery.
6. Preeclampsia superimposed on Chronic
Hypertension
• New-onset proteinuria ≥ 300 mg/24 hours in
hypertensive women but no proteinuria before 20
weeks’ gestation
• A sudden increase in proteinuria or blood pressure or
platelet count <1 lakh/mm3 in women with
hypertension and proteinuria before 20 weeks’
gestation
• More adverse outcome than preeclampsia alone
7. Preeclampsia
• New onset of hypertension & proteinuria in a previously
normotensive woman
– after 20 weeks of gestation
– Returning to normal after 12 weeks of pregnancy.
• Edema not a part of diagnosis now.
• A retrospective diagnosis
• Eclampsia : new onset of seizures or unexplained coma during
pregnancy or postpartum period in patients with pre-existing
preeclampsia and without pre-existing neurological disorder.
• )
8. Epidemiology
• Pre eclampsia – primi (10%) , multi (5%)
• Eclampsia – variable
• Chronic hypertension – 2-4%
• Textbook of obstetrics (D.C.DUTTA)
• Ref :J Prakash, Lk Pandey, Ak Singh, B Kar Hypertension In Pregnancy : Hospital Based Study
• Kamala Dhall Md, Dgo, Epidemiology Of Preeclampsia And Eclampsia (Article First Published
Online: 24 May 2010 Doi: 10.1111/J.1447-0756.1984.Tb00033.X
10. Risk Factors
• Nulliparity
• History of Preeclampsia in previous pregnancy
• Advanced maternal age
• Family history of Preeclampsia
• History of placental abruptio, IUGR, fetal
death
20. • Vasospasm and exaggerated responses to catecholamines
• Increased vascular permeability
• ↓ Colloid Oncotic Pressure
• Ref :Zinaman M, Rubin J, Lindheimer MD , Serial plasma oncotic pressure levels and
echoencephalography during and after delivery in severe pre-eclampsia.Lancet 1985 Jun
1;1(8440):1245-7.
• .
21. • Increased CO & SVR
• CVP normal or slightly increased
• Plasma volume reduced
• Increase PWP and CVP
22. • Airway is edematous;
• ↓ internal diameter of trachea
• Pharyngolaryngeal edema
• risk of pulmonary edema
24. • Hemoconcentration (pts with anemia may
appear to have normal hematocrit)
• Thombocytopaenia - most common
• DIC due to activation of coagulation
cascade overconsumption of coagulants and
platelets spontaneous haemorrhage.
29. Fetal evaluation
• Fetal movement count
• Ultrasound
• Doppler ultrasound for fetal blood flow
30. Prediction of Preeclampsia
Various screening methods are:
• Diastolic notch at 24weeks by doppler ultrasonography
• Absence or reversal of end diastolic flow
• Average mean arterial pressure ≥ 90 mmHg in second
trimester
• Angiotensin infusion test: angiotensin infusion required
to raise the blood pressure >20 mm Hg from baseline
• Roll over test: rise in blood pressure >20 mmHg from
baseline on turning supine at 28-32 weeks gestation is
positive.
32. Anti Hypertensive Drugs
DRUGS MOA SIDE EFFECTS C/I & PREVENTION
Methyldopa 250mg-1g tds
or 250-500mg iv
Central and pripheral
anti adrenergic action
Maternal-postural
hypotension, hemolytic
anemia, sodium
retention, excessive
sedation
Fetal-intestinal ileus
Hepatic disorders, psychic
pts., CCF
Labetalol
Oral-100mg tds till
800mg/d
Iv- 20 mg till desired
effect (max. 220mg)
Alpha + beta blocker Maternal-tachycardia,
hypotension
Fetal-bradycardia,
hypotension
Hepatic disorders
Hydralazine
Oral-100mg/d in 4 divided
doses
Peripheral vasodilation Maternal-hypotension,
tachycardia, arrythmia,
palpitations, lupus like
syndrome
Fetal- safe
Neonate-thrombocytopenia
Causes sodium retention
so use diuretic
33.
34. • Seizure Prophylaxis
• Routinely used in severe PE
• Magnesium sulphate: most commonly used
• Initiated with onset of labor till 24h postpsrtum
• For caesarean, started 2hrs before the section till
12hrs postpartum
• Pritchard regime: 4 gm i.v over 3-5min f/b 5 gm in
each buttock with maintenance of 5 gm i.m in
alternate buttock 4 hrly
36. MgSO4 cautions
• MgSO4 potentiate and prolong the action of both
depolarizing non-depolarizing muscle relaxants
• At higher doses Mg2+ rapidly crosses the placental
barrier, has been found to significantly ↓ FHR
variability
• Should be given cautiously with Ca2+ as may
antagonize the anticonvulsant effect of MgSO4
• Also be cautious in patients with renal impairment
• May ↑ the possibility of hypotension during regional
block
