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HYPERTENSIVE DISORDERS OF PREGNANCY Part 01

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Classification

  1. preeclampsia/eclampsia
  2. chronic hypertension
  3. chronic hypertension with superimposed preeclampsia/eclampsia
  4. transient or gestational hypertension

Preeclampsia/Preeclamptic Toxemia/Eclampsia (PET)

  1. hypertension accompanied by proteinuria and/or non-dependent edema with onset > 20 weeks
  2. BP > 140/90 mmHg or an increment of 30 mmHg systolic and 15 mmHg diastolic over a nonpregnant or T1 BP
  3. non-dependent edema (e.g. face, hands) is generalized and usually associated with excessive weight gain (> 2 kg/week)
  4. proteinuria is defined as > 1+ protein on random dipstick analysis or > 300 mg in a 24 hour urine collection
  5. 50% of all hypertension in pregnancy
  6. due to an imbalance of thromboxane (vasoconstrictor) and prostaglandin (vasodilator), causing generalized arteriolar constriction
  7. resultant vasospasm damages capillaries, leading to protein extravasation and hemorrhage

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Conditions Associated with Preeclampsia/Eclampsia

Maternal factors
  1. 80-90% of cases in primagravidas
  2. past history or family history of preeclampsia/eclampsia
  3. diabetes, chronic hypertension, or renal disease
  4. extremes of maternal age
Fetal factors
  1. IUGR
  2. hydatidiform mole
  3. > 1 fetus
  4. fetal hydrops
Fetal Complications

mainly due to placental insufficiency
  1. fetal loss
  2. IUGR
  3. prematurity
  4. abruptio placentae
Maternal Complications

  1. cerebral hemorrhage (50% of deaths)
  2. left ventricular failure/pulmonary edema
  3. liver and renal dysfunction
  4. abruption
  5. seizures
  6. DIC : release of placental thromboplastin, leading to a consumptive coagulopathy
  7. HELLP


    • hemolysis,
    • elevated liver enzymes
    • low platelets
    may only respond to fresh frozen plasma with plasma exchange
HYPERTENSIVE DISORDERS OF PREGNANCY Part 01 HYPERTENSIVE DISORDERS OF PREGNANCY Part 01 Reviewed by Radiology Madeeasy on September 08, 2010 Rating: 5
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