Hypertensive Disorder in Pregnancy Untuk Kuliah (2)

7/23/2019 Hypertensive Disorder in Pregnancy Untuk Kuliah (2)

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Hypertensive Disorders in


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Classifcation

by the working group o theNHBPEP (2000)! "estational hypertension

2! Chronic hypertension

#! Preecla$psia

%! Ecla$psia

&! Preecla$psia superi$pose' on chronic

hypertension (superi$pose' preecla$psia)


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! "estational hypertension

BP * %0+,0 $$Hg or frst ti$e 'uringpregnancy

No proteinuria

BP returns to nor$al - 2 wk postpartu$

.inal 'iagnosis $a'e only postpartu$

/ay hae other signs 1 sy$pto$s o

preecla$psia eg! epigastric 'isco$ort orthro$bocytopenia


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! Chronic hypertension

BP * %0+,0 $$Hg beore pregnancy or'iagnose' beore 20 wk not attributableto "34 or

Hypertension frst 'iagnose' ater 20 wkan' persistent ater 2 wk postpartu$


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5n'erlying causes oChronic Hypertension

Essential a$ilial hypertension 6besity 7rterial abnor$alities

En'ocrine 'isor'ers "lo$erulonephritis 8enoprial hypertension Connectie tissue 'isease

PC94


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III. PreeclampsiaIII. Preeclampsia


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/il' preecla$psia

BP * %0+,0 $$Hg ater 20 wk gestation

Proteinuria * #00 $g+2%hr or *:'ipstick


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;eere preecla$psia7nyone who $eets at least two o the

ollowing signs>P syn'ro$e seerehea'ache uncontrolle' hypertensionecla$psia


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#! 3er$ination o pregnancy

4eliery is the cure or preecla$psia

Hea'ache isual 'isturbances orepigastric pain < in'icatie conulsions

(i$$inent ecla$psia) 6liguria < o$inous sign

obIecties to orestall conulsions preent intracranial he$orrhage 1serious ital organ 'a$age


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3er$ination o pregnancy

Preter$ < conseratie Iustife' in $il'preecla$psia close' obseration an'$onitoring to co$plications

seere preecla$psia < pro$pt 'eliery aginal 'eliery

cKsection i in'icate'

n'uction o labor not har$ul to inants but unsuccessul #&A


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%! 7ntihypertensie 'rug

3o prolong pregnancy or $o'iy perinataloutco$es

blocker (>abetolol) calciu$ channel

blockers (Nie'ipine sra'ipine)


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l ' ' li i h


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&! 4elaye' 'eliery with;uperi$pose' Pre Ecla$psia (;PE)

;PE re$ote ro$ ter$

Conseratie or epectant $anage$ent inselecte' group

;ibai ,& < ;PE K2O wk < perinatal$ortality OA no $others 'ie' placental abruption ecla$psia consu$ptie coagulopathy 8.

encephalopathy intracerebralhe$orrhage rupture' hepatic he$ato$a


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4elaye' 'eliery with ;PE

n'ications or 'eliery < uncontrollable BPetal 'istress placental abruption renalailure HE>>P syn' persistent sy$pto$

7erage pregnancy prolong '


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"lucocorticoi's

Not worsen $aternal H3

4ecrease 84; i$proe etal surial

No ei'ence < beneft to a$eliorate

seerity o HE>>P syn'ro$e 3ransient i$proe he$atological lab

/ 1 ? regi$en no signifcant 'iDerence

/g leel /g 0 $EL+> < patellar reGe 'isappear

(4P8)

0 $EL+> < respiratory 'epression 2 $EL+> < respiratory paralysis 1 arrest

Cr !# < hal 'ose /g;6%


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/g;6% .etal eDects

Pro$ptly cross placenta

Neonatal 'epression occurs only i seerehyper$agnese$ia at 'eliery

Decrease in beat#to#beat variability


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Co$pare' with anticonulsants

/g;6% re'uce recurrent s@ &0A co$pare'to 'ia@epa$ re'uce $aternal 1 perinatal$orbi'ity (not sig)

/aternal $ortality re'uce' co$pare' tophenytoin (not sig) less neonatalintubation 1 NC5 a'$ission

Preent ecla$ptic s@ superior to phenytoin

>ower risk placental abruption


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7ntihypertensies

Nie'ipine 0 $g 6ral repeate' in #0 $in i necessary (NHBPEP 2000)

.ewer 'ose reLuire' to achiee BP control

without increase' a'erse eDects ;ublingual < potent 1 rapi'

Hypertensive Disorder in Pregnancy Untuk Kuliah (2)

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