Management of hypertensive disorders in pregnancy

MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY

- An evidence based approach

Dr. Mohammed Sadiq Azam M.D. (Int Med)Senior Resident, Department of Medicine, Osmania General Hospital

Physician, Princess Esra Hospital

What are we dealing with?

Is it Gestational HTN.. Or Chronic HTN?

Routine investigations

Proteinuria – How to assess??

Prevention strategy – Do s

and Don’t s…

NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN THIS REGARD

CHRONIC HYPERTENSION

PRE PREGNANCY ADVICE

GESTATIONAL HYPERTENSIONOnce upon a time called PIH, now known as...

Decide on Timing of birth

Mild Hypertension Moderate HypertensionSevere Hypertension

PRE ECCLAMPSIA

Pre ecclampsia – Who are at risk?

Signs of Severe Pre-ecclampsia

Decide on Timing of birth

Mild Hypertension Moderate Hypertension

Severe Hypertension not requiring referral to a level 2 setup

ECCLAMPSIA

Antihypertensives – WHAT NOT TO USE

Antihypertensives used - Pharmacology

Antihypertensives used – Beta Blockers

Antihypertensives used - Pharmacology

Antihypertensives used – Methyldopa

Antihypertensives used - Pharmacology

Antihypertensives used - Nifedipine

Antihypertensives used - Pharmacology

Antihypertensives used - Hydralazine

Antihypertensives used - Thiazides

Methyldopa vs Labetolol – The King vs the Challenger?

“Can I feed the baby while on my antihypertensive meds?”

Lifestyle advice

What next?

Conclusions• Hypertensive disorders complicating pregnancy are one of the major

causes of maternal and foetal mortality and morbidity.

• Early diagnosis and management can help in circumventing many of the

complications of the same.

• Both labetolol and methydopa have been recommended as first-line

drugs in various studies. Final use depends on a careful assessment of risk

benefit ratio and clinician judgement.

• Nifidipine sustained release should be used as a second line drug and

SUBLINGUAL NIFIDIPINE should NEVER be used.

Conclusions• Watch for and screen for pre-ecclampsia in high risk individuals at regular

intervals.

• Test of choice for proteinuria is an automated reagent strip reading device or

urinary spot protein:creatinine ratio.

• Aspirin is the ONLY PROVEN method of primary prevention of hypertensive

disorders in high risk individuals.

• Patient counselling and education regarding nature of illness and informed

consent prior to initiating treatment is mandatory.

• With early detection and appropriate management, the journey with

hypertension can be made a smooth one for both mother and child.

THANK YOUAny questions??

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