Pregnancy induced hypertension Gestational HT Pre-eclampsia Eclampsia HELLP syndrome – HT only – HT + proteinuria – generalised convulsion – Haemolysis, Elevated Liver enzymes, Low Platelets Hypertension Diastolic > 110mmHg on one occasion or >90mmHg on two occasions more than 4 hrs apart (or 30mmHg above the booking BP) Severe Hypertension Diastolic > 120mmHg or >110mmHg on two occasions more than 4 hrs apart (or 30mmHg above the booking BP) Proteinuria Persistant urinary protein of > 300mg/24hrs (+ or more on dipstick testing) Pre Existing Hypertension Management Methyldopa, beta-blockers and nifedipine are acceptable. Diuretics and ACE inhibitors can cause fetal compromise & therefore contraindicated Pregnancy Induced Hypertension Risk factors for HT in pregnancy 1st pregnancy FH Extremes of maternal age Medical (existing HT, thrombophilia, SLE, DM) Obstetric (multiple pregnancy, hydatidiform mole, hydrops) Management of PIH Recheck readings Check maternal well-being (serum urate (increased if PET), U&E, platelets(decreased if PET)) Pre-eclampsia Normal trophoblastic invasion à low resistance, high flow system This does not complete in PET Insufficient prostacyclin / increased thromboxane à vasoconstriction & platelet aggregation Management Admit for monitoring Consider antihypertensives Make plans to deliver baby (only cure) Eclampsia Warning signs Unusual headaches Visual disturbances Restless & agitation epigastric pain nausea & vomiting sudden severe HR & proteinuria fluid retention & reduced UO hyperreflexia & ankle clonus retinal oedema, haemorrhages & papilloedema Treatment Turn onto side to avoid aortocaval compression Insert airway & give high flow O2 MgSO4 to terminate convulsion (monitor resp & reflexes) Consider urgent delivery of baby HELLP Haemolysis, Elevated Liver enzymes, Low Platelets Can get renal failure & DIC Increased incidence of abruption