Hypertensive Hypertensive disorders in disorders in PregnancyPregnancy
Lectures 3Lectures 3Petrenko N.V., MD, PhDPetrenko N.V., MD, PhD
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MILD PREECLAMPSIA SEVERE PREECLAMPSIA
MATERNAL EFFECTS
Blood pressure BP reading of 140/90 mm Hg x2, 4-6 hr apart Rise to >160/110 mm Hg on two separate occasions 4-6 hr apart with pregnant woman on bed rest
Mean arterial pressure (MAP)
>105 mm Hg >105 mm Hg
Weight gain Weight gain of more than 0.5 kg/wk during the second and third trimesters or sudden weight gain of 2 kg/wk at any time
Same as mild preeclampsia
Proteinuria— Qualitative dipstick— Ouantitative 24 hr analysis
Proteinuria of 0.3 g/L in a 24 hr specimen or >0.1 g/L in a random day-time specimen on two or more occasions 6 hr apart (because protein loss is variable); with dipstick, values varying from 1+ to 2 +
Proteinuria of >0.5 g/L in 24 hr or >4+ protein on dipstick
Edema Dependent edema, some puffiness of eyes, face, fingers; pulmonary edema absent
Generalized edema, noticeable puffiness; eyes, face, fingers; pulmonary edema possibly present
Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus
PreeclampsiaPreeclampsia
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MILD PREECLAMPSIA SEVERE PREECLAMPSIA
MATERNAL EFFECTS
Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus
Urine output Output matching intake, ≥30 ml/hr or <650 ml/24 hr
<20 ml/hr or <400 ml to 500 ml/24 hr
Headache Absent/transient Severe
Visual problems Absent Blurred, photophobia, blind spots on funduscopy
Irritability/changes in affect
Transient Severe
Epigastric pain Absent Present
Serum creatinine Normal Elevated
Thrombocytopenia Absent Present
AST elevation Normal or minimal Marked
PreeclampsiaPreeclampsia
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MILD PREECLAMPSIA SEVERE PREECLAMPSIA
FETAL EFFECTS
Placental perfusion Reduced Decreased perfusion expressing as IUGR in fetus; FHR: late decelerations
Premature placental aging
Not apparent At birth placenta appearing smaller than normal for duration of pregnancy, premature aging apparent with numerous areas of broken syncytia, ischemic necroses (white infarcts) numerous, intervillous fibrin deposition (red infarcts)
PreeclampsiaPreeclampsia
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Lab testsLab testsNORMAL PIH HELLP
Hemoglobin/hematocrit 12 to 16 gm/dl/37% to 47%
May ↑ ↓
Platelets 150,000 to 400,000/mm3 Unchanged <100,000/mm3
PT/PTT 12 to 14 sec/60 to 70 sec Unchanged Unchanged
Fibrinogen 150 to 400 mg/dl 300 to 600 mg/dl Present
Fibrin split products (FSP) Absent Absent ↓
Blood urea nitrogen (BUN) 10 to 20 mg/dl <10 mg/dl ↑
Creatinine 0.5 to 1.1 mg/dl <1 mg/dl ↑
Lactate dehydrogenase (LDH) 45 to 90 U/L Unchanged ↑
Aspartate aminotransferase (AST) 4 to 20 U/L Unchanged ↑
Alanine aminotransferase (ALT) 3 to 21 U/L Unchanged ↑
Creatinine clearance 80 to 125 ml/min 130 to 180 ml/min ↓
Burr cells/schistocytes Absent Absent Present
Uric acid 2 to 6.6 mg/dl 4.5 to 6 mg/dl >10 mg/dl
Bilirubin (total) 0.1 to 1 mg/dl Unchanged or ↑ ↑
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EclampsiaEclampsia
Premonitory signs and symptomsPremonitory signs and symptoms HeadacheHeadache Blurred visionBlurred vision Severe epigastric painSevere epigastric pain Altered mental statusAltered mental status
Tonic- clonic convulsionsTonic- clonic convulsions HypotensionHypotension ComaComa
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Danger signDanger sign
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