Hypertensive Disorder

in Pregnancy
dr. Valleria, SpOG

Hypertensive Disorder in
Pregnancy
1.
2.
3.
4.
5.

Gestational hypertension ( Hipertensi

dalam Kehamilan )
Preeclampsia
Eclampsia
Superimposed Preeclampsia
Chronic Hypertension

Hypertensive Disorder in
Pregnancy
One

of the deadly triad (hemorrhage,

infection)
3,7 % of all pregnancy

1. Gestasional hypertension
BP >

140/90 mmHg for first time during

pregnancy
No proteinuria
BP return to normal < 12 weeks post
partum
May have other signs for preeclampsia
(epigastric discomfort, thrombpcytopenia)

2. Preeclampsia
Preeclampsia: Mild-Severe
Mild
-

:
BP > 140/90 mmHg after 20 weeks
gestation
Proteinuria > 300 mg/24 hours or > 1+
dipstick

Preeclampsia
Severe
-

BP > 160/110 mm Hg
Proteinuria 2 g/24 hours or > 2+ dipstick
Serum Creatinin > 1,2 mg/dL
Platelets < 100.000/mm3
Increase LDH
Elevated AST/ALT
Persistent headache or other cerebral or
visual disturbance
Persistent epigastric pain

3. Eclampsia
Seizures

that cannot be attributed to other

causes in women with preeclampsia
Coma

4. Superimposed preeclampsia
New

onset proteinuria > 300mg/24 hours

in hypertensive women but no proteinuria
before 20 weeks gestasion
Sign and symptoms severe preeclampsia

5. Chronic Hypertension
BP >

140 mmHg before pregnancy or

diagnosed before 20 weeks gestation

Risk Factor Preeclampsia

Nulliparous
Multiple

pregnancy
History of chronic hypertension
Maternal age over 35 years
Obesity

Patophyisiology Preeclampsia
Maternal

vascular desease
Faulty placentation
Excessive trophoblast
Reduced

uteroplacental perfusion

Endothelial

activation

Endothelial activation
Vasospasme
-Hypertension
-Seizure
-Oliguria
-Abruption
-Liver ischemia

Capillary leak

Activation of coagulatio

Thrombocytopeni
Edema
Proteinuria
Hemoconcentration

Management
Delivery is the cure for preeclampsia
> 35 weeks gestation : induction of labor
< 35 weeks gestation, no complication:
expectant ( the hope that few more weeks in
utero will reduce the risk of neonatal mortality
and morbidity )

1.

Anti hypertension
Lung maturation : dexametason 12 mg/day, 2 days
Observation : Blood pressure, symptom impanding
eclampsia, lab., fetal surveillance any disturbance
termination

Management
2. Anti hypertensive Drug
-blocking agent : labetolol
Calcium channel blocker : nifedipine
ACE inhibitor
(Angiotensin-converting-enzyme): should be
avoided : oligohidramnios, IUGR, limb
contractur, Persistent PDA, pulmonary
hypoplasia, etc
Methyldopa : delayed onset (long-acting)

Management
3. Preventive and control convulsion
- MgSO4 : control convulsion without central
nervous system depression
- i.v : 4-6 g loading dose diluted in 100 ml of
iv fluid 15-20 min, maintenance 1-2 g/
hour in 100 ml
- i.m : 4 g loading dose, 5 g i.m in both
buttock / 4 hour

Management

Before giving MgSO4 :

1.
2.
3.

The patellar refleks is present

Respiration are not depressed ( RR>16/min)
Urin output > 100ml/4 hour

MgSo4 is discontinued 24 h after delivery

MgSO4 toxicity : respiratory depression,
paralysis, and arrest
Antidotum MgSO4 : calcium gluconate

Mild Preeclampsia
>

37 weeks gestasion : termination of

pregnancy
< 37 weeks gestasion :
-

No medication
No diuretik
Limitation activity
ANC 2x/weeks : Blood Pressure, proteinuria,
refleks, fetal surveillance

Severe Preeclampsia
>

37 weeks gestasion : termination of

pregnancy
< 37 weeks gestasion :
-

Find any complications if any termination

of pregancy and treat complication
No diuretik
Limitation activity
MgSO4
Antihypertensive agents
Close observation for mother and baby

Complication
1.

Eclampsia

Generalized tonic-clonic seizures

Coma without convulsion
Antepartum, intrapartum, postpartum
Cerebral edema
ICU

Complication
2. HELLP Syndrome
-

Hemolysis : fragmented erythrocyte, bilirubun >

1,2 ml/dL
Elevated Lever enzymes : SGOT > 72 IU/L, LDH
> 600IU/L
Low Platelet count : < 100.000/mm3
DIC
Tx : dexamethason 2 x 10 mg, then 2 x 5 mg

Complication
3. Pulmonary edema
-

Tachypneu/dyspnea
Respiratory distress
Severe hypoxemia
Diffuse rales in both lung
ICU, ventilator
Furosemid

Complication
4. Acut Renal Failure
5. Hepatic rupture
6. Abruptio placentae
7. Cerebral hemorrhage
8. Visual disturbances

Prevention
Low

dose aspirin ?
Calcium?
Anti oxidant?