Hypertensive Disorder in Pregnancy Untuk Kuliah (2)
Transcript of 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'