Preeclampsia

Normal BP:

Hemorrhagic stroke is the biggest concern/risk with hypertension..

Chronic Hypertension: HTN (BP ≥ 140/90 mm Hg)..

Hypertensive urgency and emergency

Preeclampsia is a hypertensive emergency because of proteinuria, kidney damage..

Gestational Hyptertension

Pregnancy-induced hypertension that:

Gestational Hypertension BP > 220/110
Preeclampsia Gestational HTN + proteinuria
Eclampsia Preeclampsia + seizure

Preeclampsia

FLT

VEGF receptor in placenta. They become sFLT in soluble form

Genetic predisposes FLT to become sFLT that float around in blood stream and absorb available VEGF. This leads to loss of VEGF action that are needed to transform cytotrophoblast to endothelial cell and remodelling of spiral arteries necessary for placental growth.

This leads to toxin secretion that leads to:

The clinical presentation includes the following:

There is an increased incidence in patients with:

Preeclampsia Treatment

For chronic, oral therapy of HTN in pregnancy, the recommended drugs are:

α-Methyldopa

Acts on α2 (Gi) autoreceptors to inhibit NE release. Has a long history of safety for the mother and the fetus.

Labetalol

α1-blocker in VSMC, causing vasodilation. Different racemic components also act as a non-selective ß-partial agonist with some ß-blocking activity as well.

Nifedipine

L-type calcium channel blocker of the vascular type.

Although methyldopa is available as a parenteral preparation, acute and accurate control of blood pressure is better with labetalol or hydralazine. However, if nothing else is at hand, it can be used. Drug choice depends on availability and experience with a particular drug by the physician.

Seizure in eclampsia is self limiting. It will go away in 3-5 minutes. You don't need to treat that; only need to prevent it from happening with MgSO4..

Use urine output as indicator for effectiveness of treatment..

Hydralazine

Works via smooth muscle cell vasodilation:

MgSO4

Antagonizes the activity of calcium. Prevents origination of seizures by reducing activity of iGlut (glutamatergic, NMDA, calcium ionotropic neurotransmission). Mg also reduces vasospasm and reverses oliguria and edema by antagonizing calcium (takes up to 2 days). However, its effect on blood pressure levels is slow via volume reduction and relief of vasospasm. That is why you need the anti-HTN drugs to quickly reduce threat of stroke from high BP.

Overdose of Mg reduces excitability of CNS, resulting in loss of patellar reflex, respiratory and cardiac arrest. First symptom is decreased capillary reflex. In overdose,MgSO4 may produce nephrotoxicity of its own because of its renal clearance. In overdose, treat with calcium gluconate IV injection. Do not use antiepileptic medications for seizure control. MgSO4 is sufficient for seizure control and prophylaxis..

Less than 28 weeks

No fetal viability

28 to 34 weeks

37 to 41 weeks

Official full term baby.

More than 41 weeks

Post term at 41 weeks. Induce labor via:

HELLP Syndrome

Stands for Hemolysis, Elevated Liver enzymes, Low Platelets..

A very serious complication of pregnancy-induced hypertension. It usually only occurs with severe preeclampsia. Can lead to hepatic subcapsular hematomas, which can rupture and result in severe hypotension.

Pathogenesis

Platelet thrombosis in liver shears RBC, leading to hemolysis and low platelet counts. Resulting liver infarct from low O2 leads to increased liver enzymes.

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