Pregnancy Induced
Pregnancy Induced
Pregnancy Induced
HYPERTENSION/PREECLAMPSIA/
ECLAMPSIA
MAOG 2111
LEARNING OBJECTIVE
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Definisi PIH/preeclampsia
Manifestasi klinikal PIH/preeclampsia
Penyiasatan PIH/Preeclampsia
Pengurusan PIH/Preeclampsia
Komplikasi PIH/preeclampsia
Pendidikan Kesihatan PIH/Preeclampsia
INTRODUCTION
Hypertensive disorder of pregnancy are major
contributor to prematurity.
Preeclampsia is a risk factor for future cardiovascular
disease and metabolic disease in women.
Despite considerable research, the etiology of
preeclampsia remains unclear.
EPIDEMIOLOGY
Hypertensive disorder of pregnancy, including
preeclampsia, complicate up to 10% of pregnancies
worldwide, constituting one of the gretest causes of
maternal and perinatal morbidity and mortality
worldwide.
In 2011 incidence of preeclampsia has increased by
25% in the United States during the past two decades.
Preeclampsia is a leading causes of maternal and
perinatal morbidity and mortality, with estimated
50,000-60,000 preeclampsia related death per year
worldwide.
DEFINITION
Preeclampsia-eclampsia
- Is a pregnancy-specific hypertensive disease with
multisystem involvement.
- It usually occurs after 20 weeks of gestational, most
often near term and can be superimposed on another
hypertensive disorder.
- Preeclampsia, the most common form of high blood
pressure (BP) that complicate pregnancy, is primarily
defined by the occurrence of new-onset hypertension
plus new-onset protenuria.
Postpartum Hypertension
- Including preecalampsia with severe systemic organ
involvement and seizure.
- Can first develop in the postpartum period
- To be aware of symptoms of severe headache, visual
disturbance or epigastric pain.
- Late postpartum hypertension in a period that ranges
from 2 weeks to 6 months postpartum.
CLINICAL MANIFESTATION
At time of diagnosis, women are instructed to report
symptoms of severe preeclampsia;
i) severe headche
ii) visual changes
iii) epigastric pain
iv) shortness of breath
v) retrosternal pain/pressure
vi) nausea and vomitting
ANTEPARTUM MANAGEMENT
- At time of diagnosis, all women should have a
complete blood count (CBC) with platelet count and
assessment of serum creatinine and liver enzyme
levels, be evaluated for urine protein (24-hour
collection or protein/creatinine ratio)- once weekly
- Fetal evaluation should include
i) ultrasonographic evaluation for estimated fetal
weight and amniotic fluid index (calculated in
centimeter)
ii) Nonstress test (NST)
iii) Biophysical profile (BPP)
Continued evaluation
- Continued evaluation of women who have not given
birth who have mild gestational hypertension or
preeclampsia without severe features consists of the
following:
i) fetal evaluation
- daily kick count
- ultrasonography
- To determine fetal growth every 3 weeks, and
amniotic fluid volume assessment at least once
weekly.
- Nonstress test (NST) once weekly for patients with
gestational hypertension and NST twice weekly for
patients with preeclampsia without severe feature.
Antihypertensive therapy
- Antihypertensive therapy is used to prevent severe
gestational hypertension and maternal hemorrhagic strokes.
- Therapy may decrease progression to severe hypertension
but also may be associated with impairment of fetal growth.
- Hydralazine, labetolol and nifedipine,methyldopa
- Systolic BP of at least 160 mmHg or diastolic of at least 110
mmHg.
Bed rest
- Completed or partial bed rest has been recommended
to improve pregnancy outcome in women with
gestational hypertension or preeclampsia without
severe features.
- However, in other study suggesting that bed rest
should not rountinely be recommended for
management of hypertension in pregnanacy.
reason
- Prolonged bed rest for duration of pregnancy
increases the risk of thromboembolism.
COMPLICATION
Severe preeclampsia can result in both acute and long
term complication for both the women and her
newborn.
Maternal
i) Pulmonary edema
ii) Myocardial infarction
iii) Stroke (CVA)
iv) Acute respiratory distress syndrome (ARDS)
v) Coagulopathy
vi) Severe renal failure
vii) Retinal injury
HEALTH EDUCATION
- Protein and calorie restriction should be avoided in
gestational hypertension. It may increase the risk of
intrauterine growth restriction.
- In women are not pregnant, moderate exercise has
been shown to reduce hypertension and
cardiovascular disease.
- Thirty minutes of moderate exercise on most days is
currently recommended during normal pregnancy.
Reason
- Has been hypothesized to stimulate placental
angiogenesis and improve maternal endothelial
dysfunction.