Understanding Preeclampsia and Hypertension in Pregnancy
Learn about preeclampsia, gestational hypertension, and HELLP syndrome in pregnancy, including their symptoms, diagnosis, and management. Get insights into the differences between these conditions and the importance of monitoring and treatment.
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Presentation Transcript
Preeclampsia with and without Severe Features Berry Campbell, MD Maternal Fetal Medicine UofSC School of Medicine Prisma Health Midlands
Hypertension in Pregnancy Acute treatment of severe HTN Chronic HTN and pregnancy Chronic HTN with superimposed preeclampsia
Preeclampsia New onset hypertension after 20 weeks gestation BP 140/90 on 2 occasions, 4 hours apart Proteinuria ( 300 mg/24 hours or P:C 0.3 or 2+ dip) Old school--Classic triad includes edema
Gestational HTN BP 140/90 but no protein spill after 20 weeks
Preeclampsia/GHTN without SF Both associated with maternal and perinatal morbidity GHTN develops protein spill 50-70% Both risk organ dysfunction progression particularly with < 32 weeks at diagnosis Long term CV risks, CHTN risks the same
Preeclampsia with SF BP > 160 and/or 110 on 2 separate checks (4 hours apart ) Proteinuria (>300 mg/24 hour urine or P:C >0.3) OR new onset HTN with any of the following:
Preeclampsia with SF Low platelet (<100K) Renal insufficiency (Cr 1.1 or doubled) Liver impairment ( LFTs twice normal or persistent RUQ pain) Pulmonary edema New onset, persistent HA Visual disturbances OLD SCHOOL: FGR or Protein >5g/24 hours)
HELLP Syndrome One of most severe forms of preeclampsia Hemolysis (LDH 600) Elevated LFTs (AST, ALT > 2x normal) Low Platelets (< 100K) 30% develop pp 15% no HTN or protein spill Presenting sx RUQ pain 90%; N&V 50%
GHTN or Preeclampsia without SF Baseline, serial labs Twice weekly visits Antenatal testing Delivery 37 weeks if no progression
Severe Features HTN alone responds well to treatment delivery at 34 weeks Other severe features steroids, magnesium sulfate, and delivery (CNS, Pulm edema, liver impairment, renal insuff, low plt)
Preeclampsia Gestational Hypertension with any severe feature (BP, CNS, etc.) Preeclampsia with Severe Features
